Study of the appropriate time for the application of suspended bed in the treatment of severely burned children

Abstract

Objective To explore the appropriate time for the application of suspended bed in the treatment of severely burned children. Methods A retrospective analysis was performed based on the clinical data of 107 cases of severely burned children who were admitted to the Military Burn Center of the 990th (formerly 159th) Hospital of Joint Service Support Force of People′s Liberation Army from January 2000 to December 2017. Cases were divided into two groups according to the time of the application of suspended bed. In control group (n=49), patients started to use suspended bed within 3 days after injury, while suspended beds were put into use from 4 to 6 days after injury in experimental group (n=58). The following indicators were collected and analyzed: total amount of fluid infusion, amount of colloid liquid, crystal liquid and water, urine volume, resuscitation index in shock stage, visceral complications after injury, hypernatremia, mortality; time of scab formation, time of scab removal, time of wound healing, positive rate of bacterial culture and the incidence of sepsis; time of sand bonding in suspended bed and positive rate of bacterial culture of bed sediment. Date were compared with t test and χ2 test. Results In experimental group, the amount of crystal liquid, colloid liquid, water and total amount of fluid infusion in first 24 hours were (0.97±0.10) mL·kg-1·%TBSA-1, (0.67±0.13) mL·kg-1·%TBSA-1, (1 233.00±254.00) mL, (2 265.00±958.00) mL, and these indicators in first 24 hours in control group were (1.18±0.13) mL·kg-1·%TBSA-1, (0.97±0.10) mL·kg-1·%TBSA-1, (1 635.00±283.00) mL, (2 979.00±973.00) mL, the difference between the two groups was statistically significant (t=9.585, 13.617, 7.736, 3.811, with P values below 0.01). The amount of crystal liquid, colloid liquid, water and total amount of fluid infusion in the second 24 hours in experimental group were (0.53±0.07) mL·kg-1·%TBSA-1, (0.49±0.06) mL·kg-1·%TBSA-1, (1 110.00±229.00) mL, (1 755.00±649.00) mL; in control group, these indicators in the second 24 hours were (0.74±0.10) mL·kg-1·%TBSA-1, (0.75±0.12) mL·kg-1·%TBSA-1, (1 542.00±288.00) mL, (2 479.00±771.00) mL. The amount of fluid in experimental group was significantly lower than that in control group, the difference was statistically significant (t=12.529, 13.653, 9.635, 5.279, with P values below 0.01). The indexes of resuscitation in experimental group were listed following: heart rate (115.00±5.00) beats/min, mean arterial pressure (MAP) (53.00±2.70) mmHg, central venous pressure (CVP) (8.00±0.80) cmH2O, lactic acid (2.00±0.60) mmol/L, residual base (-2.10±0.70) mmol/L, hematocrit (HT) (0.42±0.02) and albumin (35.00±1.40) g/L. The indexes of resuscitation in control group were listed following: heart rate (126.00±5.00) beats/min, MAP (56.00±3.30) mmHg, CVP (9.80±1.50) cmH2O, lactic acid (3.80±0.60) mmol/L, residual base (-4.40 ±0.60) mmol/L, HT (0.53±0.03) and albumin (33.00±2.10) g/L. These indicators in experimental group were better than those in control group except urine volume, the difference was statistically significant (t=10.234, 5.585, 8.214, 16.117, -17.451, 20.448, -3.989, with P values below 0.01). The incidence of hypernatremia and visceral complications in experimental group were 3.4% and 10.3% respectively, which were significantly lower than those in control group (18.4% and 26.5%) (χ2=6.410, 4.765, with P values below 0.05), mortality in control group was 4.1% and 1.7% in experimental group, there was no significant difference (P>0.05). There was no significant difference in the positive rate of bacterial culture and the incidence of sepsis between the two groups(with P values above 0.05). Scab formation in control group was earlier than experimental group, the difference was statistically significant (t=-5.579, P< 0.01), however, the time of scab removal and wound healing in experimental group was obviously earlier than control group, the difference was statistically significant (t=-6.760, 4.212, with P values below 0.01). In control group, the time of sand bonding was significantly earlier than experimental group, the difference was statistically significant (t=-15.010, P<0.05), and the positive rate of bacterial culture of bed sediment was higher than experimental group, the difference was statistically significant (χ2=4.356, P< 0.05). Conclusions The appropriate time for the first application of suspended bed in the treatment of severely burned children should be from 4 to 6 days after injury, which can help the patients get through the shock period successfully and promote wound healing with lower mortality, wound injury and complications. Meanwhile, this timing also can increase the service life and utilization rate of suspended bed. Key words: Burns; Child; Suspended bed; Time of application