Burns : journal of the International Society for Burn Injuries
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Bromelain-based enzymatic debridement has emerged as an alternative to surgical eschar removal. Indications include partial thickness, mixed pattern, and full-thickness burns. Enzymatic debridement has been approved by the European Medicines Agency for treating burn wounds affecting <15% total body surface area (TBSA). Data and evidence for the treatment of areas >15% TBSA in one session is scarce. The aim of this retrospective study was to retrospectively analyze off-label use of enzymatic debridement in a single burn center for large TBSA burns. ⋯ Enzymatic debridement did not result in any expected or unexpected side effects in the patient groups investigated. These preliminary results indicate the potential safety of bromelain-based enzymatic debridementin the treatment of burns greater than 15% TBSA.
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Hypertrophic scar (HS) formation, a type of dermal fibroproliferative condition, is a frequent complication in wound healing resulting from burns, severe trauma, and surgical procedures. The effects of Panax Notoginseng Saponins (PNS) on the HS formation remain relatively under-explored. Hence, this study was intended to interrogate anti-apoptosis and anti-fibrosis effects of PNS on the hypertrophic scar fibroblasts (HSFs) during HS formation and assess the involvement of TRPM7 and PI3K/AKT signaling pathway. ⋯ This study suggested that PNS hampered scar formation might via inhibiting ECM and stimulating cell apoptosis by modulating the PI3K/AKT signaling. Overall, these findings in the present study could support the use of PNS for preventing HS formation, and TRPM7 may be a novel molecular target for treating HS.
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Observational Study
Point-of-care measured serum cholinesterase activity predicts patient outcome following severe burns.
Risk stratification is of utmost importance in burn therapy. However, suitable bedside biomarkers to evaluate the emerging inflammatory response following burn injuries are missing. Serum cholinesterase (butyrylcholinesterase, BChE) has been shown to be a clinically relevant biomarker in acute inflammatory diseases including burns. ⋯ BChE activity correlated negatively with burn injury severity, organ failure severity and intensive care unit resource requirements. BChE activity measured at ERA and 12 h later identified survivors and predicted 28-day patient outcome with noninferior efficacy compared to the abbreviated burn severity index (ABSI) scoring. Finally, POCT-measured BChE activity might complement ABSI scoring and possibly improve early risk stratification in acute burn care therapy.
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Observational Study
Factors impacting time to surgery and the effect on in-hospital mortality.
Early surgery improves outcomes after burn injuries but is often not available in limited resource settings (LRS), where a more conservative approach is widespread. This study aimed to analyze factors associated with delay in surgical treatment, and the impact on in-hospital mortality. ⋯ This study found that early surgery was not associated with in-hospital mortality. Independent predictors of in-hospital mortality were female sex, presence of full thickness burn, and larger burn size. Future studies should investigate if burn care capacity in LRS may influence the association between early excision and outcome.
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Large quantities of analgesics are prescribed to control pain among patients with burn injuries and may lead to chronic use and dependency. This study aimed to determine whether patients are overprescribed analgesics at discharge and to identify factors that influence prescribing patterns. ⋯ The quantity of analgesics prescribed at discharge varied widely and often prescribed for long durations of time. Standardized prescribing guidelines should be developed to optimize how analgesics are prescribed at discharge.