Burns : journal of the International Society for Burn Injuries
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Despite advances in critical care and the surgical management of major burns, highly moribund patients are unlikely to survive. Little is known regarding the utilization and effects of palliative care services in this population. ⋯ 7424 major burns were included; 1.9% received palliative care services. Patients receiving palliation had a mean age of 63.6 years (SD 19.6), mean total body surface area of 62.2% (SD 24.9%), and mean modified Baux score of 127.1 (SD 26.7). Adjusting for covariates, the incidence rate ratio was 1.42 over the 10-year period (95% CI, 1.31-1.54, p<0.001). Independent predictors of palliative consultations included older age, larger burns, deeper burns, and higher Elixhauser comorbidity score. Among patients with modified Baux scores between 100-153, those receiving palliative care services were significantly more likely to die without surgery, OR 3.24 (95% CI 1.13-10.39, p=0.029), with no significant difference in mortality, OR 11.72 (95% CI 0.87-22.57, p=0.051) CONCLUSION AND RELEVANCE: Palliative care services were increasingly used during the study period. Palliative care services in highly moribund burn patients do not impact survival and may decrease the likelihood of surgical intervention in select patients.
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Smoke inhalation injury (SII) is an independent risk factor for morbidity and mortality in patients with severe burns, however, the underlying mechanisms of SII are still not fully understood. In our study, we established an advanced rat model of SII based on the previous work, and explored the dynamic changes of pathophysiology and inflammatory factors during 28days post SII. We also measured the different expressions of miRNAs in bronchoalveolar lavage fluid (BALF) between SII and normal control rats by miRNA microarray. ⋯ Compared with the normal control group, there were 23 upregulated miRNAs and 2 downregulated miRNAs in BALF of SII group at 1day post-injury. RT-qPCR validation assay confirmed that the changes of miR-34c-5p, miR-92b-3p, miR-205, miR-34b-3p, miR-92a-3p, let-7b-5p, let-7c-5p in BALF were consistent with the conclusion of the miRNA microarray. In summary, we showed the dynamic changes of pathologic changes and inflammatory factors in rats with SII, and a subset of seven miRNAs changed in BALF after SII which may be used for diagnosis and potential therapeutic targets.