Body Surface Area Burn Research Articles

Medical Investigation and Clinical Changes in the Early Phases of Post Burn Adult Inpatients as Indicators for Prompt Infection Diagnosis, in the Hospital for Burn and Plastic Surgery, Sulaimanyah, Iraq

Background: Burn injury is one of the leading causes of morbidity and mortality worldwide. Burn related hospital acquired infections is one of the major problems in the management of these injuries. Aim of the study: To elaborate on the early laboratory and microbial culture changes in adult burn inpatients, and to make use of subtle changes in the laboratory investigations, to predict and detect infections in burn victims, in its early phases. Patients and Methods: A Clinical observational study included a random sample of one hundred adult burn inpatients from Sulaymaniyah Burn Hospital, admitted from April 2019 to January 2021, retrospectively and prospectively followed up during the course of the study. Results: thirty one (31%) patients were male and 69% were female, all patients were adults and aged ≥18 years. 51 % of them had mix II-III degree burns, while 38% second and 11% third degree burns. Hematocrit decreased, total WBC count increased while platelet in most of the patients was normal. Blood urea was increased, Serum creatinine levels were normal in most of the patient in first three weeks of their admission. Eleven patients (11%) died. Whereas 36% of the patients who died had Total Body Surface Area burn of more than 60%, while 72% of them had II and III degree burns. Also 90% of the patients had infections, majority of the isolate results were Gram-negative bacteria (66.8%), and (33.2%) were Gram-positive. Pseudomonas aeruginosa (32.5%) was the most common gram negative. The Staphylococcus aureus (33.2%) was the gram positive organism recovered. While 66.6% of patients had fever during the first week, 55.5% of patients had fever in second week. Most of the patients, who had fever, were infected with S.aureus and Pseudomonas aeruginosa throughout the second week post burn. Conclusion and recommendations; Many laboratories and microbial parameter changes occur in the early phases of post burning, of which Leukocytosis can be a good predictor for infection in burns, especially when it happens in the second week and beyond. Yet it cannot distinguish gram negative from gram positive bacterial infections. To detect any change in the back ground laboratory parameters, as soon as they happen, infections in burns can be detected or suspected

Clinical Profile of Multidrug-Resistant Organisms at Burn Center Dr. Soetomo General Hospital Surabaya from June 2020 to June 2021

Background: Burns are an ideal environment for primary wound infection to occur. Burn infection can lead to the acquisition of Multidrug-Resistant Organisms (MDRO) with certain risk factors, such as the cause, degree and total body surface area (TBSA) of burns, length of stay, and invasive procedures performed. This study aims to determine the clinical profile of burn patients who experience MDRO. Method: Data was taken using medical records at the Burn Center Dr. Soetomo General Hospital Surabaya during June 2020 – June 2021 with a descriptive study and a cross sectional approach. Result: A total of 67 burn patients were included in this study. Sixteen patients were found to have burns with MDRO, and 51 other patients only had burns without MDRO which was excluded in this study. Patient in this study were dominated by men with a total of 11 patients (68.8%), most patient were in the 19–45-year age group of 8 patients (50%) with an average of 35 ± 20.58 years, and length of stay >14 days in 11 patients (68.8%) with an average 32,75 ± 38.31 days. All patients had invasive procedures performed. Fire was the most common cause of burns, namely in 9 patients (56.3%). Severe burns occurred in 16 patients (100%) of the MDRO burns studied. Eleven patients (68.8%) had TBSA > 30% with an average of 37.06% ± 18.59%. Acinetobacter baumannii was the most MDR bacteria cultured in this study with 15 cultures (32.6%). It is followed by Pseudomonas aeruginosa with 9 cultures (19.6%) and Klebsiella pneumoniae with 4 cultures (8.7%). A. baumannii is most commonly found in blood cultures, followed by cultures of phlegm and wounds. This is in contrast to P. aeruginosa with the most findings in wound cultures, followed by cultures of sputum and blood. Conclusion: Our study shows that MDRO infection is still a matter of concern in burns. Even so, the number of samples should be increased to see the significance and the relationship between variables in future burn studies.

Prayer burns

Introduction: In Indian culture, it is considered auspicious to conduct prayers before beginning one's day or even before starting to celebrate any of the festivals. The variations in conducting the prayers are numerous, but one thing which is constant is fire, which in the form of diya or candle or incense stick is always present. This many a times becomes the source of clothes catching fire leading to burns. The flame burns can cause serious complications depending on the age and the percentage of the body involved. Herein, we are presenting an article regarding the same. Methods: All burns which occurred while praying from September 2019 to September 2021 were included in the case series. Results: In our study, the patients above 60 all had comorbid conditions, and 5 out of 8 (five out of eight) patients expired that is 62.5% of the study group. These patients had the accident at home while praying where the flame from diya which is lit on the temple floor near the idol of god caught fire to the clothes. Indian females prefer to wear clothes with flairs such as chaniya choli, long Indian skirt, or saree which increases the chances of contact with diyas or source of flame leading to accidental burns. Considering that 5 (five) patients were more than 50 years of age, they survived for mean days of 16.2 days and then expired, the three younger patients recovered with an average stay of 47.3 days. Even with extensive burns due to younger age the patients recovered and did require skin grafting in the course of their treatment. Discussion: Diminished alertness of the senses, impaired mentation, slower reaction time, reduced mobility, and decreased ability of elderly people to identify the severity or risk of a situation as well as their capacity to escape from harm, puts them at higher risk of sustaining burn injury. These circumstances will also lead to larger increased total body surface area (TBSA) and deeper burns; moreover, there is an increased risk for the development of inhalation injury. These factors are closely related to a higher mortality rate. Conclusion: Age plays an important role in treatment response in a major trauma like burns. Increased age with associated co morbidities add to the severity of the burns. Younger age group however have better survival chances, though even they required prolonged hospital stay in our study considering the higher percentage of burns involved.

Effect of blended protein nutritional support on reducing burn-induced inflammation and organ injury

BACKGROUND/OBJECTIVESPrevious studies have reported that protein supplementation contributes to the attenuation of inflammation. Serious trauma such as burn injury usually results in the excessive release of inflammatory factors and organs dysfunction. However, a few reports continued to focus on the function of protein ingestion in regulating burn-induced inflammation and organ dysfunction.MATERIALS/METHODSThis study established the rat model of 30% total body surface area burn injury, and evaluated the function of blended protein (mixture of whey and soybean proteins). Blood routine examination, inflammatory factors, blood biochemistry, and immunohistochemical assays were employed to analyze the samples from different treatment groups.RESULTSOur results indicated a decrease in the numbers of white blood cells, monocytes, and neutrophils in the burn injury group administered with the blended protein nutritional support (Burn+BP), as compared to the burn injury group administered normal saline supplementation (Burn+S). Expressions of the pro-inflammatory factors (tumor necrosis factor-α and interleukin-6 [IL-6]) and chemokines (macrophage chemoattractant protein-1, regulated upon activation normal T cell expressed and secreted factor, and C-C motif chemokine 11) were dramatically decreased, whereas anti-inflammatory factors (IL-4, IL-10, and IL-13) were significantly increased in the Burn+BP group. Kidney function related markers blood urea nitrogen and serum creatinine, and the liver function related markers alanine transaminase, aspartate aminotransferase, alkaline phosphatase, and lactate dehydrogenase were remarkably reduced, whereas albumin levels were elevated in the Burn+BP group as compared to levels obtained in the Burn+S group. Furthermore, inflammatory cells infiltration of the kidney and liver was also attenuated after burn injury administered with blended protein supplementation.CONCLUSIONSIn summary, nutritional support with blended proteins dramatically attenuates the burn-induced inflammatory reaction and protects organ functions. We believe this is a new insight into a potential therapeutic strategy for nutritional support of burn patients.

IL-23 Promotes Neutrophil Extracellular Trap Formation and Bacterial Clearance in a Mouse Model of Alcohol and Burn Injury.

Our previous studies have shown that ethanol intoxication combined with burn injury increases intestinal bacterial growth, disrupts the intestinal barrier, and enhances bacterial translocation. Additionally, studies show that Th17 effector cytokines IL-17 and IL-22, which are dependent on IL-23, play important roles in maintaining intestine mucosal barrier integrity. Recent findings suggest neutrophils are a significant source of IL-17 and IL-22. We determined the effect of ethanol and burn injury on neutrophil IL-17 and IL-22 production, as well as their ability to phagocytose and in bacterial clearance, and whether these effects are modulated by IL-23. Mice were given ethanol 4 h prior to receiving ∼12.5% total body surface area burn and were euthanized day 1 after injury. We observed that intoxication combined with burn injury significantly decreases blood neutrophil phagocytosis and bacteria killing, as well as their ability to produce IL-17 and IL-22, compared with sham vehicle mice. The treatment of neutrophils with rIL-23 significantly increases IL-22 and IL-17 release and promotes expression of IL-23R, retinoic acid-related orphan receptor γt, Lipocalin2, and Nod-like receptor 2 following ethanol and burn injury. Furthermore, IL-22- and IL-17-producing neutrophils have enhanced neutrophil extracellular trap formation and bacterial killing ability, which are dependent on IL-23. Finally, although we observed that peritoneal neutrophils harvested after casein treatment are functionally different from blood neutrophils, both blood and peritoneal neutrophils exhibited the same response to rIL-23 treatment. Together these findings suggest that IL-23 promotes neutrophil IL-22 and IL-17 production and their ability to kill bacteria following ethanol and burn injury.

Practical Computer Vision Application to Compute Total Body Surface Area Burn

Critical burn management decisions rely on accurate percent total body surface area (%TBSA) burn estimation. Existing %TBSA burn estimation models (eg, Lund-Browder chart and rule of nines) were derived from a linear formula and a limited number of individuals a century ago and do not reflect the range of body habitus of the modern population. To develop a practical %TBSA burn estimation tool that accounts for exact burn injury pattern, sex, and body habitus. This population-based cohort study evaluated the efficacy of a computer vision algorithm application in processing an adult laser body scan data set. High-resolution surface anthropometry laser body scans of 3047 North American and European adults aged 18 to 65 years from the Civilian American and European Surface Anthropometry Resource data set (1998-2001) were included. Of these, 1517 participants (49.8%) were male. Race and ethnicity data were not available for analysis. Analyses were conducted in 2020. The contributory %TBSA for 18 body regions in each individual. Mobile application for real-time %TBSA burn computation based on sex, habitus, and exact burn injury pattern. Of the 3047 individuals aged 18 to 65 years for whom body scans were available, 1517 (49.8%) were male. Wide individual variability was found in the extent to which major body regions contributed to %TBSA, especially in the torso and legs. Anterior torso %TBSA increased with increasing body habitus (mean [SD], 15.1 [0.9] to 19.1 [2.0] for male individuals; 15.1 [0.8] to 18.0 [1.7] for female individuals). This increase was attributable to increase in abdomen %TBSA (mean [SD], 5.3 [0.7] to 8.7 [1.8]) among male individuals and increase in abdomen (mean [SD], 4.6 [0.6] to 6.8 [1.7]) and pelvis (mean [SD], 1.5 [0.2] to 2.9 [0.9]) %TBSAs among female individuals. For most body regions, Lund-Browder chart and rule of nines estimates fell outside the population's measured interquartile ranges. The mobile application tested in this study, Burn Area, facilitated accurate %TBSA burn computation based on exact burn injury pattern for 10 sex and body habitus-specific models. Computer vision algorithm application to a large laser body scan data set may provide a practical tool that facilitates accurate %TBSA burn computation in the modern era.

Impact of Kinect-based virtual reality training on physical fitness and quality of life in severely burned children: A monocentric randomized controlled trial

Pediatric burns lead to persistent and detrimental muscle breakdown, weakness and poor quality of life, so rehabilitation is integral for improving physical and psychological outcomes. However, children with burns are a major challenge to a rehabilitation team. To overcome these challenges, enjoyable and interesting interventions are suggested. Objective: we aimed to determine the impact of the Xbox Kinect on cardiopulmonary fitness, muscle strength, lean mass, quality of life and enjoyment in severely burned children after hospital discharge. Methods: this was a randomized controlled trial in a single centre. Participants (n=40 children) with burn injuries were randomized to the Xbox training group (n=20) or control group (n=20) during 12 weeks. All children received a home programme rehabilitation and Xbox training children received Xbox training. Outcomes included cardiopulmonary fitness (VO2peak), muscle strength (peak torque), lean mass (whole-body and regional), quality of life and physical activity enjoyment at baseline, immediately after hospital discharge, and 12 weeks after the intervention. Results: the mean (SD) age of the 40 children was 12.97 (1.42) years and total body surface area of burn was 51% (5). The groups did not differ in characteristics at baseline (P>0.05). After 12 weeks of the intervention, the groups significantly differed in VO2peak, peak torque, quality of life (P<0.001), lean mass and leg lean mass (P<0.05) in favour of Xbox training. The mean difference in VO2peak, peak torque, lean mass and leg lean mass was 3.25 (2.1; 4.5) ml/kg/min, 7.5 (5.8; 9.2) Nm, 1.81 (0.5; 3.1) kg, and 1.1 (0.1; 2.1) kg, respectively. Lean trunk mass did not significantly differ between groups (P=0.07). The Xbox training group reported significantly more enjoyment than did the control group (P<0.001). Conclusion: Xbox Kinect training can increase cardiopulmonary fitness, muscle strength, lean mass and quality of life in burned children. It is one of the most enjoyable, motivated and efficient treatment modalities that should be widely introduced into the pediatric burn rehabilitation. Trial registration. ClinicalTrials.gov (ID: NCT04350034).

Length of Stay per Total Body Surface Area Burn Relative to Mechanism: A Pediatric Injury Quality Improvement Collaborative Study.

Studies on length of stay (LOS) per total body surface area (TBSA) burn in pediatric patients are often limited to single institutions and are grouped in ranges of TBSA burn which lacks specific detail to counsel patients and families. A LOS to TBSA burn ratio of 1 has been widely accepted but not validated with multi-institution data. The objective of this study is to describe the current relationship of LOS per TBSA burn and LOS per TBSA burn relative to burn mechanism with the use of multi-institutional data. Data from the Pediatric Injury Quality Improvement Collaborative (PIQIC) were obtained for patients across five pediatric burn centers from July 2018 to September 2020. LOS per TBSA burn ratios were calculated. Descriptive statistics and generalized linear regression which modeled characteristics associated with LOS per TBSA ratio are described. Among the 1267 pediatric burn patients, the most common mechanism was scald (64%), followed by contact (17%) and flame (13%). The average LOS/TBSA burn ratio across all cases was 1.2 (SD = 2.1). In adjusted models, scald burns and chemical burns had similar LOS/TBSA burn ratios of 0.8 and 0.9, respectively, whereas all other burns had a significantly higher LOS/TBSA burn ratio (p<0.0001). LOS/TBSA burn ratios were similar across races, although Hispanics had a slightly higher ratio at 1.4 days. These data establish a multi-institution LOS per TBSA ratio across PIQIC centers and demonstrate a significant variation in the LOS per TBSA burn relative to the burn mechanism sustained.

A multicenter study analyzing the association of vitamin D deficiency and replacement with infectious outcomes in patients with burn injuries

Vitamin D (25OHD) deficiency is associated with poor outcomes in intensive care populations. The primary objective of this 7-center study was to determine if 25OHD deficiency is associated with infectious outcomes in adult burn patients. Generalized linear mixed modeling was used to control for center effect, percent total body surface area burn (% TBSA), age, and presence of inhalation injury. A total of 1147 patients were initially included (admitted January 2016 through August 2019). After exclusions, 234 (56.8%) in the deficient (25OHD<20 ng/mL) and 178 in the non-deficient group (25OHD ≥ 20 ng/mL) remained, surpassing a priori power requirements. The non-deficient group had their concentration drawn earlier (p < 0.001), were more likely to be male (p = 0.006), Caucasian (p < 0.001), have lower body mass index (p = 0.009), lower % TBSA (p = 0.002), and taking a 25OHD supplement prior to admission (p < 0.001). Deficient patients were more likely to have an infectious outcome (52.1% vs 36.0%, p = 0.002), acute kidney injury with renal replacement therapy (p = 0.009), less ventilator free days in the first 28 days (p < 0.001), and vasopressors (p = 0.01). After controlling for center, % TBSA, age, and inhalation injury the best model also included presence of deficiency (OR 2.425 [CI 1.206–4.876]), days until 25OHD supplement initiation (OR 1.139 [CI 1.035–1.252]), and choice of cholecalciferol over ergocalciferol (OR 2.112 [CI 1.151–3.877]). To the authors' knowledge, this is the first multicenter study to evaluate the relationship between 25OHD and infectious complications in burn patients.

Mortality from Burn: An Autopsy Based Study from Nepal

Introduction: In developing countries like Nepal burn deaths are a major public health problem due to their increased mortality, morbidity and long-term disability. A few clinical studies on burns have been reported from Nepal however, autopsy based studies on burns are limited.&#x0D; Objectives: To study the socio-demographic characteristics of victims of burns and evaluate the cause and magnitude of fatal burn injuries retrospectively.&#x0D; Methodology: A two years retrospective analysis of burn deaths brought for autopsy was conducted from January 2017 to December 2018 in a central level hospital of Nepal.&#x0D; Results: Out of 775 total cases autopsied 38 (4.90%) cases were burn related deaths. The majority of the deaths 17(44.70%) occurred in the age group 21-30 years with a preponderance in females 22(57.89%). Majority of the victims were married females 25(65.78%) and most of them were housewives 14(36.84%). Flame burn 23(60.52%) was the most common cause of all burns. The Total Body Surface Area (TBSA) Burn between 50-69% was observed in majority of the cases 27(71.05%).Most of the victims 15(39.47%) survived over 10 days post injury. Burn incidents were mainly accidental 33(86.84%) in nature followed by suicidal burns 5(13.15%). The main cause of burn death was septicemic shock 16(42.10%) followed by neurogenic shock 10(26.31%).&#x0D; Conclusion: The results of this study show that burns injuries are mostly accidental in nature; therefore, the risks of burn injuries should be rightly addressed and appropriate burn prevention strategies should be developed to reduce the frequency and burn related deaths.

Detecting Patient Health Trajectories Using a Full-Body Burn Physiology Model

A whole-body physiology model of inflammatory burn injury was used to train an algorithm to correctly detect patients’ states. The physiology model of a thermal injury takes the surface area of patient skin burned as an input to the model and responds to common treatments. This model is leveraged to build a database of patient physiology as a function of total body surface area burn, without treatment, over a 48-h window. Using this database, we train a model to determine patient injury status as a function of the available physiology data. The algorithm can group virtual patients into three distinct categories, corresponding to long term patient health. The results show that, given an initial virtual patient and injury, the algorithm can correctly determine the placement of that patient into the corresponding category, effectively classifying long term patient outcomes.

Особливості формування імунної відповіді на термічну травму

To study the effect of thermal trauma on the immune response formation, 43 patients aged 16 to 58 with body surface area of burns 20-60% were examined. The neutrophilic granulocytes (NG) and monocytes functional activity, the content of myeloperoxidase and substances with a positive reaction to Schiff’s periodic acid (PAS- stained substances), the cytokines content were determined: interleukin-1β (IL-1β), IL-2, IL-4, IL- 6, tumor necrosis factor-α (TNF-α). Thermal damage caused changes in the immune response, which were characterized by a pro-inflammatory phase in which innate immunity cells (neutrophilic granulocytes, monocytes) acquired high functional activity, producing a higher content of proinflammatory cytokines. On the 2-3rd day after the burn injury in the peripheral blood, the interleukin-1β (IL-1β) content was 133.5 ± 21.1 pg/ml, the tumor necrosis factor α (TNF-α) content was 265 ± 115.5 pg/ml, which exceeded the reference values by 5.1 and 10.9 times, respectively. The content of IL-6 on the 2-3rd day was 85.30 ± 13.10 pg/ml. Also a concomitant syndrome of compensatory anti-inflammatory response developed with increasing production of anti-inflammatory IL-4: on the 2-3rd day after burn injury, its content was 268.5 pg/ml, exceeding the reference values by 8.2 times. The content of anti-inflammatory IL-10 was decreased. This suggests that anti-inflammatory cytokines do not compensate for the high content of pro-inflammatory factors. On the 7th-8th day after the burn injury, there was a tendency to further increase the content of pro-inflammatory cytokines IL- 1β and TNF-α to 148.0 ± 27.0, and 281.2 ± 146.7 pg/ml, respectively, while the content of IL-6 on the 7-8th day was 131.0 ± 11.1 pg/ml, the anti-inflammatory cytokine IL-10 increased slightly, and the content of IL-4 decreased. These changes in the early period of burn disease dynamics, as well as reduced activity of myeloperoxidase and PAS- stained substances NG, point for a functional deficiency of NG, reduced enzymatic activity and cells energy resources decompensation. These changes could clinically lead to SIRS progression and multiorgan dysfunction.

A Prospective Clinical Study of the Effect of Recombinant Human Growth Hormone in Wound Healing of Severely Burned Children

Abstract Background A burn is a thermal injury caused by biological, chemical, electrical and physical agents with local and systemic repercussions. There are several ways of classifying burns: Classification by mechanism or cause, depth and extent of burn . Objectives The objective of this study was to determine the safety and efficacy of using recombinant human growth hormone (rhGH) in the treatment of pediatric burn victims and their probable effect on accelerating burn wound healing. Patients and Methods This study was an Interventional randomized controlled Double Blind Study in which Patients subdivided randomly into 2 groups: Group A received somatotropine hormone after their 3 days of resuscitation besides their conventional treatment during their stay in the Burn ICU. Group B received the conventional treatment only in the Burn ICU. Results The comparison between the GH group and the control group showed that that there was statistically significant difference found between the two studied groups regarding TBSA of burn at 3rd week. The mean TBSA in GH group was ( 9.06 ± 7.47 ) while in the control group (13.94 ± 11.96) with P value (0.041). There was highly statistically significant difference found between the two studied groups regarding Insulin like growth factor .the mean Insulin like growth factor in GH group was (16.48 ± 11.40) while in the control group(2.77 ± 0.64) with P value(0.000). Conclusion The use of recombinant Growth hormone with a dose of 0.2 mg/Kg SQ 2 days per week with 3 days time interval in pediatric burn patients after their primary resuscitation from the burn injury, shows a marvelous improvement concerning the total body surface area of burn(TBSA) as the patient received the growth hormone showed a decrease total body surface area of burn(TBSA) than the control group. This may be accounted for the faster wound healing and readiness for grafting .

Exploding power: a statewide review of lithium battery related burns

Introduction: With the increase of lithium battery devices, including electronic cigarettes and battery power banks, there has been a steady rise in burn injuries secondary to device malfunction. These devices may cause chemical or flame burns. Our aim was to identify and classify epidemiological trends of explosions from lithium battery devices across the state of New South Wales (NSW), Australia. Methods: A review of the NSW Burn Injury Service (SBIS) database from January 2005–December2019, together with medical records from the burns units at the Children’s Hospital at Westmead (CHW), the Concord Repatriation General Hospital (CRGH) and the Royal North Shore Hospital (RNSH) was conducted. All patients who suffered a burn secondary from a lithium battery device were included and data was extracted on mechanism of injury, severity of injury and management. This study was approved by the ethics committees of CHW, RNSH and CRGH [2020/PID00179]. Results: Of the 24 patients identified, six were paediatric and 18 were adults. The majority were male (7:1) with a mean age of 29.0 (+/- 16.6 years). The mean total body surface area burnt was 2.5% (+/- 0.9) [range 0.1–21.0%]. The majority occurred after 2014 and involved spontaneous explosions. Their injuries ranged from partial to full thickness burns with flame being the most common type (n=15). Three quarters of the cases (n=18) occurred in a home setting. Conclusions: Lithium battery device explosions can result in a mix of burn depth injuries from flame, contact and electrical, or chemical burns. Consumers need to be made more aware of the potential risks associated with use of lithium battery powered devices.

Characterization of severely burned patients and evaluation of factors associated to mortality. An observational retrospective cohort study in San Vicente Fundación Hospital

Introduction Burns are common in developing countries and place a large burden on the medical and social care systems. However, information about management and outcomes from such countries is scarce. The purpose of this study was to analyze the epidemiology and main factors related to the mortality in severely burned patients at the Hospital Universitario San Vicente Fundación in Medellín, Colombia. Methods An observational retrospective cohort study was conducted. To establish prognostic factors associated with mortality, we analyzed variables such as age, sex, burned surface, and degree of burn, among others. Demographic, clinic, and management features as well as complications and factors associated with mortality were analyzed using logistic regression. Results 4516 clinical histories were reviewed, 225 were included in the study. 76.9% were men, with a median age of 35 years; 64.9% were fire burns. The median burned body surface area was 42%. There were inhalation injuries in 135 patients and ocular in 106 patients. The main complication was infection followed by rhabdomyolysis. The overall hospital stay was 27 days, and the median length of stay at the intensive care unit was 7 days with in-hospital mortality of 30.7%. The variables associated with mortality were age, burned body surface area, degree of burn, and kidney injury. Surgical intervention was protective. Conclusions Severely burned patients in our hospital have similar outcomes and, in some cases, better outcomes than those reported in the literature in countries with similar characteristics, and we have seen that in the last years, there has been a better experience in the management of these patients. Elderly, extension, and depth of burnt tissue are markers of poor outcomes. Early surgery and intubation have shown better outcomes, probably due to infection control and removal of necrotic tissue, airway management, and ventilatory support for metabolic and hemodynamic derangement.

Burn Injury Induces Proinflammatory Plasma Extracellular Vesicles That Associate with Length of Hospital Stay in Women: CRP and SAA1 as Potential Prognostic Indicators.

Severe burn injury is a devastating form of trauma that results in persistent immune dysfunction with associated morbidity and mortality. The underlying drivers of this immune dysfunction remain elusive, and there are no prognostic markers to identify at-risk patients. Extracellular vesicles (EVs) are emerging as drivers of immune dysfunction as well as biomarkers. We investigated if EVs after burn injury promote macrophage activation and assessed if EV contents can predict length of hospital stay. EVs isolated early from mice that received a 20% total body surface area (TBSA) burn promoted proinflammatory responses in cultured splenic macrophages. Unbiased LC-MS/MS proteomic analysis of early EVs (<72 h post-injury) from mice and humans showed some similarities including enrichment of acute phase response proteins such as CRP and SAA1. Semi-unbiased assessment of early human burn patient EVs found alterations consistent with increased proinflammatory signaling and loss of inhibition of CRP expression. In a sample of 50 patients with large burn injury, EV SAA1 and CRP were correlated with TBSA injury in both sexes and were correlated with length of hospital stay in women. These findings suggest that EVs are drivers of immune responses after burn injury and their content may predict hospital course.

Response of Aerobic Capacity to Low-Level Laser Therapy in Burned Patients.

Severe burns lead to decreased pulmonary function and impaired aerobic capacity for long periods postinjury. Low-level laser therapy is a modality used to improve aerobic capacity, enhance exercise performance, and increase the time until fatigue when used before aerobic exercises. This work aims to determine the impacts of pre-exercise low-level laser therapy on aerobic capacity in burn cases. Sixty adults burned cases of both sex, aged from 25 to 40 years, with second-degree healed thermal burns, and the total burned body surface area ranged from 20 to 40% participated in this study after complete wound healing. They were randomly categorized into two groups of equal numbers. The study group received low-level laser therapy before aerobic exercises, three sessions per week for 12 weeks, while the control group performed aerobic exercises three times weekly for 12 weeks. All cases received the routine physical treatment program. Aerobic capacity was assessed for both groups by measuring maximum oxygen consumption and time to exhaustion at baseline and 12 weeks following interventions. There was a statistically significant rise in the mean values of maximum oxygen usage and time to fatigue after 12 weeks of treatment in both groups. However, after comparison, the improvements in the study group were statistically significant than those in the control group with P < .01 and P < .05, respectively. Low-level laser therapy has a beneficial therapeutic impact on promoting aerobic capacity, improving maximum oxygen consumption, and increasing treadmill time in burned cases when preceding aerobic exercises.

Continuous infusion versus intermittent infusion vancomycin in a burn center intensive care unit

BackgroundVancomycin is a common and critical drug for empiric antimicrobial therapy in the infected burn patient. However, profound physiologic changes may impede the clinical effectiveness and amplify the potential nephrotoxicity of vancomycin. MethodsThis was a retrospective cohort study at a large academic medical center and regional burn center. Patients with ≥10% total body surface area burn that received intravenous vancomycin were considered for study inclusion. Patients were assigned to the intermittent infusion or continuous infusion cohort if they received vancomycin for ≥48 h with ≥1 documented vancomycin serum concentration. The target steady state drug level for continuous infusion was 17−22 mg/L. The target steady state trough drug level for intermittent infusion was 15−20 mg/L. The primary efficacy and safety outcomes were time to therapeutic drug level and nephrotoxicity respectively. ResultsThirty continuous infusion subjects with 88 plasma drug levels and thirty intermittent infusion subjects with 80 plasma drug levels were analyzed within the study period. There was a significant difference in the number of subjects that achieved a plasma vancomycin level within the target range during the course of therapy (73.3% for continuous infusion vs. 26.7% for intermittent infusion, p = 0.0003). The time to therapeutic level was 3.90 days for continuous infusion and 5.22 days for intermittent infusion (p = 0.0393). Nephrotoxicity occurred less frequently in the continuous infusion cohort (23.3% vs. 53.8%). ConclusionContinuous infusion vancomycin was associated with more rapid attainment of target levels and a lower rate of nephrotoxicity.

Epidemiology of Childhood Burn: A 5-Year Retrospective Study in the Referral Burn Center of Northern Iran Northern Iran

Background: Burns are the second most common etiology of injury death in children under 5 years old and are the most common cause of death in a home accident. Materials &amp; Methods: This study was performed to investigate the epidemiology of childhood burn in children under 16 years old referred to Velayat Burn Center, Rasht City, Iran, from 2013 to 2018. Data were collected from electronic hospital records of burn patients aged under 16 years of age. Results: Out of 717 patients, 44.5% were girls, and 55.5% were boys (sex ratio=1.2). The highest frequency of burns (56.1%) was reported in the 1-5 years age group. The most common cause of burn was scalds (76%), and the most common burn severity was second-degree burns (46.7%). The Mean±SD duration of hospitalization was 3.07±4.15 days, and the hospital stay was significantly associated with the cause of the burn, Burned Body Surface Area (BBSA), and burn severity. The highest frequency was reported on Saturdays, i.e., (the first working day in Iran) (22.7%), between 6 and 12 o’clock (42.8%). Conclusion: This study found that children in 1-5 years old were the most susceptible age group for burn injuries and scalds were the most common cause of the burn. The male to female ratio was 1.2, and the majority of burns occurred in the winter.

TPPU treatment of burned mice dampens inflammation and generation of bioactive DHET which impairs neutrophil function

Oxylipins modulate the behavior of immune cells in inflammation. Soluble epoxide hydrolase (sEH) converts anti-inflammatory epoxyeicosatrienoic acid (EET) to dihydroxyeicosatrienoic acid (DHET). An sEH-inhibitor, TPPU, has been demonstrated to ameliorate lipopolysaccharide (LPS)- and sepsis-induced inflammation via EETs. The immunomodulatory role of DHET is not well characterized. We hypothesized that TPPU dampens inflammation and that sEH-derived DHET alters neutrophil functionality in burn induced inflammation. Outbred mice were treated with vehicle, TPPU or 14,15-DHET and immediately subjected to either sham or dorsal scald 28% total body surface area burn injury. After 6 and 24 h, interleukin 6 (IL-6) serum levels and neutrophil activation were analyzed. For in vitro analyses, bone marrow derived neutrophil functionality and mRNA expression were examined. In vivo, 14,15-DHET and IL-6 serum concentrations were decreased after burn injury with TPPU administration. In vitro, 14,15-DHET impaired neutrophil chemotaxis, acidification, CXCR1/CXCR2 expression and reactive oxygen species (ROS) production, the latter independent from p38MAPK and PI3K signaling. We conclude that TPPU administration decreases DHET post-burn. Furthermore, DHET downregulates key neutrophil immune functions and mRNA expression. Altogether, these data reveal that TPPU not only increases anti-inflammatory and inflammation resolving EET levels, but also prevents potential impairment of neutrophils by DHET in trauma.