Journal of burn care & research : official publication of the American Burn Association
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Numerous studies have identified strategies to reduce mechanical ventilation duration by targeting appropriate sedation levels. However, applicability of these strategies to critically injured patients with burn injury has not been established. At our medical center, methadone is commonly used early in the care of burn patients to treat background pain and limit the development of opioid tolerance. ⋯ There was no statistical difference in the duration of intensive care unit or hospital length of stay between groups. Our results suggest that early methadone initiation may have a significant effect on ventilator outcomes in critically injured patients with burn injury. However, further research is warranted.
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Color measurements are an essential part of scar evaluation. Thus, vascularization (erythema) and pigmentation (melanin) are common outcome parameters in scar research. The aim of this study was to investigate the clinimetric properties and clinical feasibility of the Mexameter, Colorimeter, and the DSM II ColorMeter for objective measurements on skin and scars. ⋯ This study shows that all three instruments can provide reliable color data on skin and scars with a single measurement. The authors also demonstrated that they can assist in objective skin type classification. For scar assessment, the most valid parameters in each instrument were identified.
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Advances in burn care have decreased mortality in the past 20 years, but affecting elderly mortality rates (>65 years) remain challenging. This study evaluates the impact of home caregiver support on elderly burn patients' mortality. The authors retrospectively reviewed patients aged 65 and older admitted to their burn center from July 1995 to October 2004. ⋯ Only 21% of the survivors had a child as their primary caregiver; however, 48% of the nonsurvivors had a child as the primary caregiver (P ≤ 0.05). On multivariate analysis, age, TBSA, and child as primary caregiver were all independent predictors of mortality. Having a child as a caregiver provided the largest impact, with an odds ratio of 4.4 (95% confidence interval, 1.2-15.62; P = .02).
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In recent years, transpulmonary thermodilution techniques (PICCO) offer an attractive and more ideal end point for fluid resuscitation. The study included 30 adult burned patients between 25 and 60% TBSA. The study group received fluid resuscitation guided by the PICCO. ⋯ Nevertheless, the attempt to achieve them was associated with a significant tissue edema. Although PICCO is a very beneficial tool in the estimation of amounts of fluid resuscitation, the values of ideal end points need to be adjusted in burn patients. The traditional values of intrathoracic blood volume, extravascular lung water, and cardiac index are associated with significant tissue edema that can easily complicate sepsis in these immunocompromised patients.
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Because of ineffectiveness and tolerance to benzodiazepines and opioids developing with time, drugs acting via other receptor systems (eg, α-2 agonists) have been advocated in burn patients to improve sedation and analgesia. This study in severely burned pediatric subjects examined the hemodynamic consequences of dexmedetomidine (Dex) administration. Eight intubated patients with ≥20 to 79% TBSA burns were studied between 7 and 35 days after injury. ⋯ In three patients, the MAP decreased to <50mm Hg with the bolus dose of Dex. Of the remaining five patients, three patients completed the study receiving the highest infusion dose of Dex (2.5 µg/kg/hr), whereas in 2 patients the infusion part of the study was begun, but the study was stopped due to persistent hypotension (MAP < 50mm Hg). These observations indicate that a bolus dose of Dex (1.0 µg/kg for 10 minutes) and high infusion rates may require fluid resuscitation or vasopressor support to maintain normotension in critically injured pediatric burn patients.