506 A Burn Center’s Four Year Experience with a Cerium Nitrate & Silver Sulfadiazine Burn Cream

Abstract

Morbidity from burn wound infection & sepsis remains high, but can be improved by early excision & grafting. However, certain situations preclude early surgery. In these cases, topical agents allow for staged excision. The combination of cerium nitrate & silver sulfadiazine (Cerium) is an inexpensive burn cream with broad antibacterial activity. It also forms an eschar over the wound that may promote reepithelialization. Methemoglobinemia (MetHba), an oft-cited side effect, is rare, but the compound is infrequently used worldwide. This is a retrospective cohort study investigating the effects of Cerium at a regional burn center. After IRB approval, patients admitted between 7/1/2014 & 7/1/2018 were screened to determine if they received Cerium. Data including demographics, burn injury & management, laboratory values & cerium application were extracted. Primary endpoints were time to surgery of Cerium-treated burns, reepithlialization & incidence of MetHba & its treatment. Of the 142 patients meeting inclusion criteria, the mean age was 56.3 & the majority were black (46%) males (67%). The most common etiologies were flame (43%), contact (25%) & scald (18%). Smoking was prevalent (28.5%). Mean TBSA was 9.9% with mean adjusted Baux score of 67.9 & APACHE II score of 10.8. 64.3% were admitted to the ICU & 10.7% had inhalation injury. Time to Cerium application was 1.67 days with 15.5 total doses received. Total TBSA treated with Cerium was 6.1% (4.5% full thickness, 1.6% partial thickness). Time to any surgery was 2.6 days whereas the time to surgery for areas treated with Cerium was 4.8 days. 10.7% of patients had treated wounds smaller than presentation at time of surgery. The mean pre-Cerium methemoglobin (MetHb) value was 1.2, while checks 12-36 h & 48-72 h post first application were 1.2 & 1.4, respectively. 9.8% developed MetHba levels >2.5%. All patients except 1 were asymptomatic. The symptomatic patient became hypoxic with MetHb of 9.4%, required reintubation, & was treated with Methylene Blue. At our center, Cerium is a well-tolerated medication with a minimal side-effect profile. Only one patient (0.7%) developed clinically significant MetHba requiring intervention. Reintubation in this patient was multifactorial as he had been extubated the same day & required frequent suctioning for copious, thick secretions, in addition to MetHba. Previous reports have described patients tolerating MetHb levels up to 31.8% without intubation. It can successfully be used to temporize burn wound excision & grafting, with our data supporting reepithelialization. Future work will study Cerium prospectively. Cerium cream is a topical dressing with few side effects which allows delayed burn excision & may improve tissue salvage.