Burn Injury Patients Research Articles

A 5-year Retrospective Study of Burn Injury at Tarakan Regional General Hospital Jakarta

Introduction: Burn patients deserve more attention because of their high morbidity and mortality rates. According to the World Health Organization, approximately 180.000 deaths per year are associated with burns. We aim to obtain the characteristics of burn patients at Tarakan Regional General Hospital Jakarta as a type A referral center hospital from 2018 to 2022 to examine patient trends, provide appropriate services for burn patients, and reduce the rate of poor quality of life caused by disability and death. Methods: A cross-sectional method with descriptive study was used. Medical records of patients with burns admitted to Tarakan regional general hospital Jakarta between January 2018 and September 2022 were evaluated. 191 burn patients were reviewed based on age, sex, total burn surface area, burn degrees, etiology, intervention, and discharge status. Results: The total number of burn patients at the Tarakan hospital Jakarta from 2018 - 2022 was 191, with an increase of 248% from 2018 to 2022. With a gender ratio of 1.03:1, 97 subjects were male, and 94 were female. Most patients have dominated with adults as much as 80.1%. The highest incidence of burns is due to gas explosions, with a total area of burn injury at 21-30% TBSA occurring at 40.84%, and most burns ensue in the second degree as much as 59.69%. In the age group under 18 years, 73,05% of the common cause of burns is scald. The most extensive burns occur on 10-20% of the body surface area, and 73.68% of subjects suffer from second-degree burns. Debridement and wound dressing were done in the operating room on average four times per patient. The mortality rate in Tarakan Regional Hospital is 2.6% due to > 40% TBSA burns. Conclusion: Burn injury patients at Tarakan regional hospital Jakarta from 2018 to 2022 have increased, with gas explosions being the most common cause in the adult age group while in the children group by scald. Third-degree burns cause most deaths. According to these results, the proper facilities and infrastructure at hospitals in Jakarta may also improve the quality of treatment for burn patients.

Occurrence and antimicrobial profiling of K. pneumoniae in burn patients at burn ward, Allied Hospital, Faisalabad

Background: Klebsiella pneumonia is an opportunistic pathogen causing a great array of illness both in humans and animals and responsible for high mortality rate in burn patients. Aim: To determine occurrence of K. pneumonia in burn wound patients and to check antibiotic sensitivity of K. pneumoniae. Methods: A retrospective cross sectional study was conducted and 50 samples of burn wound patients from Allied Hospital Faisalabad were taken for isolation, identification and antibiotic resistance pattern of K. pneumonia. Samples then inoculated on MacConkey agar for pure colonies. For identification gram staining and biochemical test were performed. Kirby-Bauer disk diffusion technique was used to determined antibiotic sensitivity profiling K.pneumoniae against various disks. Results: On MacConkey agar mucoid, lactose fermenting pink colonies of K. pneumoniae were observed. Among the biochemical tests, catalase, citrate and VP test were found to be positive whereas indole and methyl red tests were found to be negative. Occurrence of K. pneumoniae was 28% in burn patients. Antibiotic sensitivity profiling showed that K. pneumonia was found highly sensitive to Imipenem (88.94%), meropenem (79.32%), ertapenem (75%), moderately sensitive to aminoglycoside group (amikacin 59.13%, gentamicin 52.40%, Netilmicin 50.96%), piperacillin-tazobactam (53.84%) mildly sensitive to tobramycin (49.51%), nitrofurantoin (48.07%), levofloxacin (45.19%) Conclusion: K. pneumoniae and other gram negative bacilli are frequently associated with nosocomial burn infection. Furthermore, most isolates of K. pneumoniae from burn units were MDR K. pneumonia. Keywords: Opportunistic pathogen, Antibiotic sensitive, Burn, Mortality, Nosocomial.

Meta-analysis of the effects of xenogeneic acellular dermal matrix dressings in the treatment of wounds in burn patients

Objective: To evaluate the efficacy and safety of xenogeneic acellular dermal matrix (ADM) dressings for the treatment of wounds in burn patients. Methods: The meta-analysis method was adopted. Databases including Chinese Journal Full-text Database, Wanfang Database, VIP Database, and Chinese Biomedical Database were retrieved with the search terms in Chinese version of ", , , " and PubMed, Embase, Web of Science, and Cochrane Library were retrieved with the search terms in English version of "xenogeneic acellular dermal matrix, dressing, burn wound, burn" to obtain the publicly published randomized controlled trials on the efficacy of xenogeneic ADM dressings for the treatment of wounds in burn patients from the establishment of each database to December 2021. The outcome indexes included wound healing time, ratio of scar hyperplasia, Vancouver scar scale (VSS) score, ratio of complications, ratio of skin grafting, and ratio of bacteria detection. Rev Man 5.3 and Stata 14.0 statistical softwares were used to conduct a meta-analysis of eligible studies. Results: A total of 1 596 burn patients from 16 studies were included, including 835 patients in experimental group who received xenogeneic ADM dressings therapy and 761 patients in control group who received other methods therapy. The bias risk of all the 16 included studies was uncertain. Compared with those in control group, patients in experimental group had significantly shorter wound healing time, lower VSS scores (with standardized mean differences of -2.50 and -3.10, 95% confidence intervals of -3.02--1.98 and -4.87--1.34, respectively, P values both <0.05), and lower ratios of scar hyperplasia, complications, skin grafting, and bacteria detection (with relative risks of 0.58, 0.23, 0.32, and 0.27, 95% confidence intervals of 0.43-0.80, 0.14-0.37, 0.15-0.67, and 0.11-0.69, respectively, P<0.05). Subgroup analysis showed that the difference of intervention measures in control group might be the source of heterogeneity in wound healing time. There was no publication bias in ratio of scar hyperplasia (P≥0.05), while there was publication bias in wound healing time, VSS score, and ratio of complications (P<0.05). Conclusions: Xenogeneic ADM dressings can shorten the wound healing time of burn patients, reduce the VSS score and the ratios of scar hyperplasia, complications, skin grafting, and bacteria detection.

Wound Pain as a Determinant of Function in Patients Hospitalised for Burns.

Burn wounds most often occur on visible parts of the body. They therefore cause fear of disfigurement and rejection by those around them. In addition, they cause pain. The main aim of this study was to analyse factors affecting the functioning of patients hospitalised for burns. The study included 57 patients hospitalised for burns. Each person was surveyed twice: on day seven after admission and on the day of discharge from the hospital. The following research tools were used: a personal questionnaire to collect clinical data and the scales of the Katz Activities of Daily Living (ADL), the short-form McGill Pain Questionnaire (SF-MPQ), the Beck Depression Inventory (BDI) and the Satisfaction with Appearance Scale (SWAP). On the discharge day, compared to day 7, there was an improvement in the patient's level of functioning in all areas analysed. Pain intensity (p < 0.0001), depression (p < 0.0001) and dissatisfaction with appearance (p = 0.0239) decreased significantly. Improvements in daily functioning were also obtained (p < 0.0001). Multiple regression was performed to estimate the effect of selected variables on patients' level of functioning. Burn area (p = 0.0126), pain level (questionnaire part B: p = 0.0004 and questionnaire part C: p = 0.0208) and gender (p = 0.0413) had a significant impact on the level of daily functioning. Pain complaints are the most crucial predictor affecting the functional status and depression levels in burn wound patients. Increased levels of depression promote dissatisfaction with one's appearance.

Characteristics of patients resuscitated after burn related out-of-hospital cardiac arrest

AimThis study’s objective was to describe the characteristics of burn injury patients who were resuscitated after burn related out-of-hospital cardiac arrest (OHCA). MethodWe conducted a retrospective cohort study and examined characteristics of burn related OHCA using data from a Japanese nationwide burn registry that was collected between April 1, 2011 and March 31, 2020. First, we compared the characteristics of burn patients with and without OHCA. Second, among burn patients with OHCA, we compared the characteristics of survivors with non-survivors. ResultsIn the database, there were 16,995 hospitalised burn patients and 256 burn related OHCA. Thirty-two of the 256 burn patients (13%) survived after admission. Among patients with burns who also had OHCA, flames were the most common injury mechanism (74%); in comparison to all other injury mechanisms, the rate of flame burn was significantly higher in burn patients with OHCA than in burn patients without OHCA. The most common cause of death for burn related OHCA is carbon-monoxide poisoning (46%). Compared with survivors, non-survivors had a larger burn area, greater age and more complications. such as inhalation injuries and perineal burn injuries. Compared to other mechanisms of burn injury, electrical burn injuries were more common among survivors. In twelve patients with electrical burns, eight patients survived (67%) OHCA; of those eight patients, six (50%) could be discharged home. ConclusionPatients with burn related OHCA have a poor prognosis; however, patients who sustain electrical shock injuries may do better.

The Use of Biodegradable Wound Dressing in the Treatment of Donor and Burn Wounds in Patients with Thermal Injury

The Use of Biodegradable Wound Dressing in the Treatment of Donor and Burn Wounds in Patients with Thermal Injury

Effects of Flaxseed Oil and Olive Oil on Markers of Inflammation and Wound Healing in Burn Patients: A Randomized Clinical Trial.

To study the anti-inflammatory and antioxidant effects of flaxseed oil and olive oil on inflammatory markers for facilitating wound healing. One hundred and twelve patients were randomly selected to four groups with a total burn surface area (TBSA) of 20-50%. The four groups includes olive oil (OO), flaxseed oil (FO), mixture of olive oil and flaxseed oil (OF), and control group and received 30g of oils for three weeks. Serum high-sensitivity C-reactive protein (hs-CRP), ferritin and albumin level as inflammatory markers, as well as cholesterol, triglyceride, high-density lipoprotein (HDL) and low-density lipoprotein (LDL) as the lipid profile were explored. Wound healing was assessed by photographing on days 2, 8, 15, and 22 (during three weeks of intervention) and were analyzed in imageJ software. The greatest reduction in the level of hs-CRP and ferritin was observed in the OF (-21.38±44.41) (-132.79±165.36), while the lowest reduction was reported in the control group (-36.36±79.03) (141.08±262.36). Compared to control group, OO significantly increased albumin (0.88±0.65). Reduction of wound healing at the end of the first week of intervention was not significant in the study groups. However, the stereology examination showed significant improvement in wound healing at the end of the second and third weeks in the OF. Based on the findings, combination of herbal oils reduce inflammation and improve wound healing and showed positive effects on the size of wounds in burn patients.

Retracted: The Trend of Burn Injury Patients in Ningbo between 2012 and 2021: A Clinical Study.

[This retracts the article DOI: 10.1155/2022/9969158.].

Emerging Therapies for Full-Thickness Skin Regeneration.

The classical treatment of extensive full-thickness skin loss due to trauma or burns has been the split-thickness skin graft. While split-thickness skin grafts close the wound, they leave patients with visible scars, dry skin, pruritis, pain, pigmentation alterations, and changes in sensation. The optimal replacement for full-thickness skin loss is replacement with intact full-thickness skin. New technologies combined with advances in the understanding of the mechanisms behind wound healing have led to the development of techniques and products that may eventually recapitulate the functions, appearance, and physical properties of normal skin. Autologous homologous skin constructs, minimal functional skin units, and composite bioengineered skin with dermal substitutes all represent potential avenues for full-thickness composite skin development and application in extensive wounds. This article summarizes the progress, state, and future of full-thickness skin regeneration in burn and massive wound patients.

The epidemiology of in-hospital burn patients in a tertiary hospital in Damascus, Syria. A retrospective cohort study

BackgroundSyria has been facing a dreadful crisis for the past 11 years, which has had a significant toll on the healthcare system of the country, and its ability to adequately manage acute injuries. In this research, we study the epidemiology and outcomes of burn patients admitted to the burn center of Al-Mouwasat Hospital in Damascus, Syria. MethodsA retrospective cohort research was conducted from January 2017 to December 2021. All accessible paper-based medical records of burn injury patients admitted to the hospital were evaluated. ABSI score was used to classify injury degrees. Chi-square test and logistic regression model were used to study the association between demographic variables and outcomes. ResultsOf the 641 patients, 367 (57.3%) were males and 274 (42.7%) were females. Children represented more than half of our sample 377 (58.8%). The most common cause of burns was flame 393 (61.3%), followed by scalding 199 (31.0%). Most of the patients had a more than 10% TBSA of burns 511 (79.7%). 209 (32.6%) patients had a moderate ABSI score, followed by moderately severe in 149 (23.2%) patients. Children, patients who had high ABSI scores, and those who needed respiratory support were more likely to die than others 2.545 (1.079-6.004), 9.208 (4.061-20.879), respectively. ConclusionDeath was the outcome of third of the hospitalized patients. Furthermore, Children made up more than half of the sample, and had the highest rates of leaving the hospital against medical advice. These results underline the importance of an updated nationally uniformed protocol for the management of burn patients.

Phenotypic and genotypic characterization of metallo-β-lactamase producing Pseudomonas aeruginosa isolated from burn patients

Pseudomonas aeruginosa is an opportunistic pathogen associated with many nosocomial infections. This study aimed to detect blaIMP and blaVIM genes and their common subtypes, including blaIMP-1, blaIMP-2, blaVIM-1, and blaVIM-2, among imipenem-resistant Pseudomonas aeruginosa strains. In this study, 117 P. aeruginosa strains were isolated from clinical samples of burn wound patients in Velayat hospital, Rasht, Iran, between 2018 and 2019. These isolates were tested for antimicrobial susceptibilities by disk diffusion and Metallo-β-Lactamase (MβL) activity. The polymerase chain reaction (PCR) test was applied to detect MβLs encoding genes in MβL-producing strains. The resistance rates were as follows: Tobramycin (59%), Gentamicin (57%), Piperacillin (52%), Ciprofloxacin (51%), Ceftazidime (32%), and Amikacin (26%). Among 27 (23%) imipenem-resistant isolates, 13 (48%) produced the MβL enzyme. PCR results of imipenem-resistant isolates showed that five and four isolates contained the blaVIM (4 blaVIM1, 2 blaVIM2) and blaIMP (4 blaIMP1, 2 blaIMP2) genes, respectively. In addition some of isolates had more than one gene. In this study, 48% of imipenem-resistant strains produced the MβL enzyme. Therefore, systematic surveillance to detect MβL-producing bacteria and rational prescription and use of carbapenems could be helpful to prevent the spread of carbapenem resistance.

Rehabilitation of hand through leap motion control on burn injury patients

Burn injuries, especially severe burns, triggers immune and inflammation response, disturbances of metabolism and distributive type of shock, all of this can be said as hard to treat and may lead to cause multiple organ failure. The fact that the injury not only effects physical health but also mental health his mental health and quality of life is critical. As a result, people with burn injuries cannot be deemed recovered if wounds have healed; rather, burn injuries cause long-term fundamental changes that must be focused in order to improve quality of life. As a result, burn care providers encounter a variety of issues, including managing acute and critical care, long-term care, and rehabilitation. Hand is the most commonly injured body part out of all accidents that are work related , ranks third of all workplace injuries and necessitating surgical and lengthy recovery. Hand burns make it difficult to function. The rehabilitation process has benefited from the usage of virtual reality (VR). LMC is a form of virtual reality game that uses new technology to provide biofeedback and training for fine motor function and functional skills. According to this review paper, leap motion training will enable hand burns patient to enhance finger mobility, reduce scar thickness, and improve hand function along with enhancing quality of life of patient. Although improvement in condition depends on severity of burn but this gadget proved to be a boon for hand rehab. on burn population. . Finally in conclusion of review it can be said that leap motion training may aid patients with hand burns in increasing finger range of motion, reducing scar thickness, and improving hand function.

A Clinico-Epidemiological Study among Burn Injury Patients in a Tertiary Care Hospital of Eastern India

Background: Every year in India about 7 million people suffer from burn injury, which is a leading cause of not only mortality, but morbidity and disability among the burn patients, leading to emotional trauma and stigma. Objectives: The present study was conducted in a peripheral medical college of West Bengal to describe the epidemiology, clinical presentation, and outcome in burn patients and also to identify contributing factors influencing the outcome in burn patients. Methodology: In this descriptive cross-sectional study, all consecutive burn patients admitted in Dept of surgery in 2018 were included. Data was collected regarding socio demographic profile, mechanism, type and degree of burn, total body surface area involved, time taken to reach health facility and outcome. Results: Out of 514 burn patients, majority were 20 to 60 years age group, females, Muslim in religion, from rural background, completed primary education, homemaker and having monthly income of the family below Rs 5000. Most of the burns were accidental, thermal in nature occurred at household level. About one third had burns involving dangerous areas of body. Average length of stay in hospital was 6.104 days with 20% case fatality and directly proportional with body surface area involved. Conclusion: Safety measures and building awareness can prevent burn injury at household level. Early initiation of treatment, infection control and following standard management protocol can avert mortality in tertiary setting. Rehabilitation and psychosocial care are urgently needed to combat disability. Keywords: Burn, Clinico-epidemiology, Length of stay, Outcome

The Trend of Burn Injury Patients in Ningbo between 2012 and 2021: A Clinical Study.

Objective This study was designed to understand the local changes of burn injuries in recent 10 years, so as to provide reliable reference data and viewpoints for prevention and vigilance of local burn injuries. Methods In this study, 184 patients with a burn injury admitted to our hospital from 2012 to 2021 were enrolled and analyzed retrospectively. According to their information in the electronic database, the number of patients with burn injuries and the location of each disaster each year were analyzed, and the age, sex, hospital stay and hospitalization expense of each patient were collected. With 5 years as the boundary, the patients were divided into a 2012–2016 group and a 2017–2021 group and the differences of the two groups in the abovementioned aspects were compared. Results During 2012–2021, the incidence rate of burn injuries in men was higher than that in women and workplaces had a higher burn injury rate than residents' homes. Compared with the period of 2012–2016, the number of fires or explosions and the number of patients with a burn injury during 2017–2028 both increased, but there was no significant change in disaster location, male-female ratio, age, average hospital stay, and average hospitalization expense. Conclusion In the face of the increasing prevalence of burn injuries, we should strengthen fire-fighting knowledge-related education and fire prevention management and actively explore post-burn injury treatment strategies and potential treatment targets to promote the development of burn injury management and treatment strategies.

RETRACTED ARTICLE: Burn Wounds: Proliferating Site for Biofilm Infection.

Burn wounds can create significant damage to human skin, compromising one of the key barriers to infection. The leading cause of death among burn wound patients is infection. Even in the patients that survive, infections can be notoriously difficult to treat and can cause lasting damage, with delayed healing and prolonged hospital stays. Biofilm formation in the burn wound site is a major contributing factor to the failure of burn treatment regimens and mortality as a result of burn wound infection. Bacteria forming a biofilm or a bacterial community encased in a polysaccharide matrix are more resistant to disinfection, the rigors of the host immune system, and, critically, more tolerant to antibiotics. Burn wound-associated biofilms are also thought to act as a launchpad for bacteria to establish deeper, systemic infection, and ultimately bacteremia and sepsis. In this review, we discuss some of the leading burn wound pathogens and outline how they regulate biofilm formation in the burn wound microenvironment. We also discuss the new and emerging models that are available to study burn wound biofilm formation in vivo.

Urine Hydrogen Peroxide Levels and Their Relation to Outcome in Patients with Sepsis, Septic Shock, and Major Burn Injury.

Hydrogen peroxide (H2O2) and oxidative stress have been suggested as possible instigators of both the systemic inflammatory response and the increased vascular permeability associated with sepsis and septic shock. We measured H2O2 concentrations in the urine of 82 patients with severe infections, such as sepsis, septic shock, and infections not fulfilling sepsis-3 criteria, in patients with major burn injury with associated systemic inflammation, and healthy subjects. The mean concentrations of H2O2 were found to be lower in patients with severe infections compared to burn injury patients and healthy subjects. Patients with acute kidney injury (AKI), vs. those without AKI, in all diagnostic groups displayed higher concentrations of urine H2O2 (p < 0.001). Likewise, urine concentrations of H2O2 were higher in non-survivors as compared to survivors (p < 0.001) at day 28 in all diagnostic groups, as well as in patients with severe infections and burn injury (p < 0.001 for both). In this cohort, increased H2O2 in urine is thus associated with mortality in patients with sepsis and septic shock as well as in patients with burn injury.

528 Evaluation of phosphate replacement practices in burn patients

IntroductionBurn injury causes acute shifts in phosphorus leading to hypophosphatemia and negative sequelae, such as motor neuropathy, muscle weakness, cardiac failure, and respiratory failure. These patients require frequent phosphorus level monitoring and repletion beyond the needs of a general critical care patient. Data suggests patients with normal phosphorus levels have lower incidence of ventilator wean failure and positive clinical outcomes. There is limited data evaluating phosphate replacement practices in burn patients for their intensive care unit (ICU) length of stay while also evaluating those who concomitantly receive continuous renal replacement therapy (CRRT) as it is the primary mode of renal replacement therapy in this population and further depletes phosphorus levels.MethodsThis was a single-center, retrospective, observational study of patients with a burn injury admitted and discharged from a burn intensive care unit (BICU) from January 1, 2016 to June 30, 2020 who received phosphate. Patients less than 18 years of age and those admitted to the BICU for non-burn injuries were excluded. Burn injury type, number of phosphorus doses per day, and phosphorus levels were collected. Normal phosphorus was defined as 2.5-4.9 mg/dL and hypophosphatemia as < 2.5mg/dL. Patient data was evaluated in 24-hour time intervals as defined as midnight to midnight. Phosphorus lab values were included in data analysis if there was corresponding phosphate administration in that 24-hour interval. The primary objective was to assess the temporal dose-response to phosphate replacement in burn patients.ResultsThere were 291 patients who met criteria, 116 were selected in chronological order by admission date and were included in data analysis. The mean age was 51.51 years and the mean total body surface area burned was 21.48%. Flame burn accounted for 83.6 % (n=97) of patients and 37.06% (n=43) of patients had concomitant inhalation injury. The mean amount of phosphate given to a patient per day was 28.38 mmol and patients on CRRT received a mean amount of phosphate of 33.34 mmol per day. In response to phosphate administration, the mean change in phosphorus was 0.334 ± 1.08 mg/dL. In patients on CRRT, the mean change in phosphorus was 1.4 ± 1.89 mg/dL. Patients experienced hypophosphatemia 69.63% of the days that they received phosphate repletion and patients on CRRT had hypophosphatemia 87.39% of the days they received phosphate repletion.ConclusionsHypophosphatemia is common in the burn injury population and current phosphate replacement practices are insufficient to replete phosphorus in burn injury patients.

97 Arterial Waveform Variations as Measures of Resuscitation Adequacy in a Porcine Model of Burn Injury

IntroductionOptimized fluid resuscitation of burn patients is a clinical care challenge as both under- and over- resuscitation have deleterious consequences. The gold-standard endpoint guiding burn resuscitation is urinary output (UO), which is known to have limited efficacy. We investigated the potential of the dynamic indices of fluid responsiveness derived from arterial blood pressure (BP) waveforms in conveying information about burn resuscitation. In particular, we investigated pulse pressure variation (PPV) and systolic pressure variation (SPV), which have been shown to be valuable in a number of other indications.MethodsWe conducted a retrospective analysis of arterial BP waveform data acquired from six anesthetized and mechanically-ventilated pigs (33±5 kg weight and 40% total burned surface area) which were instrumented for hemodynamic monitoring for 24 hours. The animals were either under-, over-, or adequately-resuscitated (guided by a burn resuscitation decision support system), with two animals in each group. PPV and SPV were calculated on an hourly basis. Fluid responsiveness thresholds of 15% and 6% were used respectively for PPV and SPV, as per literature.ResultsAll of the animals experienced an immediate rise in PPV and SPV following the injury (PPV and SPV start from large values as seen in Fig. 1 and Fig. 2). In the under-resuscitated group, PPV and SPV increased above the threshold, reaching maximum values in the last eight hours (PPV: 49.8±20%, SPV: 24.7±3.6%), indicating severe hypovolemia. In the over-resuscitated group, PPV and SPV decreased below the threshold, reaching their minimum in the last eight hours (PPV: 8.7±3.6%, SPV: 4.1±1.9%), indicating major hypervolemia. In the adequately-resuscitated group, PPV and SPV maintained closer to the threshold throughout the duration of the experiment, and at the end, PPV was 15.6±4.2% and SPV was 6.2±2.6%.ConclusionsOur initial results suggest that PPV and SPV may help distinguish under-, adequately-, and over-resuscitated burn patients, and potentially complement UO in the hemodynamic assessment of the burn injury patients.

716 Safety and benefits of intraoperative enteral nutrition in critically ill pediatric burn patients

IntroductionBurn injuries significantly increase a patient’s metabolic demand. Adequate nutrition is essential to aid in recovery and reduce morbidity and mortality. This is important for pediatric patients, who have limited reserves and are in a period of growth, in contrast to adults. Burn patients often need multiple surgeries, with standard perioperative fasting periods leading to multiple nutritional interruptions. Continuous intraoperative feeding has been a proposed solution, but there is no current consensus on its role and safety, particularly in the pediatric population. The goal of our study was therefore to examine the safety and benefits of intraoperative nutrition in critically ill pediatric burn injury patients.MethodsA systematic review of MEDLINE, PubMed, Scopus, and Google Scholar was conducted using the following terms: Feeding or enteral or nutrition or fasting and adolescent or youth or pediatric or child or teen and burn or thermal injury or fire. The primary outcome was incidence of aspiration. Secondary outcomes included patient nutritional status (caloric deficit, weight), wound healing, days spent in the intensive care unit, ventilator days, pneumonia, number of surgeries, length of hospital stay, and mortality. Pooled analyses of binary outcomes were computed.ResultsFour studies consisting of 496 patients, met inclusion criteria. All studies were level IV evidence, but had high methodological quality. The median burn total body surface area (TBSA) was 43.8% (IQR 33.4-58.8%), with a median of one-third of patients having an inhalational injury. Patients underwent a median of 4.2 surgeries (IQR 1.8-7.4). Intraoperative feeding was conducted through nasoduodenal tubes. There were no aspiration events. Pooled analysis demonstrated that there were no differences in rates of aspiration, pneumonia, or wound infection (p >0.05) between patients who were intraoperatively fed and those who were not. Those fed intraoperatively had significantly more surgeries, ventilator days, longer hospital stays, but lower mortality (p< 0.05). There was large heterogeneity in nutritional assessment methods. Intraoperatively fed patients had an average gain of 144.4 kcal/kg and 1.7 days of exclusive enteral nutrition (vs. loss of -119.1 kcal/kg and -1.4 days) and cumulative positive caloric balance of +2673kcal ±2147 (vs. loss of -7899kcal ±3123), compared to those with interrupted feeding.ConclusionsContinuous intraoperative duodenal feeding during burn surgery appears to be safe in the Pediatric burn population, with no reported episodes of aspiration. Uninterrupted feeding was also associated with weight maintenance and reduced caloric deficit. It may also have survival benefit, as continuously fed patients needed more surgeries and intensive/hospital care, but had decreased mortality.

T5 Tracking Cardiac Output During Burn Resuscitation via Pulse Wave Analysis

IntroductionUrine output (UOP) still remains the primary endpoint utilized as a surrogate for cardiac output (CO) and adequacy of perfusion during burn resuscitation. The role of arterial blood pressure (BP) waveform as a guiding tool for burn resuscitation has not been rigorously explored. As we move toward developing and validating novel endpoint to complement UOP, we compared the potential of pulse wave analysis (PWA) of arterial BP waveforms for estimating cardiac output (CO) and stroke volume (SV) in a large animal model of 40% total body surface area (TBSA) burns with varying resuscitation paradigms.MethodsAnesthetized swine were instrumented and hemorrhaged 15% of their blood volume, and sustained a 40% TBSA full-thickness contact burn with aluminum billets. Animals were kept in a surgical ICU setting overnight, during which anesthesia was maintained with a combination of propofol, ketamine, and fentanyl. Animals were randomized to 3 different intravenous fluid (lactated Ringer’s, LR) levels: under resuscitation with no IV fluids, adequate resuscitation protocolized with a clinical decision support tool, or over resuscitation with a starting rate of 500mL/hour. We computed 20 surrogate measures of CO and SV (10 each) via PWA of arterial BP, and calibrated them to reference CO via thermo-dilution and SV on a subject-by-subject basis. Surrogate performance was quantified in terms of correlation coefficient and root-mean-squared error (RMSE) relative to reference CO and SV.ResultsAnimals received 0±0, 4.4±1.6, and 9.1±1.3 mL/kg/% TBSA in the under, adequate, and over resuscitation groups (p=0.0036), respectively. Among the ten surrogate measures of CO and SV, 4 surrogates had positive proportionality to reference CO and SV consistently. The best surrogate measure of CO and SV was [mean BP-diastolic BP]/[heart period] and [mean BP-diastolic BP], respectively, which yielded r value of 0.82+/-0.19 and RMSE of 0.23+/-0.14 lpm for CO and r value of 0.85+/-0.17 and RMSE of 2.7+/-2.0 ml for SV (Fig. 1).ConclusionsThe initial results suggest that PWA-based surrogates of CO and SV have the potential to track reference CO and SV in extremes of resuscitation post-burn. The current model produces under-resuscitated, adequately resuscitated, and over-resuscitated animals, making it possible to rigorously examine the efficacy of PWA-based tracking of CO and SV in a wide spectrum of burn resuscitation scenarios. Hence, PWA may provide metrics useful for developing surrogates of CO and SV as novel treatment endpoints of burn resuscitation that indicate perfusion and volume status of burn injury patients.