Acute Period Of Burn Disease Research Articles

Fatty acid-binding protein as a marker of intestinal damage and potential predictor of mortality in acute period of burn disease

Fatty acid-binding protein as a marker of intestinal damage and potential predictor of mortality in acute period of burn disease

The effect of hyperoxia on the hemostasiological status of severely burned patients.

The state of the hemostasis system was studied in 9 patients of the middle age group (44 ± 9.94 years) who received thermal trauma on an area of more than 32% (49.4 ± 18.3) of the body surface, accompanied by the development of burn shock. The standard therapy for burn injury was supplemented with HBO sessions. Treatment with hyperbaric oxygen was carried out in pressure chambers BLKS-307, BLKS-307/1. The state of the coagulation, anticoagulant and fibrinolytic links of the hemostasis system, as well as the viscoelastic properties of the blood, were assessed immediately before the HBO session and immediately after it. The total number of comparison pairs was 45. Under the influence of HBO therapy, there was an increase in the activity of antithrombin III (ATIII), protein C (PrS) and a decrease in the viscoelastic properties of blood (p <0.05). Positive deviations in the values of ATIII, Pr C, von Willebrand factor, APTT, prothrombin and thrombin time, fibrinogen, factor XIII, XIIa-dependent fibrinolysis, D-dimers and thromboelastography parameters were revealed. The maximum frequency of their occurrence was recorded for ATIII (95%), the minimum - for the D-dimer (62%). After HBO procedures, undesirable deviations of the hemostatic system parameters were also noted. They were chaotic, were compensated by an increase in the activity of physiological anticoagulants and were not accompanied by complications of a thrombogenic nature. Thus, conducting HBO therapy sessions in the acute period of burn disease increases the activity of physiological anticoagulants and stabilizes the viscoelastic properties of blood. There is a high frequency of occurrence of positive effects of hyperoxia on the components of the hemostasis system. The identification of its undesirable effects indicates the need to monitor the state of the hemostasis system during HBO procedures.

Нарушения функции почек в остром периоде ожоговой болезни и их прогностическое значение

Цель исследования: определить влияние тяжелой термической травмы на изменение уровня показателей функции почек в острый период ожоговой болезни. Материалы и методы. Проведен ретроспективный анализ 132 пациентов с тяжелой ожоговой травмой, которые были распределены на две группы в зависимости от исхода ожоговой болезни. Результаты. Были исследованы 132 истории болезни пациентов с тяжелой ожоговой болезнью. У 5,4 % (n = 3) пациентов I группы и 85,5 % (n = 65) пациентов II группы наблюдалось развитие острого поражения почек. Также у 10,5 % (n = 8) пациентов II группы в анамнезе отмечалось хроническое заболевание почек. В первые сутки острого течения ожоговой болезни отмечалось повышение уровня креатинина во II группе — 84,8 ± 4,2 мкмоль/л, что превышало показатели I группы, которые были ниже нормы — 67,9 ± 2,1 мкмоль/л. Показатели уровня мочевины сыворотки крови были повышены с первых суток ожоговой болезни в I и II группах и достигали максимума на 14-е сутки острой фазы ожоговой болезни (р = 0,304 и р = 0,694) соответственно. Протеинурия в исследуемых группах наблюдалась с первых суток ожоговой болезни и достигла максимума на 7-е сутки в І группе (0,22 ± 0,1 г/л, p = 0,115) и на 14-е сутки — во II группе (0,2 ± 0,1 г/л, p = 0,069). Темп суточного диуреза в течение всего периода ожоговой болезни существенно не менялся в обеих группах. Выводы. Течение тяжелой ожоговой болезни у больных сопровождается развитием почечного поражения, что в совокупности с возрастом, степенью поражения и наличием сопутствующей патологии обусловливает высокую летальность.

Intestinal fatty acid binding protein as a marker of damage intestinal barrier in children with burn injury

Introduction. Intestinal fatty acid binding protein (I-FABP) can serve as one of biomarkers of the damage to the intestinal mucosa in burned children occupying a special place among the complications and causes of their death. Materials and methods. There were examined 24 children with burns from 20% to 80% of the body surface. Blood serum I-FABP and lactate levels were determined during both the acute period of burn disease and septicotoxemia. Results. In the acute period wide variations in I-FABP values (from 22.67 to 385.18 pg/ml) were demonstrated. During the septicotoxemia I-FABP level increased by an average of 1.4 times, reflecting intestinal cell damage. Children with a burn area &gt;40% had a higher I-FABP level during all follow-up periods compared to children with a burn ≤ 40%. In the acute period there was a positive correlation between the lactate and I-FABP levels. During the septicotoxemia, despite the increase of lactatemia and I-FABP level, this relationship was absent. The maximum increase in I-FABP level was observed in patients with complications of burn disease on the part of the intestine (duodenitis, bulbitis, stress ulcers) and with the development of sepsis. Conclusion. It seems promising to further study this biomarker in order to timely diagnose increased intestinal permeability in children with thermal trauma and develop proper treatment tactics to prevent possible complications, such as intestinal erosive and ulcerative bleeding, the development of bacterial translocation, sepsis and multi-organ failure syndrome.

AGGREGATION AND SIZE OF PLATELETS IN CHILDREN WITH BURN DISEASE

Introduction. One of the main factors involved in the pathogenesis of burn disease consists in the disturbance of microcirculation and haemostasis, caused by increased platelet aggregation. Mechanisms underlying the enhancement of platelet aggregation are poorly understood. Main results were obtained for adult patients at the onset of the burn disease, with no similar data on paediatric patients being available. There is evidence of a relationship between the size of platelets (MPV) and their functionality.Aim. To undertake a study of spontaneous and ADP-induced platelet aggregation and their size in children with burn disease.Materials and methods. We studied the aggregation and size of platelets in children aged 3–17 years, in whom burn areas covered 10–70 % of the body surface at the onset of the disease and before discharge. Spontaneous platelet aggregation was analysed under conditions of induced shear flow, whereas ADP-induced aggregation was studied employing a turbidimetric method. The study of platelet sizes was carried out using a conductometric method.Results. Spontaneous platelet aggregation increases significantly in children with burn disease. The integrated optical density of the formed aggregates, their area and perimeter were estimated for the first time. These indicators remained elevated even after burn wounds had been completely closed. In burn disease, changes in ADP-induced platelet aggregation were multidirectional in nature. Mean platelet volume (MPV) was increased during the acute period of burn disease, decreased during the period of toxaemia, and normalised by the time of patients’ discharge. Changes in MPV did not affect the aggregation properties of platelets. There was no correlation between the degree of aggregation and the severity of hyperfibrinogenemia. The blood of burn patients contained a large number of activated platelets, which was the reason for the increase in their spontaneous aggregation, not requiring the participation of exogenous inducers.Conclusion. An increase in spontaneous platelet aggregation was observed in children after a thermal injury, which remained elevated until the burn wounds were completely closed. A significant increase in the number of activated platelets constituted the reason for the increase in spontaneous platelet aggregation.Conflict of interest: the authors declare no confl ict of interest.Financial disclosure: the study had no sponsorship.

Peculiarities of the wound healing process in the acute period of burn disease depending on the antiseptic used

Background. Burn injury, as one of the most common types of trauma, requires a comprehensive approach to treatment, including surgical and conservative treatment with effective post-burn wound protection. One of the main obstacles to wound healing is purulent-infectious complications, for prevention of which antiseptics are widely used.&#x0D; The aim is to study the microbiological, histological features of the wound healing course in the acute period of burn disease with the use of various antiseptics.&#x0D; Materials and methods. In the research there were involved 44 patients with burns (burn area 10–20 % of the body surface), treated in the Clinical Center for Thermal Injury and Plastic Surgery of Communal Non-Commercial Enterprise “Vinnytsia Regional Clinical Hospital named after M. I. Pirogov” (2018–2019). Depending on the antiseptic therapy, these patients were divided into three observation groups. Patients in the 1st study group (n = 15; mean age 48.07 ± 12.05 years) were treated with 2.0 % povidone-iodine during dressing. In the 2nd group (n = 15; mean age – 48.53 ± 14.76 years) antiseptic based on 0.02 % decamethoxin was used. In patients of the comparison group (n = 14; mean age – 47.71 ± 12.39 years) a solution of 10.0 % NaCl was administrated for topical wound management. Microbiological assessment of the condition of the wound surface (on 3, 7, 14, 21 days) and histological examination of tissue samples from the bottom of the wound (on 3, 7, 14 days) were carried out by means of standard methods.&#x0D; Results. Under the use of antiseptic agents based on 2.0 % povidone-iodine and 0.02 % decamethoxin during the treatment period in patients with burns up to 14 days, an effective reduction in the number of conditionally pathogenic microorganisms on the wound surface to lg (4.8 ± 0.4) and lg (3.06 ± 0.5) CFU/ml, respectively, was registered and it was significantly 1.5 times lower than that based on 10 % sodium chloride solution (p &lt; 0.05). When applying decamethoxin for 14 days at the same time as the eradication of conditionally pathogenic microorganisms, moderate colonization of wounds was registered by representatives of normal skin microbiota (Corynebacterium spp., S. epidermidis). Histologically, there was found that with the use of 2.0 % povidone-iodine, the wound healing course was accompanied by a marked decrease in inflammation signs, as well as a pronounced inhibition of the formation of granulation tissue (10–14 days). The use of 0.02 % decamethoxin was accompanied by the formation of granulation tissue of sufficient maturity for atodermoplasty, in the presence of signs of inflammatory cellular reaction with the presence in the superficial parts of the bottom of the post-burn wounds of the fibrinoid layer, with signs of permanent formation of new hemocapillaries in it, surrounded by a thin argyrophilic mesh. When using a hypertonic sodium chloride solution before autodermoplasty, the granulation tissue had signs of uneven inflammatory cell infiltration. Signs of leukocyte-necrotic tissue changes, fibrinoid-leukocyte layers with fragments of tissue detritus, signs of resuscularization of granulation tissue were recorded.&#x0D; Conclusion. Microbiological data strongly suggest the efficacy of 0.02 % decamethoxin and 2.0 % povidone-iodine in reducing microbial wound colonization infection compared to 10.0 % NaCl. The use of antiseptics and hypertonic sodium chloride solution in the acute period of burn disease provides a marked reduction in histological signs of inflammation in the wound with a noticeable positive effect of decamethoxin and 10.0 % NaCl on the formation of granulations and their revascularization compared with povidone-iodine (p &lt; 0.001).

Violations of protein metabolism in children in the acute period of burn disease

Introduction . Burn pathology is one of the most serious problems of pediatric surgery, which is associated with a high frequency of injuries, severe clinical course, due to the imperfection of adaptive capacity in children. Among the main target organs in burn disease a special place is occupied by the liver, one of the manifestations of it’s insufficiency are violations of protein metabolism. Purpose of the study. To evaluate the characteristics of protein status in burnt children in the acute period of burn disease. Materials and methods. Were examined in 22 children on 2–6 and 13–16 days after burn injury. The concentrations of total protein, albumin, prealbumin, C-reactive protein, urea, fibrinogen, prothrombin and antithrombin III activity were evaluated. Statistical data processing was performed using the program Statistica 6.1. Results. It is shown that the acute period of burn disease in children occurs on the background of hypo – and dysproteinemia. A decrease in the concentration of the albumin fraction (albumin, prealbumin) and globulins was revealed. The study of individual representatives of the globulin fraction showed an increased content of fibrinogen and C-reactive protein, almost unchanged activity of antithrombin III and a decrease in the average prothrombin activity. At the same time, it is noteworthy that the lowest values of antithrombin activity were observed in children with developed sepsis. The minimum value of prothrombin activity and content of prealbumin discovered in a patient with a fatal outcome. Conclusion. The obtained data indicate the possibility of using the parameters of the protein spectrum as markers of unfavorable (doubtful) prognosis of burn disease.

Hyperhydration in Burn Patients: the Current State of the Issue

The article presents the current state of hyperhydration issue in burn patients as a result of excess volume of infusion therapy during the acute period of burn disease. We report the data on the pathogenesis of burn disease and standard formulas for determining the volume of infusion therapy in case of burn shock, mechanisms and clinical manifestations of hyperhydration in burn patients and modern methods of its management. Since the danger of hyperhydration persists even after a shock in an acute period of burn disease, a method is proposed for determining the baseline volume of infusion therapy in the post-shock period. The developed algorithm is effective for prevention of hyperhydration in burn patients and covered by an invention patent.

Diagnosis and treatment of disseminated intravascular coagulation in burn patients

The aim — to study the violations of the hemostasis system in the acute period of burn disease in severely burned as a prophylaxis for thrombotic complications and provision of early surgical treatment.Materials and methods. The state of the blood clotting system was studied in 80 patients with deep dermal burns from 20 % to 60 % TBSA in the period from the first to the 14th day after the trauma. The age — 18 to 65 years. The following parameters of hemostasis were investigated: the number of platelets; serum fibrinogen, soluble fibrin, antithrombin III, protein C, partially activated thromboplastin time (APTT), prothrombin index, total fibrinolytic activity of blood plasma.Results and discussion. A moderately prolonged clotting time with the remaining level of platelets and fibrinogen were observed in all patient groups during the first day after the burn injury. The parameters of APTT were lowered on the 1st — 2nd day after the trauma in patients with IST for more than 90 units could have indicated the first phase of DIC syndrome; on the 3rd—5th day, an extension of the APTT was determined, which could have indicated a tendency for bleeding, especially during early operations. The level of antithrombin III was decreased in severely burned patients during the first 3 days after the burn injury, the plasma recalcification time decreased to 45 ± 5.4 s. Patients with extremely severe burns received 1.5 ± 0.3 L of fresh frozen plasma daily for 6.0 ± 1.5 days and also 0.6 ± 0.1 L of plasma for the following 10 days after the injury.Conclusions. Patients with deep common burns have are at high risk for thrombotic complications. Such include an increase in level of fibrinogen (&gt; 5.5 g/L), soluble fibrin (&gt; 4 mg/100 mL), prolongation of APTT (&gt; 45 s), decrease in antithrombin III and protein C (&lt; 75 %), fibrinolytic activity (&lt; 65 %). The hemostasis system has the phase character of its functional state with widespread deep burns. Acceleration of blood coagulation was determined during the first two days after the trauma with the depression of physiological anticoagulants: antithrombin III and protein C. From day 3 — 4, intravascular coagulation corresponds to the hypocoagulation phase with the main inhibitors spending. Correction of the hemostasis system is achieved by fresh­frozen blood plasma prescription at a dose of 10 — 20 ml/kg and direct anticoagulants at a dose of heparin 200 — 400 un/kg until the PTT level reaches 40 — 60 s, the recalciation time is up to 2 minutes, the level of antithrombin III is above 60 — 70 %.

A comparative description of dynamics of metabolic response indexes in the phases of burn disease course depending on terms of the onset of surgical intervention.

A question of possibilities of influence on decline of progressing systemic response on the burn trauma remains open, despite actuality and active study of this problem. The aim of this work was carrying out a comparative description of dynamics of metabolic response indexes in the phases of burn disease (BD) course depending on terms of the beginning of the surgical intervention. Рatients with a thermal trauma were inspected and analyzed in this work. All the patients were estimated for the index of the thermal defeat severity, the percentage of the area of deep burn, a general area of burn, the age of a patient and the presence of respiration system burn. According to these, all the patients were divided into separate groups of research. The 1st group included 46 injured with the index of thermal defeat severity (TDS) from 61 to 90 units. The 2 group included 29 patients with the TDS index over 91 units. According to the terms of surgical intervention, patients of these groups were divided into sub-groups: 1.1 and 2.1, where the first surgical intervention was conducted five days before burn disease; 1.2 and 2.2, where the first surgical intervention was conducted five days after of burn disease. The level of cortisol and glycaemia of blood serum of injured people on different stages of inspection were taken into consideration. The diagnostically-curative program was conducted according to the clinical protocol of medical care to injured with thermal trauma. Estimating the dynamics of cortisol level, there was a considerable increase of it over the first twenty-four hours in both groups, which preserved during an acute period of burn disease. In the patients of the sub-group 2.1, with the TDS index over 91 units, who underwent early surgical tactics, the further activating of a sympathic adrenal system on the 7th day after the burn (an increase in cortisol by 82% compared with the previous indicator) was noted. From the first twenty-four hours after the burn, injured people suffered from a stress-induced hyperglycaemia which developed in all research groups, the latter did not depend on the severity of the burn trauma and did not correlate with the cortisol level of blood serum. With the early surgical treatment of burns, a more rapid normalization of blood glucose level in patients of 1.1 and 2.1 sub-groups on the 5th and 7th day of burn disease accordingly occurred.

ANALYSIS OF CHANGES OF MULTIPLE ORGAN FAILURE FORMATION DEPENDING ON THE TERMS OF SURGICAL TREATMENT OF SEVERE BURNS

Oxygen imbalance on the tissue level is the main reason for homeostasis disorders and development of multiple organ failure as a severe complication after severe burns. The issues of influence on the microcirculatory system and the consequences of its damage remain topical and free-answered. The objective of this work was the comparative analysis of the dynamics of changes of multiple organ failure formation depending on the term and beginning of surgical treatment of severe burns.105 patients with a thermal trauma were examined and analyzed. To determine severity of thermal damage all the patients were assessed for injury severity index (ISI), the area of deep burn (ADB, %), a general area of burn (GAB, %), the age of a patient, and the presence of respiration system burn. According to ISI all the patients were divided into the groups of research. The 1st group included 46 injured with the ISI from 61 to 90 units. The 2 group counted 29 patients with the ISI index over 91 units. According to the terms of surgery, patients of these groups were divided into sub-groups: 1.1 and 2.1, where the first surgery was performed in less than five days of burn disease; 1.2 and 2.2, where the first surgery was performed after five days of burn disease. The scale SOFA was used to assess the risk of developing morbidity and mortality associated with sepsis. The diagnostic-therapeutic program was conducted according to the clinical protocol of medical aid given to injured individuals with thermal trauma. Against the ground of the performed intensive therapy during the acute period of burn disease the dependence of multiple organ failure formation on the time of the surgery beginning was not found.

Burn encephalopathy and syndrome of hypermetabolism-hypercatabolism: is there an interrelation?

Aim : To define an influence of hypermetabolism-hypercatabolism syndrome on the burn encephalopathy development on the base of study of metabolic changes on the background of an acute period of burn disease. Materials and methods : there were examined 104 patients separated in 2 groups depending on heaviness of injury. There were defined the levels of cortisol, neurospecific enolase (NSE), glucose and blood protein. There were assessed memory, thinking and psychological state of patients. Results : At admission to hospital the cortisol level in patients of 1 and 2 groups was 270,5±29,2 ng/ml and 330,3±17,4 ng/ml, glucose level - 6,0±0,4 mmol/l and 7,7±0,5 mmol/l in 1 and 2 groups respectively. The protein level of blood maximally decreased at 3 day and was 53,6±1,1 g/l in patients of the 1 group and 48,9±1,1 g/l in patients of the 2 group. An increase of cortisol level depended on heaviness of thermal trauma. There was defined correlation between the levels of cortisol and neuron specific enolase in patients of the 1 group at 3 day (R=0.638, p=0.006), in patients of the 2 group at 7 day (R=0.488, p=0.002). In patients of the 1 group sleep disorder and delirium development did not depended on the level of metabolic changes. At the 7 day there was defined correlative connection between cortisol level and memory (R=-0,681, p=0,071) and thinking (R=-0,520, p=0,038). In patients of the 2 group cortisol level at 1 day determined the memory and thinking disorders to the septic-toxemia stage. Sleep disorder correlated with expressed hypoproteinomia at 3 day (R=-0,483, p=0,001). The delirium development was caused with an increase of blood serum cortisol at 1 day after thermal trauma (R=0,467, p=0,058). Conclusion : The one of mechanisms of nerve tissue injury was the development of metabolic changes caused by stress on the background of heavy thermal trauma. The dynamics of cortisol level to the burn shock stage corresponded with the changes of neurospecific enolase level of blood serum as a marker of the nerve tissue injury

Intravenous Laser Therapy in Young Children with Thermal Injuries

Objective : to evaluate the laboratory and clinical effects of combined intravenous laser therapy in young children with thermal injuries in the acute period of burn disease. Subjects and methods. Forty children whose mean age was 2.67±0.35 years were examined; thermal injuries accounted for 25.05±1.01% of the total body surface area; of them degrees IIIaIIIb was 19.04±0.85%. A comparison group (n=15) received conventional therapy without taking into account and correcting baseline and current hemostasiological disorders. On day 1, a study group (n=25) had programmed anticoagulant therapy and intravenous laser therapy at different radiation frequencies with a Mustang 20002+ laser therapy apparatus (patent for invention No. 2482894) in addition to the conventional therapy. The laser therapy cycle was 6 to 16 sessions. The investigators estimated and compared the following examined parameters: white blood cell count; leukocytic index of intoxication; plasma average mass molecules at a wavelength of 254 nm; toxogenic granularity of neutrophils; wound exudate discharge time; surgical plasty area; and hospitalization time. Results. The positive laboratory and clinical effects of the performed combined intravenous laser therapy in the combined therapy of burn disease in young children were comparatively shown in the study group patients. The significant decrease in the level of an inflammatory response and endogenous intoxication led to a rapider burn wound cleansing, active epithelization, and reduced surgical plasty volumes. Conclusion. Combined intravenous laser therapy signif icantly exerts antiinflammatory and detoxifying effects in young children with 40% thermal injuries in the acute period of burn disease. Abolishing a systemic inflammatory response by combined intravenous laser therapy initiated early regenerative processes in the burn wound and caused reductions in surgical plasty volumes and hospitalization time, which optimizes ther apy for burn disease.

Hemostasis system condition in infectious complication development in severe burned patients

Over the period of the history of combustiology one of the main problems for treatment of patients with burns is infection, both local - bacterial pneumonia - and generalized - sepsis - characterized by extremely severe course, complex diagnostics and high lethality rate. However, the role of hemostasis disorders in infectious complication development in severe burned patients is taken into consideration insufficiently. The aim of the study is to reveal the most relevant hemostasis system changes in sepsis and pneumonia in patients with serious heat injury in an acute period of burn disease.

Changes in the excitability of the heart during the acute period of burn disease

Changes in the excitability of the heart during the acute period of burn disease