Sepsis In Burn Patients Research Articles

Simultaneous Determination of Lactulose and Mannitol in Urine of Burn Patients by Gas-Liquid Chromatography

Ratios of lactulose/mannitol excretion in urine have been used to assess the extent of intestinal permeability in various disease and trauma conditions. Reported studies have used this technique to correlate altered gastrointestinal mucosal permeability to translocation of bacteria and endotoxin, leading to occult sepsis in burn patients. Enzymatic methods of analysis for urine concentrations of mannitol and lactulose were used in these studies. We have found that urine from patients with severe burns frequently contains compounds that interfere with the enzymatic methods. We describe using gas-liquid chromatography to determine mannitol and lactulose simultaneously in the urine of burn patients. To avoid the multiple peaks for the anomeric forms of the reducing sugars during precolumn trimethylsilyl derivatization, we converted the sugars to oximes before the silylation step. The method gave good recoveries of mannitol and lactulose added to burn patients' urine samples. Unlike the enzymatic methods, gas-liquid chromatography eliminates the effect of interfering compounds and allows for the simultaneous determination of both sugars in urine samples.

Circulating fibronectin depletion in burned patients: relationship to development of infection and prognostic value.

The time course of the level of plasma fibronectin (PFN) and its relationship to severity of injury, infection, and prognosis were studied in 27 burn patients with body surface area (BSA) burn greater than 20%. PFN was measured daily or every two days using a laser nephelometer. During the first four postburn days, a decrease in PFN was observed that was significant on days 2 and 3. On postburn day 2, a positive correlation was found between PFN decrease and extent of injury. The decrease was of high prognostic value. Between postburn days 4 and 16, PFN levels of infected patients were significantly lower than those of noninfected ones, but the onset of infection was not preceded by any significant decrease in PFN levels. This study offers arguments in favor of a close relationship between PFN deficiency and sepsis in burn patients, but it is impossible to assert that this deficiency plays a major role in the occurrence of infection.

Nutritional indicators of postburn bacteremic sepsis.

The potential of nutritional assessment parameters in predicting sepsis in burn patients was investigated. Sixty-two consecutive patients (mean age 41 years) with an average burn size of 19% were studied. Values were obtained on postburn day 10 for serum albumin, transferrin, nitrogen balance, total lymphocyte count, skin test reactivity, and percentage of ideal body weight. Parameters predictive of imminent septic episode included serum albumin less than 3.0 g/dl (p less than 0.001), total lymphocyte count less than 1500/mm3 (p less than 0.001), anergy (p less than 0.001), and serum transferrin less than 150 mg/dl (p less than 0.001). Nitrogen balance and percentage of ideal body weight were not found to contribute to group discrimination.

Diagnosis and treatment of cannula related intravenous sepsis in burn patients

Diagnosis and treatment of cannula related intravenous sepsis in burn patients

A simple method of predicting severe sepsis in burned patients

A simple method of predicting severe sepsis in burned patients

A simple method of predicting severe sepsis in burn patients

A simple method of predicting severe sepsis in burn patients

Diagnosis and treatment of cannula-related intravenous sepsis in burn patients

The Journal of Trauma: Injury, Infection, and Critical Care: October 1980 - Volume 20 - Issue 10 - p 912

Diagnosis and treatment of cannula-related intravenous sepsis in burn patients.

Suppurative thrombophlebitis was identified in 193 (4.2%) of 4,636 burn patients treated during the years 1960-1978. A single vein was involved in 162 patients, while 31 had multiple vein involvement. The distribution and incidence of suppuration in individual veins reflected the frequency of cannulation, with an increase in the use of central vein cannulae, during the last 10 years, paralleled by a rise in central vein suppuration. The infecting organisms reflected the patients' surface flora. Local signs of infection were present in less than half (35%) of the patients and recovery of a positive blood culture in a clinically septic patient was the most frequent clinical presentation prompting exploration of previously cannulated veins. Pathogenetic mechanisms are identified and criteria defined for determining the extent of excision necessary. Ninety veins were excised from 75 patients during the 1969-1978 period, of whom 30 (40%) survived (three other patients with antibiotic treated central vein disease also survived). Treatment failure was attributable to inadequate excision in 12 patients, suppuration within another unexcised vein in eight patients, hematogenous dissemination of infection in five patients in whom the local disease had been eradicated, and other disease in 20 patients. Prophylaxis must emphasize limited duration of cannulation. Timely diagnosis and treatment can effect maximum salvage and reduce the likelihood of systemic dissemination.

A simple method of predicting severe sepsis in burn patients

Twenty-six patients with major thermal injury were studied with sequential tests of immunocompetence. Five to 8 days after burn, 12 of 26 patients developed a marked depression in the phytohemagglutinin response (17 ± 8 percent of baseline) and an increase in suppression of the normal mixed leukocyte response (70 ± 13 percent suppression), which was followed by severe life-threatening sepsis 4 to 5 days later. Concomitant with this marked immunosuppression, the 12 patients developed red debris in the normally white mononuclear layer of the Ficoll-Hypaque density centrifugation gradients used to separate mononuclear cells. None of the 14 patients with minimal or no sepsis developed red debris in Ficoll-Hypaque gradients, nor did they show signs of immune depression by phytohemagglutinin or mixed leukocyte response assays. The only patients in the severe sepsis group who survived were those given aminoglycosides at the time red debris was observed on the Ficoll-Hypaque gradients. The presence of red debris on Ficoll-Hypaque separation appears to be a simple and reliable predictor of impending sepsis, which allows the use of antibiotics before the clinical onset of sepsis.

Impaired gluconeogenesis in extensively injured patients with gram-negative bacteremia

Glucose kinetics and gluconeogenic precursors were studied in burned patients with or without gram-negative bacteremia. Gram-negative sepsis in burned patients impairs the increased rate of hepatic glucose production which characteristically occurs after thermal injury.

Early Detection of Elevated Serum Procalcitonin Is Required as Warning Sign of Sepsis in Burn Patients

Backgrounds: Procalcitonin (PCT) is a marker of the inflammatory response. This biomarker also plays a key role in burn injury, as it is accompanied by systemic inflammatory response syndrome (SIRS). Elevated level of serum PCT possibly interprets the state of inflammation and multiple organ dysfunctions (MOD) with the risk of lethal outcome.Patients and Methods: We detected high serum PCT level associated with its warning state of inflammation in 3 adult patients. We found that each high PCT level was continued by its state of inflammation. These four patients encounter serum PCT level into more than 10 ng/ml. Sepsis was diagnosed according to American Burn Association Sepsis Criteria.Results: High elevated PCT serum level (161.70 ng/mL) was detected on the first patient 8 days post burn injuryand died on the next 5 days. on the second patient, high PCT serum level (40.81 ng/mL) detected 9 days after burn injury and died on the next 2 days. The third patient was detected with high PCT serum level (12.28ng/mL) 2 days after burn injury was died on the next 2 days. The pediatric patient was detected with high PCT level (23.41 ng/ml)11 days after burn injury and died on the next 4 days.Summary: We found that it is important to initiate PCT measurements in burn patients at the time of admission. Daily measurement of PCT levels is needed for an early diagnosis and treatment of burn sepsis, monitoring therapy and MOD prevention.

The burn autopsy. Fatal complications of burns.

The pathologic findings and interpretations of 335 autopsies performed on patients who died of extensive cutaneous burns during the period 1960 to 1967 are presented. The information accumulated during this period is unique in that the burn wounds were systematically examined postmortem, the patients studied were young, and the number with preexisting disease was negligible. Comparison of the major fatal complications prior and subsequent to topical antibacterial therapy confirms the marked decline in sepsis due to invasive bacterial infection of the burn wound that has been reported previously. There has been an increase in fungal colonization and infection of the burn wound coincident with the use of the topical antibacterial agent, Sulfamylon. Sepsis, although reduced in magnitude due to control of one of its major sources, continues to be the single most frequent fatal complication of burns. Infective and respiratory complications together account for two-thirds of deaths in patients who survive the initial phase of thermal injury. The infected cannulated vein now rivals infection of the burn wound as a source of sepsis in burned patients. The increase in deaths attributed to respiratory complications has occurred only in patients with extensive burns and may be an apparent rather than a real increase.