Burn Dressing Changes Research Articles

Analgesic Use of Virtual Reality for Burn Dressing Changes in Low- and Middle-income Countries: A Feasibility Study.

The paucity of pain management options in resource-limited settings is a significant and systemically unaddressed problem. To improve global health equity, it is important to bridge this gap in care without introducing the peril of opioid dependence. We present a proof-of-concept case series wherein virtual reality (VR) was successfully used to manage discomfort in patients undergoing burn dressing changes in sub-Saharan Africa. Nine patients presenting with burn injuries of variable severity underwent routine stabilization and dressing as part of standard-of-care treatment. During dressing changes, a VR intervention consisting of the Dream Flight interactive game displayed on an Oculus Quest 2 headset was offered to patients. Patient mood scores were collected before VR initiation and at the conclusion of the dressing change by a translator using the Youth Feelings Scale. There were no adverse events associated with use of the VR headset and no patients elected to terminate the VR during their procedure. Patients and physicians subjectively reported satisfaction with the device's utility in the procedure. Before VR initiation, the 95% confidence interval for patient mood score was 4.89 ± 1.725. After VR initiation, the 95% confidence interval for patient mood score was 8.78 ± 1.40. Our results of this proof-of-concept case series to suggest both feasibility of use and positive influence on patient discomfort and periprocedural satisfaction. We propose that VR should be explored as an analgesic alternative and/or adjunct to narcotics in resource-limited countries, particularly for high-pain, low-duration procedures.

725 Satisfaction of Patient, Burn Nurse/Tech and Anesthesia Provider for Monitored Anesthesia Care Burn Dressing Change

725 Satisfaction of Patient, Burn Nurse/Tech and Anesthesia Provider for Monitored Anesthesia Care Burn Dressing Change

Effect of Therapeutic Hospital Clown Use on Children's Behavioral Adherence During Burn Dressing Changes

Effect of Therapeutic Hospital Clown Use on Children's Behavioral Adherence During Burn Dressing Changes

A Comparison of the Effect of Visual and Auditory Distractions on Physiological Indicators and Pain of Burn Dressing Change Among 6–12-Year-Oldchildren: A Clinical Trial Study

PourposeThis study aimed to compare the effect of audiovisual distraction on physiological indicators and pain of burn dressing change among 6–12 year-old children. Design and methodsThe study was a single-blind clinical trial with a three-group that sample size was 120 children aged 6–12 years admitted to the burn ward of Hamadan Besat Hospital. Data collection tools were the Oucher pain scale, a Cheklist form of the physiological Indicators, and apulse oximetry device. The cartoons were shown for visual group and the melodic poems were played for the auditory group 2 min before the dressing until the end of the procedure (at 2-min intervals). Data were analyzed by SPSS-16 software one-way, variance analysis and post-hoc Bonferroni test. ResultsTherewere statistically significant differences between visual, auditory and control groups in the mean pain intensity scores at all measurement times, the mean arterial blood oxygen saturation percentage at all measurement times except for the10 min before the dressing and the start of the procedure and the mean heart rate at all measurement times except for 10 min before dressing (p < 0.001). Post-hoc tests showed that the difference in the mean heart rate was related to the difference between the visual and auditory distraction groups during and at the end of the dressing (p < 0.05), the visual and control groups at all measurement times (P < 0.001) and the auditory and control groups at all measurement times (p < 0.05). ConclusionAudiovisual distraction is effective in reducing the fluctuations of physiological indicators and the burn dressing pain intensity in children at all times of measurement, especially during changedressing. Practice implicationsThe findings of this study are relevant to clinical practice because they suggest preparing children before and during a burning procedure situation.

712 Title: Monitored Anesthesia Care (MAC) Burn Dressing Changes Even in Critically Ill Patients Is Incredibly Safe

Abstract Introduction Objective: Identify prevalence and factors associated with hypoxia and blood pressure changes during MAC anesthesia for inpatient burn dressing change. Methods Retrospective chart review on 112 adult inpatients undergoing 1 or more burn dressing changes under MAC from March 2014 to December 2017 at a single burn center. Results Study population was 112 burn inpatients undergoing 210 burn dressing changes under MAC. Median age was 43 years (range 18–93) with 78% male and 95% Caucasian. Average BMI was 29.7 (range 18–66). Average % total body surface area (TBSA) burn was 24% (range 1%-70%). Number of MAC dressing changes per patient was 1 to 16 with most (71.4%) undergoing 1 MAC dressing change. Among 210 MAC cases, 5 involved a hypoxemic event (defined as a % O2 saturation of &amp;lt; 90%) and 14 involved a blood pressure changed (defined as a mean arterial pressure (MAP) of &amp;lt; 60 mmHg) on 7 different patients Three of the hypoxic events were also associated with hypotension (1.4%) None of these events were associated with poor outcomes. Conclusions MAC anesthesia for dressing changes are performed on inpatients during all stages of the burn recovery. Anesthesia is involved with the initial dressing changes on the critical care individuals. The MAC anesthesia is titrated to the condition of the patient with very low frequency of hypoxia or severe hypotension. Applicability of Research to Practice Burn dressing changes are challenging anesthesias because of the often associated co-morbidities of the presenting patients. Other factors that are considered are the NPO status and nutritional requirements of the patients. The desire to accomplish the dressing changes with the least amount of disruption of this while caring for these ill patients can be safely accomplished with MAC dressing changes. This provides an incredibly safe environment for the patient with the rapidly titratable medications that allow the dressing changes to be completed efficiently.

The Effect of Medical-Directed Play on the Severity of Pediatric Pain During Burn Dressing Change in Children: A Clinical Randomized Trial

The Effect of Medical-Directed Play on the Severity of Pediatric Pain During Burn Dressing Change in Children: A Clinical Randomized Trial

The Effect of a Multi-Dimensional Play Program on Children’s Pain Intensity During Burn Dressing Change in Burn Intensive Care Units: A Clinical Trial

The Effect of a Multi-Dimensional Play Program on Children’s Pain Intensity During Burn Dressing Change in Burn Intensive Care Units: A Clinical Trial

Case Study: Videogame Distraction Reduces Behavioral Distress in a Preschool-Aged Child Undergoing Repeated Burn Dressing Changes: A Single-Subject Design

This single-subject design study evaluated the feasibility and efficacy of passive and interactive videogame distraction on behavioral distress for a preschool-aged child receiving repeated burn dressing changes. A 4-year-old girl underwent 3 baseline and 10 videogame distraction sessions (5 passive and 5 interactive) using a restricted alternating treatments design. Observed behavioral distress was coded, and parents and nurses rated the child's distress and cooperative behavior. Relative to baseline, behavioral distress decreased and cooperative behavior increased immediately after the onset of videogame distraction. Single Case Randomization Tests revealed significantly lower behavioral distress and greater cooperation during interactive videogame distraction relative to passive videogame distraction. Interactive videogame distraction appears to be a feasible and effective pain management strategy for a preschool-aged child undergoing repeated painful medical procedures.

A clinical case study of a participation intervention method for burn dressing change in two children

Each year in Iceland, approximately 23 children are hospitalized due to severe burns (Landspitali-University Hospital Database, 2002). Ages range from 3.5 to 16 years. All of these have pain associated with the burn. Severe burns are one of the most painful experiences known to people and well remembered [1]. Minor burns have fewer physiologic consequences than major burns, but may be equally painful during their treatment and healing, such as burn dressing change (BDC) [2]. Limited evidence exists concerning interventions to foster a sense of control and comfort in children undergoing treatment due to burn [3]. Although the key to control burn pain in children remains pharmacological [4], there is a growing recognition that other approaches may not only reduce the discomfort of painful procedures but may enable children to cope better with this difficult experience [5,6]. The limited references found in the literature are becoming dated; however, they are still used in clinical practice world wide. One of these is the Participation Intervention Method for BDC [7–9]. The theoretical basis for this approach is ‘‘learned helplessness’’ proposing that an organism experiences no contingency between behavior, responses and outcome [10]. That is, a person comes to believe that events can neither be predicted nor controlled, and this feeling is most intense when the outcomes are unpleasant and when the situation appears unchangeable. Learned helplessness is characterized by

The Effects of Self-Selected Music on Anxiety and Pain during Burn Dressing Changes

The purpose of this study was to examine the effects of music therapy on state anxiety and pain among patients undergoing burn dressing changes. A convenience sample of 32 adult burn patients who were eligible and provided consent were included in the study which was a quasi-experimental study of a nonequivalent control group pretest-posttest design. Fifteen patients in the control group received the routine burn dressing changes but 17 patients in the experimental group listened to self-selected music through headphones connected to a CD player during burn dressing changes for three days. All subjects of the music group chose the type of music that would relax them. Before and after burn dressing changes, subjects completed the State Anxiety Inventory and self-report of pain scores. There was a significant reduction in state anxiety before and after burn dressing changes in those who received music therapy in contrast to those who did not receive music therapy. The music group reported lower pain scores before and after burn dressing changes than did the non-music group. These findings indicate that music therapy composed of self-selected music is a valuable intervention for the treatment of pain and anxiety in patients undergoing burn dressing changes.

Treatment-resistant pain and distress during pediatric burn-dressing changes.

Recent research has suggested some efficacy for the use of hypnosis in the control of pain and distress in a pediatric population undergoing painful medical procedures. Here, we study a sample (N=23) of pediatric subjects undergoing burn-dressing changes and receiving either an imagery-based or control (social-support) treatment. Subjects' levels of distress were assessed with the Observational Scale of Behavioral Distress. Results indicated that distress behaviors in this population can be measured reliably using this scale. However, no support was found for the main hypothesis that imagery treatment would be superior to control treatment in the alleviation of distress, nor were these treatments effective in comparison to baseline conditions. We discuss the formidable problem that burn and dressing-change pain presents, as well as the reasons why this treatment attempt might have failed to have the predicted effects. We also discuss important developmental considerations regarding the adequate assessment of pain and distress.

PAIN AND ANXIETY WITH BURN DRESSING CHANGES

Society of Critical Care Medicine; 27th Educational and Scientific Symposium; San Antonio, Texas, USA; February 4-8, 1998: Poster Hall: Thursday, February 5, 1998 5: 45-7: 15 pm; Friday, February 6, 1998 11: 40 am-1: 00 pm; Saturday, February 7, 1998 11: 40 am-1: 00 pm: Poster Presentations: Burns/Trauma

Pain and Anxiety with Burn Dressing Changes

Pain and Anxiety with Burn Dressing Changes

The Effect of Selected Cognitive and Behavioral Techniques on Patient Pain, Anxiety and Salivary Cortisol Levels During Burn Dressing Change Procedures

The Effect of Selected Cognitive and Behavioral Techniques on Patient Pain, Anxiety and Salivary Cortisol Levels During Burn Dressing Change Procedures

Pain during burn dressing change in children: relationship to burn area, depth and analgesic regimens

To determine the level of pain that acutely burned children experience, we obtained pain scores before, during and after burn dressing change (BDC). Pain scores were higher during the BDC, consistent with severe pain during this procedure. A positive correlation between pain scores and the body surface area (BSA) burned suggests that pain increases with the size of the burn. Contrary to widely held beliefs, comparison of mean pain scores and the percent of 3rd degree burn revealed that the larger the area of full-thickness injury, the greater the pain. Regardless of wide variations in patient characteristics, fixed doses of oral narcotics were usually prescribed for pain. Patients with BSA > 70% experienced severe pain during BDC despite the type, dose or route of opioids. These findings suggest the need for 1. (a) education to correct the myth that ‘third-degree burns don't hurt’ 2. (b) revision of analgesic prescribing patterns in the burned child 3. (c) research to determine the mechanisms (e.g., tolerance or deafferentation) underlying the opioid-resistant nature of pain after large burns.

The assessment of pain and plasma β-endorphin immunoactivity in burned children

The need for better analgesia during burn dressing changes (BDCs) in acutely burned children led us to assess pain during BDC with a large 0–10 thermometer-like scale which was well accepted and appeared to reflect the varying degrees of pain that patients experienced. Pain scores were obtained at least once each minute throughout 33 BDCs in 15 patients of 8–17 years. Plasma levels of β-endorphin immunoactivity (iB-EP) were measured at 5 intervals before and after BDC; mean values (± S.E.M.) ranged from 30.5 ± 4.63 pg/ ml (before BDC and analgesic) to 19.2 +- 3.02 pg/ ml (immediately following BDC). The mean pain score (MPS) for each BDC was inversely related to the iB-EP levels of that day ( P < 0.001 with 4 of the 5 iB-EP determinations). The MPS varied directly with the extent of burn injury and inversely with weight; the 2 variables together predicted MPS as well as the iB-EP alone ( r 2= 43 and 36% respectively).