Care Of Burn Patients Research Articles

PANORAMA DA FISIOTERAPIA OFERTADA A PACIENTES COM SEQUELAS DE QUEIMADURA

Introduction: Burns are thermal, electrical, chemical or radioactive traumas that damage body tissues and can lead to death. Objective: To analyze the data and information collected in the system, referring to the quantity of physiotherapeutic care offered, by the SUS, to patients with burn sequelae, in Brazil, in the last 10 years. Materials and methods: Data were obtained from the DATASUS database. The collected data was organized in an Excel spreadsheet, displayed in graphs and analyzed based on scientific literature. Result: In Brazil, in the last 10 years, 97,685 physiotherapeutic services were offered to medium and large burn patients, through the SUS. The largest number of care for medium and large burn patients was concentrated in the northeast region of Brazil and the smallest number in the Central-West region. Conclusion: The study provided a broad overview of the physiotherapeutic care provided to patients with burns in Brazil over the last ten years.

Venous Thromboembolism Incidence, Risk Factors, and Prophylaxis in Burn Patients: a National Trauma Database Study.

Comprehensive studies on the incidence, risk factors, and prophylactic measures related to venous thromboembolism (VTE) are lacking in burn care. This study characterizes VTE risk and existing prevention measures to improve and inform overall patient care in the field of burn care on a national scale. The US National Trauma Data Bank (NTDB) was queried from 2007 to 2021 to identify burn-injured patients. Descriptive statistics and multivariate regression analyses were used to explore the association between demographic/clinical characteristics and VTE risk as well as compare various VTE chemoprophylaxis types. There were 326,614 burn-injured patients included for analysis; 5,642 (1.7%) experienced a VTE event during their hospitalization. Patients with VTE were significantly older, had greater BMIs and %TBSA, and were more likely to be male (p<0.001). History of smoking, hypertension or myocardial infarction, and/or substance use disorder were significant predictors of VTE (p<0.001). Patients who received low molecular weight heparin (LMWH) were less likely to have VTE compared to patients treated with heparin when controlling for other VTE risk factors (OR: .564 95% CI .523-.607, p<0.001). Longer time to VTE chemoprophylaxis (>6 hours) initiation was significantly associated with VTE (OR=1.04 95% CI 1.03=1.07, p<0.001). This study sheds light on risk factors and chemoprophylaxis in VTE to help guide clinical practice when implementing prevention strategies in burn patients. This knowledge can be leveraged to refine risk stratification models, inform evidence-based prevention strategies, and ultimately enhance the quality of care for burn patients at risk of VTE.

Use of Integra dermal regeneration template in burn patients: An Italian expert consensus Delphi study

IntroductionBurn injuries pose significant challenges in healthcare, with Integra dermal regeneration template (DRT) emerging as a prominent solution to enhance wound healing and recovery. Although there is no clear consensus on its technical use and application. We convened a panel of 14 burn specialists aiming to provide consensus regarding the application and usage of Integra in managing burn wounds. MethodsPanelists employed a modified Delphi technique to assess agreement and provide feedback on 81 initial statements covering various aspects of Integra DRT application in burn wound care over three subsequent rounds. This study was endorsed by the Italian Society of Burn Surgery (SIUST). ResultsFourteen heads of burn unit departments participated in the Delphi process. At the end of the third round and subsequent discussion on the final statement list, the panel achieved consensus on 24 statements shaping recommendations for Integra application across various aspects, including wound bed preparation, acellular dermal matrix application, definitive coverage, and complication management. ConclusionThe resultant 24 finalized statements from this Italian consensus offer a comprehensive and practical framework for employing Integra DRT in burn patient care. Reflective of specific Italian expertise and practice, these recommendations supplement and refine existing literature, serving as a dynamic guide subject to periodic updates aligned with evolving evidence and experience in the field of burn surgery.

A Qualitative Study on Nurses' Experiences Working in Burn Units in South Punjab, Pakistan.

Background: Nurses play an integral role in the multidisciplinary team managing care for burn patients. Their unique insights and experiences in such high-stress environments are crucial yet often underexplored. This study aims to illuminate the challenges and experiences of nurses in burn units within tertiary care hospitals in South Punjab, Pakistan. Objective: To explore and document the experiences of nurses working in burn units, focusing on the challenges they face and the coping mechanisms they employ. Methods: A qualitative study was conducted in 2022 using purposeful sampling to select 16 nurses from burn units at tertiary care hospitals in South Punjab, Pakistan. Data were collected through semi-structured, in-depth interviews and analyzed using thematic analysis to identify key themes and sub-themes. Results: Analysis of the interview data revealed four main themes and sixteen sub-themes. The main themes identified were Workload, Spiritual Beliefs in Patient Care, Nursing Education Services in Hospitals, and Work-Life Balance. These themes encompass the physical, emotional, and spiritual challenges faced by nurses, as well as their educational needs and the impact of their work on personal life. Conclusion: Nurses in burn units encounter numerous challenges that affect both their professional duties and personal lives. There is a critical need for better support structures, including modern facilities, continuous training, and more attentive administrative practices. Enhancements such as increased staffing, unit rotation, and provisions for financial and motivational incentives are necessary to improve care for burn patients and support the well-being of nurses.

Effects of Virtual Reality on Analgesia in Wound Care and Physical Therapy for Burn Patients: A Systematic Review and Meta-analysis

ObjectivesThis systematic review and meta-analysis aimed to determine the effectiveness of virtual reality (VR) in alleviating pain and improving the experience of burn patients during wound care and physical therapy. DesignA systematic review and meta-analysis. Data SourcesPubMed, Embase, the Cochrane Database, and the Web of Science. Review/Analysis MethodsWe searched four electronic databases for randomized controlled trials (RCTs) published from the earliest available date up to March 1, 2022. The primary outcome was worst pain intensity, while secondary outcomes encompassed pain unpleasantness intensity, time spent thinking about pain, and fun experience intensity. Risk of bias was evaluated using the Cochrane Collaboration's tool. ResultsThis study included 21 trials. The combined data revealed that the VR group experienced a significant reduction in worst pain intensity, pain unpleasantness intensity, and time spent thinking about pain compared to the control group. Moreover, VR treatment was associated with a significant increase in the fun experience intensity. Implications for nursingVirtual reality has the potential value of auxiliary analgesia in burn care, and exploring a more perfect scheme of VR-assisted analgesia is worthwhile. ConclusionsThe results of this meta-analysis indicate that VR can effectively reduce worst pain intensity, pain unpleasantness intensity, and time spent thinking about pain during wound care and physical therapy for burn patients. Additionally, it enhances fun experience intensity of the treatment period. Therefore, VR shows promise as a valuable complementary pain management intervention for burn patients.

Pediatric Burn Teams: Moving from Multidisciplinary to Transdisciplinary.

Pediatric burn care has improved to the point where even patients with massive burns have a reasonable chance of survival. An important component of this success is the pediatric multidisciplinary burn team. The pediatric burn team is made up of all the disciplines that are required to provide optimal care of the patient as well as their family. The pediatric burn team in its initial iteration was multidisciplinary, with each discipline focusing on their own area without much overlap. However, over time the burn team has become more cooperative and interdisciplinary leading to improved outcomes for children with burn injuries. Ultimately, pediatric burn teams may be able to function in a transdisciplinary manner which would potentially allow for even more innovation in the care of burn patients.

Critical Care of the Pediatric Burn Patient.

Life-saving pediatric burn care is often initiated in hospitals that are not designated as a pediatric burn center. Therefore, familiarity with critical care of pediatric burn patients is crucial for physicians working in all healthcare settings equipped to care for children. Management of airway, mechanical ventilation, preservation of ideal circulatory status, and establishment of vascular access in pediatric burn patients requires many unique considerations. This article aims to summarize important principles of critical care of children with significant burn injuries for review by physicians and surgeons working in hospitals designated as a pediatric burn center and those that stabilize these patients prior to referral.

Impact of COVID-19 infection on clinical outcomes of adult burn patients: A retrospective observational cohort study in Iran

The COVID-19 pandemic has exacerbated the significance of burn injuries as a critical public health challenge, demanding the exploration of effective strategies for prevention and care, particularly for individuals with burns. This retrospective observational cohort study aimed to analyze the characteristics of adult burn patients admitted to three reference centers in Iran from October 2020 to October 2023. The study focused on patients and burn wound characteristics, complications and morbidities, and treatment plans. Among the 382 patients aged 20 to 84, our findings suggested that being male decreased the likelihood of COVID-19 infection by about 77 %. Thermal burns accounted for 50.2 % of COVID-19-positive patients and 49.8 % of COVID-19-negative patients. Notably, the risk of COVID-19 infection increased with higher degrees of burn (p = 0.006) in both groups. Among the complications, pneumonia (p = 0.003) and paralytic ileus (p = 0.015) were significantly more common in COVID-19-positive patients. Additionally, COVID-19-positive patients underwent more frequent interventions such as skin grafting (p = 0.035) and surgical debridement (p = 0.030). These findings emphasize the importance of a carefully planned and proactive multidisciplinary management strategy to ensure optimal care for burn patients.

Efficacy of transfer form implementation for adult burn patients between institutions to the Israeli National Burn Center

Burns are serious injuries associated with significant morbidity and mortality. In Israel, burn patients are often transferred between facilities. However, unstructured and non-standardized transfer processes can compromise the quality of patient care and outcomes. In this retrospective study, we assessed the impact of implementing a transfer form for burn management, comparing two populations: those transferred before and after the transfer form implementation. This study included 47 adult patients; 21 were transferred before and 26 after implementing the transfer form. We observed a statistically significant improvement in reporting rates of crucial information obtained by Emergency Room clinicians and inpatient management indicators. Introducing a standardized transfer form for burn patients resulted in improved communication and enhanced primary management, transfer processes, and emergency room preparation. The burns transfer form facilitated accurate and comprehensive information exchange between clinicians, potentially improving patient outcomes. These findings highlight the importance of structured transfer processes in burn patient care and emphasize the benefits of implementing a transfer form to streamline communication and optimize burn management during transfers to specialized burn centers.

Adult Burn Survivors and Burn Care Staff Perceptions Regarding Transitioning From the Burn Unit: A Cross-Country Qualitative Study in Ghana and China.

Rehabilitative care for burn patients in developing countries is often wrought with several issues. Post-discharge support is equally challenging as there is often limited rehabilitative care as the burn survivors and their families transition. To inform practice, this study sought to explore the perspectives of adult burn survivors and burn care staff regarding transitioning from the burn unit and the development of a transitional rehabilitation programme. We employed interpretive description for this study. Semi-structured face-to-face interviews were conducted with adult burn survivors and burn care staff across two tertiary healthcare facilities in Lanzhou, Gansu Province of China, and Ghana. The thematic analytical approach was employed to analyse the data. Forty-six participants comprising 26 adult burn survivors and 20 burn care staff participated in this study. Two themes and five subthemes emerged from the data. Transitioning from the burn unit to the home was described as complex with varied biopsychosocial needs emerging. However, available support was not comprehensive to resolve these needs. Existing pre-discharge support is limited across both settings. Burn survivors expressed interest in taking on an active role in the rehabilitation process and being able to self-manage their post-burn symptoms following discharge. Transitional rehabilitative support should include an active follow-up system, ensure patient- and family-centred support, and offer a bundle of comprehensive rehabilitative services using locally available items which do not financially burden burn survivors and their families. In conclusion, transitioning from the burn unit is filled with varied health needs. Transitional rehabilitative care is required to bridge the pre-discharge and post-discharge periods.

Role of exercise in nursing care for burn wound patients: A narrative review from a nursing perspective

Burn injuries are a global health issue with extensive physical and psychological ramifications. Nursing care plays an instrumental role in the recovery of individuals with burn wounds. There is a growing interest in incorporating exercise programs as a supplementary approach alongside conventional burn wound care. This review meticulously assesses the influence of exercise interventions integrated into nursing care for burn wound patients. By amalgamating current empirical evidence, it seeks to provide valuable insights into potential advantages, obstacles, and optimal strategies. Burn injuries encompass a spectrum of noteworthy physical, psychological, and socioeconomic repercussions. Exercise confers several benefits, including enhanced circulation, prevention of muscle wasting, expedited wound healing, effective pain management, anxiety alleviation, and bolstered self-esteem. Nurses occupy an indispensable position in promoting exercise not only for prevention but also during rehabilitation, addressing mental health concerns, and facilitating education. Ultimately, exercise emerges as a substantial contributor to holistic burn patient care, thereby warranting further exploration and the development of comprehensive guidelines.

Application of improved Beck oral score in oral care of burn patients with mechanical ventilation

Objective: To explore the application effect of improved Beck oral score in oral care of burn patients with mechanical ventilation, to provide practical basis for oral care of such patients.Methods: A total of 42 patients with tracheotomy and mechanical ventilation in the Department of Burn Surgery of Baogang Hospital in Inner Mongolia from January 2021 to December 2022 were selected as the study objects, and the patients were randomly divided into observation group and control group, with 21 cases in each group. The control group was given routine oral care, and the observation group was given oral care according to improved Beck oral score. The following were compared between the two groups: Age, total burn area, third-degree burn area, acute physiological and chronic health assessment scores, as well as improved Beck oral scores; the incidence of oral odor, plaque index, mouth ulcer and ventilator-associated pneumonia (VAP) after 7 days; the detection of microorganism in oral secretions.Results: After 7 days, the oral condition of patients in observation group was effectively improved, and the oral comfort level was significantly improved. The incidence of oral odor (2.57±1.59), dental plaque index (2.62±1.47), oral ulcer evaluation (2.24±1.09), VAP incidence (9.52%) and improved Beck oral score (8.09±1.92) in observation group were all lower than those in control group, which was (3.95±1.82), (3.57±1.21), (3.14±1.24), (38.09%), and (9.90±2.21) respectively. The difference was statistically significant (p &lt; .05). The oral normal flora in observation group (71.43%) was higher than that in control group (28.57%), and the difference was statistically significant (p &lt; .05). The oral gram-positive bacteria (19.05%) and Gram-negative bacteria (23.81%) in observation group were lower than those in control group, which was 52.38% and 57.14% respectively, and the difference was statistically significant (p &lt; .05).Conclusions: The application of the improved Beck oral assessment method in dynamic oral care can effectively reduce the content of oral pathogens, lower the incidence of pulmonary infection, and improve the quality of life of patients.

Burn Injuries in the Pediatric Population - The Experience of a Single Center Over a Period of Two Years.

Introduction: The study investigated the therapeutic approach and clinical management of pediatric burn patients admitted to the Pediatric Surgery and Orthopedics Clinic of the County Emergency Hospital Craiova over a two-year period (2017-2018). The primary objective was to evaluate the effectiveness of the treatments applied, including grafting procedures and their impact on long-term prognosis. Material and Methods: The cases of 80 children with burns of varying severity were retrospectively analyzed. Patients were classified according to the severity and the mechanism of burn injury. The collected data were processed using Microsoft Excel 2021. Patients were classified into three categories based on the affected body surface area (BSA): Category 1 patients, with a BSA = 10%, showed very good results and required less intensive care. Category 2 patients, with a BSA between 10% and 50%, had good outcomes but needed more prolonged care. Category 3 patients, with a BSA = 50%, had satisfactory results but faced more challenges in recovery, highlighting the need for enhanced prevention measures and better treatment protocols. Results: The majority of patients came from rural areas, and thermal burns were the most common. The effectiveness and safety of the treatments applied were highlighted, with a generally favorable impact on long-term prognosis. Treatment included both surgical and non-surgical approaches, with generally favourable clinical outcomes. Conclusion: The study highlights significant differences between rural and urban environments, suggesting the need for prevention and education campaigns regarding pediatric burns and improved access to medical services. It also emphasizes the need for integrated management to reduce the severity and complications associated with burns. The results provide a solid foundation for future strategies aimed at improving the care of paediatric burn patients.

Technologies used in the treatment of burn victims in intensive care: a scope review.

to analyze the technologies used by the nursing team in the treatment of skin lesions caused by burns in patients under intensive care. this is a scope review conducted on the LILACS, Medline, PubMed, and CINAHL databases without temporal or language restrictions. the highlighted technologies included the use of specialized dressings, biological agents such as probiotics and cyanobacteria, as well as negative pressure therapies and enzymes such as papain and collagenase. Some technologies, such as nanocrystalline silver, demonstrated efficacy in infection control. the study identified essential technologies in burn care, emphasizing the need for further research on "soft" technologies. The findings support the promotion of evidence-based nursing care for burn patients in intensive care and enhance knowledge about effective treatments.

Expanding horizons in burn care: a new paradigm for General Surgeons in Brazil.

The role of the burn surgeon in Burn Treatment Centers (BTCs) is crucial for complementing the multidisciplinary approach in the treatment of burn patients. Globally, the areas of General Surgery and Plastic Surgery are the primary surgical specialties dedicated to this function. The structuring of the Burn Patient Care Line in Minas Gerais highlighted the need to expand the "Burn Care" Field of Expertise, extending it to General Surgery. With the inevitable expansion of the Care Line, pioneered by the state of Minas Gerais, to the federal level, the need for specialized surgical training encompasses both the state context and anticipates the national scenario in the short term. Therefore, the expansion of the "Burn Care" Field of Expertise is fundamental to meeting specific demands and improving the quality of care offered to burn patients, in accordance with international standarts.

The role of nursing care in the management of post-burn epidermal cancer: A narrative review

Severe burns, affecting over 20% of the body, induce systemic dysfunction and immune suppression, correlating with increased cancer risk, especially skin cancer. Nurses play a crucial role in averting complications, which is explored in this study through a comprehensive literature review. The literature review focused on nursing care for post-burn skin cancer; a systematic search covered databases including Magiran, Scientific Information Database, and PubMed and Google Scholar search engine. Keywords "nursing", "skin cancer", and "burn" were strategically combined with Boolean operators. From an initial 580 articles, 10 met eligibility post-screening. The results have shown that optimal care for burn patients necessitates an interdisciplinary approach with the burn nurse at its core, coordinating patient care across multiple disciplines. The nurse's responsibilities encompass a comprehensive understanding of multisystem organ failure, critical care methodologies, diagnostic procedures, and psychosocial skills. Meticulous wound care, infection prevention, and pain management are pivotal, with the nurse actively engaging in nursing research. The origin of cancers within burns involves hypotheses of persistent cell proliferation, chronic inflammation, toxin exposure, and compromised immunological defense. Nursing care, particularly in detecting and treating wound inflammation, is pivotal in preventing cancer. Nurses contribute to patient education on skin cancer prevention, emphasizing lifestyle choices and providing crucial psychological support. Nursing diagnoses, based on symptomatology studies, include "risk for impaired skin integrity", "impaired skin integrity", "acute pain", "chronic pain", and "impaired comfort". These diagnoses guide tailored interventions to prevent skin cancer incidence.In sum, nurses are pivotal in comprehensive burn care, overseeing wound care, infection prevention, and patient education on UV radiation dangers. They advocate healthy lifestyles to reduce skin cancer risk, provide psychological support, and encourage commitment to prevention practices. Nursing diagnoses guide tailored interventions, contributing to ongoing improvements in burn care and enhancing the quality of life for survivors.

Quality of life and functional Outcomes among Burn Patients: A Cross Sectional Survey

Background: Burn injuries are a significant health issue leading to physical and emotional complications, impacting both social life and mental health. They necessitate a comprehensive approach for recovery, intertwining various physical and psychological aspects. The primary aim is to sustain a satisfactory level of functionality and life enjoyment, tailored to the individual's essential needs, for an extended period. Objective: The principal objective of this study was to quantitatively evaluate the quality of life and functional outcomes in burn patients. Methods: In this cross-sectional study, data was gathered from 156 burn patients from three medical facilities: Aziz Bhatti Shaheed Teaching Hospital in Gujrat, CMH Kharian, and Jinnah Hospital in Lahore. The Burn Specific Health Scale-Brief (BSHS-B) questionnaire was employed for data collection. The sample included patients aged 18-65 years with varying degrees of burn severity. Results: Data was processed using SPSS version 25. The average age of the patients was 34 years, with a gender distribution of 53.21% female and 46.79% male. Marital status was divided into 66.03% married and 33.97% unmarried individuals. Socio-economic status revealed 4.49% from upper-class, 41.67% from middle-class, and 53.85% from lower-class levels. The average Quality of Life (QoL) score was 70.42 ± 33.75, indicating a diverse range of experiences among participants. Conclusion: The findings suggest that individuals with burn injuries can achieve a satisfactory quality of life and functional independence. This underscores the importance of comprehensive care and support for burn patients to enhance their overall well-being.

Burn Resuscitation and Early Management

Burns are the fourth most common type of trauma worldwide, after traffic injuries, falls, and interpersonal violence. This is a concise review of recent burn fluid management literature. Strategies to avoid over-resuscitation are discussed. Advances in the care of burned patients have historically been related to the larger field of critical care, especially regarding infectious complications, nutritional supplementation, and metabolic manipulations. The unique resuscitation requirements of burn patients have recently been re-examined to minimize over-resuscitation and its associated complications, which can also be an issue in non-burned critically ill patients. However, burn patients often require multiple sequential operations. The loss of the normal skin barrier increases the risk of multiple infections, sepsis, and organ failure. This review will summarize some of the recent advances in burn care.

Advanced Management of the Burn Patient

Burn injuries are a significant public health concern, with a substantial global burden. These injuries can result in complex, life-threatening situations that require advanced management strategies. This review explores the epidemiology, significance, and advanced management of burn patients. We delve into the theoretical framework, covering definitions, risk factors, complications, and various management approaches. The discussion highlights the latest advances in burn care, including early burn wound excision, fluid resuscitation, infection control, and rehabilitation. The evolving landscape of burn care research and its implications for improved patient outcomes are emphasized. In conclusion, this article underscores the importance of a multidisciplinary approach to burn patient care and the need for continued research to enhance the quality of life for survivors.

Acute care for burn patients: fluids, surgery, and what else?

Recently published initiatives spanning the burn care spectrum have substantially changed the standard of care in burn care. The purpose of this article is to describe new impactful concepts in burn first aid, triage, resuscitation, and treatment as well as their impact on future research. First aid after burn injury traditionally consists of extinguishing the burn and applying dressings. Recent evidence suggests that applying 20 min of cool tap water to the burn wound in the first 3 h postburn mitigates burn injury extent. National burn center transfer criteria have been updated, impacting patient initial transfer and management. The adverse effects of hydroxocobalamin, a commonly used antidote for cyanide toxicity, have been delineated. Initial burn resuscitation recommendations for both volume and potentially fluid type are being reexamined. The emergence of innovative skin substitutes may improve burn survival by providing a physiologically stabilizing intermediate dressing. Finally, formal clinical practice guidelines for early mobility in the ICU after burn injury have been defined. These changes in burn care, triage, resuscitation, and treatment have challenged traditional burn care standards, created new standards, and are the basis for future prospective randomized trials.