Survival Of Burn Patients Research Articles

Risk Factors of Mortality and Long-Term Survival in Burn Patients With/Without Extracorporeal Membrane Oxygenation: A 16 Year Real-World Study.

Burn patients face cardiopulmonary failure risks, with recent observational studies suggesting promising outcomes for extracorporeal membrane oxygenation (ECMO). However, the effectiveness and long-term survival remain unclear. Our study aims to assess mortality risk factors and long-term survival in burn patients with and without ECMO. This study used Taiwan's National Health Insurance Research Database and designed a case-control with onefold propensity score matching across variables including sex, age, total body surface area (TBSA) burned, and index date. We analyzed mortality and survival risk factors in each stratified group with/without ECMO. Finally, we analyze the mortality according to ECMO and TBSA burned, and the cause of death and long-term survival. From 2000 to 2015, 4,556 burn patients with ECMO compared to an equivalent number without ECMO. Primary mortality include male, age >65, TBSA ≥30%, escharotomy, hemodialysis, and bacteremia. The ECMO group showed lower survival across all stratified risk factors, with the primary cause of death being burn-related issues, followed by respiratory and heart failure. The overall mortality rate was 54.41% with ECMO and 40.94% without ECMO (p < 0.001). Additionally, long-term survival is lower in the group with ECMO. This research provides a valuable real-world gross report about ECMO efficacy and long-term survival among burn patients with/without ECMO.

Association of inflammatory biomarkers with overall survival in burn patients: a systematic review and meta-analysis

IntroductionThe inflammatory response to burn injuries can lead to organ dysfunction that ultimately results in increased mortality and morbidity. This meta-analysis was conducted to determine the efficacy of inflammatory biomarkers, including the neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), procalcitonin (PCT), and C-reactive protein (CRP) as predictive tools of mortality among burn patients.Material and methodsThe biomarker levels of survivors and non-survivors were consolidated according to guidelines for Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Three main databases were searched electronically: PubMed, Web of Science, and Scopus, on December 8, 2022. The Newcastle–Ottawa Quality Assessment Scale (NOS) was used to evaluate and score the methodological quality of the included studies. The standard mean difference (SMD) with a 95% confidence interval (CI) was utilized.ResultsTwenty-four studies were included in our systematic review and meta-analysis, (3636 total burn patients), of whom 2878 survived. We found that deceased burn patients had elevated levels of NLR (SMD = 0.60, 95% CI; 0.19–1.00, P < 0.001), CRP (SMD = 0.80, 95% CI; 0.02–1.58, P = 0.04), and PCT (SMD = 0.85, 95% CI; 0.45–1.24, P < 0.001), compared to survivors. However, we found no association between PLR and mortality among burn patients (SMD = 0.00, 95% CI; -0.14–0.15, P < 0.001). In addition, CRP was significantly higher in non-survivors (SMD = 0.80, 95% CI; 0.02–1.58, P =0.04). Similar results were also found about PCT (SMD = 0.85, 95% CI; 0.45–1.24, P < 0.001). When we analyzed the PCT data, collected in the first 24-48 hours, we found similar results; the PCT level was significantly higher in non-survivors in the immediate postinjury-period (SMD = 0.67, 95% CI; 0.31–1.02, P < 0.001). There was no publication bias among studies on the role of NLR in burn (Egger’s test P = 0.91). The based cut-off values for NLR (13), CRP (71), and PCT (1.77) yielded sensitivities of 69.2%, 100%, and 93.33%, and specificities of 76%, 72.22%, and 72.22% respectively.Discussion/ConclusionsPCT is a marker of sepsis, therefore its elevated level is presumably associated with a higher incidence and severity of sepsis among non-survivors. In addition, NLR and CRP are promising biomarkers for predicting and guiding prevention against burn deaths in clinical settings.

Healthcare-Associated Infections' Characteristics Among Burn Patients and Risk Factors of Mortality: A Study Based on Data From a Tertiary Center in Iran: Nosocomial Infections Among Burn Patients.

Background: Burn patients are more likely to get healthcare-associated infections (HAIs). The current study aimed to investigate the characteristics of HAI and mortality risk factors among burn patients admitted to a tertiary center in Iran. Methods: A retrospective study was conducted in 2021 on burn patients who developed HAI after hospitalization in a tertiary center in Ahvaz, Iran. The records of patients admitted and managed between March 2019 and March 2020 were reviewed. Statistical analysis was carried out using IBM SPSS Version 26, with p < 0.05 considered statistically significant. Results: Of the 1,659 admitted patients, 395 (23.8%) developed HAI during the study period. After excluding patients with incomplete medical records and those with fungal or viral infections, 363 patients remained. The majority of these cases occurred in male patients. The most common type of HAI was burn wound infection (56.2%). Patients were mainly affected by Gram-negative bacteria, Pseudomonas aeruginosa (39.7%), while the most common Gram-positive bacteria was Staphylococcus epidermididis (9.6%). The most common antibiotic resistance among P. aeruginosa-infected patients was reported against imipenem, followed by gentamicin and ciprofloxacin; however, the mentioned organism was mainly sensitive to colistin. Gender, age, bloodstream infection (BSI), ventilator-associated infection (VAI), ICU admission, and total burned surface area (TBSA) resulted in 3.585, 1.028, 2.222, 7.469, 5.278-, and 1.031 times higher mortality rates, respectively. Conclusion: Female gender, advanced age, BSI, VAI, and ICU admission are risk factors for HAI. These findings emphasize the need for focused infection prevention and management to improve high-risk burn patient survival.

The epidemiology of burns in a tertiary care center of Rajasthan

Background: The aim of the present study is to determine the epidemiological pattern and outcome of burn injuries in a tertiary care centre of Rajasthan so that effective evidence based burn prevention programs can be generated and strong burn emergency health system can be established. Methods: This study includes retrospective data analysis of patients conducted over 2 years from January 2020 to December 2021 at burns and plastic surgery department of Sawai Man Singh (SMS) Hospital Jaipur situated in Rajasthan. Results: Total patients managed in SMS hospital were 2007 in 2 years. 65% were males and 35% were females. Most commonly affected age group was 25-39 years with 29% patients. Flame burns was most common mode with 49.6% cases among all age groups and both genders. Median TBSA was 35% as per this study. 37% patients were operated in same admission and definitive reconstruction was done. Mortality was there in 26.7% cases. Conclusions: Our study addresses the need of not only increasing the expenditure over prevention and education programs but also developing resources to improve the survival of burn patients in Rajasthan state. This study may contribute to establishment of strong infrastructure to prevent and treat severe burn injuries.

Food Security as a Predictor of Global Pediatric Postburn Mortality.

Food security (FS) is defined as access to sufficient and nutritious food. Children, especially those in low- and middle- income countries (LMICs), are disproportionately affected by low FS. We hypothesized high FS would be predictive of decreased pediatric postburn mortality in LMICs. Publicly-available, deidentified datasets were obtained from the World Health Organization's Global Burn Registry (GBR) and Economist Intelligence Unit's Global FS Index (GFSI). The GFSI calculates FS scores annually from intergovernmental organization data reviewed by a panel of experts. FS scores are reported on a 0-100 scale with 100 indicating the highest FS. Patients aged 0-19 years were included; after linking GBR and GFSI datasets, countries with <100 burn patients were excluded. Data were analyzed with descriptive statistics and bivariate analyses. Multiple logistic regression controlling for confounders was used to quantify associations between mortality and FS score. Significance was set at p<0.05. From 2016-2020, there were 2,246 cases including 259 deaths (11.5%) over nine countries. Those who died had a higher median age (7 [IQR 2, 15] vs. 3 [2, 6] years, p<0.001), higher proportion of females (48.6% vs. 42.0%, p=0.048), and lower median FS score (55.7 [IQR 45.3, 58.2] vs. 59.8 [IQR 46.7, 65.7], p<0.001). Increasing FS score was associated with decreased odds of postburn mortality [multivariable odds ratio 0.78 (0.73-0.83), p<0.001]. Increasing FS score was associated with decreased pediatric postburn mortality. International efforts to increase FS in LMICs may help improve pediatric burn patient survival.

Inhalation Injury Severity Score on Admission Predicts Overall Survival in Burn Patients.

Inhalation injury is diagnosed in up to one-third of burn patients and is associated with increased morbidity and mortality. There are multiple scoring systems to grade inhalation injury, but no study has evaluated the ability of these scoring systems to predict outcomes of interest such as overall survival. We conducted a prospective, observational study of 99 intubated burn patients who underwent fiberoptic bronchoscopy within 24 hours of admission and graded inhalation injury using three scoring systems: Abbreviated Injury Score (AIS), Inhalation Injury Severity Score (I-ISS), and Mucosal Score (MS). Agreement between scoring systems was assessed with Krippendorff's Alpha (KA). Multivariable analyses were conducted to determine if variables were associated with overall survival. At admission, median AIS, I-ISS, and MS scores were 2 for all scoring systems. Patients who died had higher overall injury burden than those who survived and had similar median admission AIS and MS scores, but higher I-ISS scores. There was strong correlation between the inhalation injury grade at admission using the three scoring systems (KA=0.85). On regression analysis, the only scoring system independently associated with overall survival was I-ISS (score 3 compared to scores 1-2: OR 13.16, 95% CI 1.65-105.07; p=0.02). Progression of injury after initial assessment may contribute to the poor correlation between admission score and overall survival for injuries graded with AIS and MS. Repeated assessment may more accurately identify patients at increased risk for mortality.

The factors affecting mortality in intensive care unit of a burns center.

To determine the characteristics of patients, mortality-affecting factors and mortality rate in follow-up burn-injured patients in an intensive care setting at a burns treatment centre. The retrospective study was conducted between May and November 2014 at Kocaeli Derince Training and Research Hospital Burn Treatment Centre, Kocaeli, Turkey, and comprised data from January 2008 to January 2013 of in-patients who had been treated at the intensive care unit. The therapy outcomes and the follow-up processes were evaluated. Data was analysed using SPSS 17. Of the 381 patients, 105(27.6%) were females and 276(72.4%) were males. The overall mean age was 28.4±21.1 years. There were 52(13.6%) mortalities, while 329(86.4%) survived. The mean total body surface area was 18.3±12.9% in those who survived compared to 52±24.3% in those who died (p<0.000). The highest rate of death was observed in those aged >66 years (p<0.000). The impact of flame burns on mortality was statistically significant (p<0.05). The impact of inhalation burns, suicide, abuse, operational requirements and systemic disease on mortality was statistically significant (p<0.05). Older age, higher total body surface area, flame burns, presence of inhalation burn, third degree burn, suicide attempt, presence of systemic disease, duration of prolonged mechanical ventilation and operation requirements were found to be poor prognostic factors for survival in burn patients.

A comparative study of outcomes of burns across multiple levels of care

BackgroundBurn injuries are a significant contributor to the burden of diseases. The management of burns at specialised burn centres has been shown to improve survival. However, in low- and middle-income countries (LMICs) major burns are managed at non-specialised burn centres due to resource constraints. There is insufficient data on survival from treatment at non-specialised burn centres in LMICs. This study aimed to compare the outcomes of burns treatment between a specialised burn centre and five non-specialised centres. MethodsA prospective cohort study was conducted on patients aged 18 years or above from January 1, 2021 to September 30, 2021. Participants were selected from the admission register at the emergency department. All burns irrespective of the mechanism of injury or %TBSA were included. Data were entered into REDCap. Statistical analysis of outcomes such as positive blood culture, length of hospital stay (LOHS) and 90-day mortality between specialised burn versus non-specialised centres was performed. Furthermore, an analysis of risk factors for mortality was performed and survival data computed. ResultsOf the 488 study participants, 36% were admitted to a specialised burn centre compared to 64% admitted to non-specialised centres. The demographic characteristics were similar between centres. Patients at the specialised burn centre compared to non-specialised centres had a significantly higher inhalation injury of 30.9% vs 7.7% (p < 0.001), > 10%TBSA at 83.4% vs 45.7% (p < 0.001), > 20%TBSA at 46.9% vs 16.6% (p < 0.001), and a median (IQR) ABSI score of 6 (5−7) vs 5 (4−6) (p < 0.0001). Furthermore, patients from specialised burn vs non-specialised centres had a longer median (IQR) time from injury to first burn excision at 7 (4−11) vs 5 (2−10) days, higher rate of burn sepsis 69% vs 35%, increased LOHS 17 (11−27) vs 12 (6−22) days, and 90-day mortality rates at 19.4% vs 6.4%. After adjusting for cofounding variables, survival data showed no difference between specialised burn and non-specialised centres (HR 1.8 95% CI 1.0–3.2, p = 0.05). ConclusionAlthough it appears that the survival of burn patients managed at non-specialised centres in a middle-income country is comparable to those managed at specialised burn centres, there is uncounted bias in our survival data. Hence, a change in practice is not advocated. However, due to resource constraint specialised burn centres in addition to managing major burns should provide training and support to the non-specialised centres.

Enteral Glutamine Supplementation is Associated with Lowering Wound Infection Morbidity and Length of Hospital Stay among Burn Patients: A Meta-analysis and Systematic Review

Background. Significant nutritional support to meet increased energy expenditure is vital for burn patient's survival. Burn injury may lead to a significant decrease in Glutamine levels, which inspired the hypothesis that glutamine supplementation following burn injury would improve outcomes. Hence, the purpose of this meta-analysis study was to provide the rationale for determining the efficacy and safety of enteral glutamine in burn patients.&#x0D; &#x0D; Methods. We conducted a meta-analysis based on PRISMA design to assess the potency of enteral glutamine supplementation as adjuvant treatment in patients with burn trauma. PubMed, Sciencedirect, and Google scholar were searched systematically using the following keywords: "enteral glutamine" and "burn patients" and "critical ill" and "infection" and "length of stay". Newcastle-Ottawa Scale (NOS) was used to assess the quality of papers included in our meta-analysis. A Z test was used to determine the significance of pooled effect estimates. Publication bias was assessed using Egger's. We used Comprehensive Meta-Analysis (CMA) version 2.1 to analyze the data.&#x0D; &#x0D; Results: A total of 12 studies recording 344 cases and 335 controls were enrolled for our analysis. Data on hospital Length of Stay (LOS) was found that enteral glutamine supplementation provided a significant result in reducing the LOS (Std mean diff: 0.70, 95%CI: 0.16 – 1.24; p=0.0100). We also found that a higher risk of positive wound culture was significantly observed in patients without the supplementation of enteral glutamine (OR 2.15, 95% CI: 1.41 – 3.27; p=0.0003) compared to patients receiving enteral glutamine supplementation among burn patients.&#x0D; &#x0D; Conclusion: In our meta-analysis study, enteral glutamine in burn patients confers significantly shorter LOS and lower risk of wound infection among burn patients. We suggest that enteral glutamine supplementation may be a beneficial intervention for the management of burn patients.

Aspartate transaminase/alanine transaminase (De Ritis ratio) predicts survival in major burn patients

BackgroundAlthough treatment of burn patients has significantly improved in recent decades, major burns remain fatal. Therefore, the evaluation of the death risk of the patients with extensive burns is very important. The ratio between the serum levels of aspartate transaminase and alanine transaminase (De Ritis ratio) was an independent predictor of poor outcomes in patients with acute ischemic stroke, cardiac surgery, non-metastatic renal cell carcinoma, and upper urinary tract urothelial carcinoma. Our aim was to determine whether the ratio between the serum levels of AST and ALT (De Ritis ratio) was useful to assess prognosis in extensively burned patients. MethodsWe conducted a single-center cohort study at the Burns Department of Changhai Hospital. This retrospective observational analysis was performed based on the clinical data of major burn patients admitted between May 1, 2005 and April 30, 2018. Univariate and multivariate logistic regression analyses were performed on variables such as age, sex, total body surface area (TBSA), De Ritis ratio, and serum albumin level, which may affect mortality in major burn patients. We assessed their diagnostic value and found the cut-off value by receiver operative characteristic (ROC) curve analysis. We used the Kaplan–Meier curve to display the impact of the De Ritis ratio and serum albumin level on survival in burn patients. ResultsA total of 351 patients with extensive burns were included in the study. The cohort predominantly consisted of males (74.64%), and most of the patients (78.35%) had been burned by a flame. Age, TBSA, inhalation, and the De Ritis ratio were found to be independent risk factors for the 30-days mortality of major burn patients, while age, TBSA, inhalation, and the De Ritis ratio were independent risk factors for 90-day mortality. Further, the De Ritis ratio was a better mortality predictor than serum albumin in severely burned patients, whose area under ROC for 30-day and 90-day mortality was 0.771 (95% confidence intervals [CI], 0.708–0.835) and 0.750 (95% CI, 0.683, 0.818). ConclusionsThe De Ritis ratio was useful as a prognostic indicator for major burn patients, which can be conveniently obtained through blood examination. Regardless of whether the prediction was for 30-day or 90-day mortality, the accuracy remained high. Moreover, compared to serum albumin level, the De Ritis ratio was superior in assessing the prognosis of extensively burned patients.

613Pediatric Burn Bibliotherapy - An Initial Assessment of Novels About Young Burn Survivors and Their Collective Experiences

Abstract Introduction Bibliotherapy is the use of books as a therapeutic intervention for structuring interaction between facilitator and participant based on the mutual sharing of literature. Bibliotherapy has been utilized to address childhood teasing, healthy lifestyles in children, and eating disorders. With the dramatic improvements in survival of burn patients over the past decades, biographies and novels featuring pediatric burn survivors have emerged. These patients often face significant barriers in accessing psychosocial support. Our team hypothesized that bibliotherapy could benefit pediatric burn patients. In order to test this hypothesis, as a first step, our team conducted an assessment of the available burn survivor literature. Methods WorldCat book database was queried using the terms “Burn Patient Fiction” (45 results) and “Burn Patient Biography” (53 results). The authors identified 12 books out of these 98 results likely to be appropriate for adolescent and teenage burn patients based on the brief summaries. The 12 books were then read by the research team and analyzed for burn patient demographics and relevant clinical data when available. Simple descriptive statistics were utilized for numerical data Results Out of 12 books read, 5 were biographies &amp; 7 fictional novels. Protagonists mean age at time of injury was 8.7±5.1 years (range 2–16), with 5 males and 7 females. Average injury size was 57±21% TBSA (range: 14–85). 10 of 12 protagonists suffered facial burns; 7 of 12 suffered hand burns. Oral health/dental issues were described in 4 of 12 books. Geographically, these English language novels spanned Australia (1), Canada 92), and the U.S. (9). Average page length was 237±88 pages (range: 64–372). In 11 of 12 books, mechanism of injury involved flame from car accidents (2), house fires (4), and campfires (2). With regards to sources of positive support during the recovery phase, family was the most commonly cited source (11 novels) followed by friends (10), spiritual/religious support (5), sports (3), burn survivor groups (3), hospital psychiatrists (3), and performing arts (2). Appropriate audience group for most books were teenagers (11) with 5 books deemed also appropriate for adults (only 1 book judged appropriate only for adults), and 2 books appropriate for adolescents. Conclusions Several novels and biographies with pediatric burn survivor protagonists have been written over the past 20 years. Commonalities across these books include flame burn etiology, relatively large TBSA, and burn injuries to visible body areas (face and hand). Family and friends were the most common emotional support for these protagonists. Most books were appropriate for teenagers.

BlaOXA, blaSHV-, and blaTEM- extended-spectrum β-lactamases in Gram-negative strains from burn patients in Lahore, Pakistan.

Gram-negative bacterial pathogens are associated with complications of post-burn infections that showed significant association with different genotypic variants of extended-spectrum β-lactamases. In this study, we aimed to determine the distribution of ESBL gene variants among bacterial pathogens from post-burn infections. Cephalosporin-resistant isolates were collected from Jinnah Burn and Reconstructive Surgery Centre, Lahore. Phenotypic testing: double-disk synergy test, combination disk test, multiplex PCR for blaOXA, blaTEM, and blaSHV genes were performed. Of the 53.5% cephalosporin-resistant isolates, 50.7% were community-acquired and 49.3% were nosocomial pathogens. Seventy-two percent of post-burn infections were found in males (p-value = 0.92, OR = 1.04). The age of burn victims ranged from 4 to 85 years (mean = 28.9, SD = 15.6). Pseudomonas aeruginosa was most predominant at a rate of 49%. There were 83.3% multidrug-resistant isolates, which showed susceptibility to meropenem, imipenem, and amikacin in 28.7%, 25.3%, and 26% respectively. In phenotypic tests 16% ESBLs detected by the DDST and 14% confirmed by the CDT. Molecular detection proved effective for the detection of 79.7% blaTEM, 37.7% blaOXA, and 18.8% blaSHV isolates. blaTEM genes were confirmed in 18.1% CDT-positive isolates, with 62.6% diagnostic accuracy (95% CI = 54.7-70) and 88% specificity (95% CI = 80.4-93.4). The antimicrobial resistance associated with the ESBL-producing Pseudomonas spp. and Enterobacteriaceae is becoming a challenge for the treatment and survival of burn patients. The high rate blaTEM, blaOXA, and blaSHV genes confirm the need to improve the management of burn patients in order to prevent post-burn infections.

Continuous Venovenous Hemofiltration is Associated with Improved Survival in Burn Patients with Shock: A Subset Analysis of a Multicenter Observational Study

Introduction: Acute kidney injury (AKI) is associated with high mortality in burn patients. Previously, we reported that timely initiation of renal replacement therapy (RRT) with an individualized preference toward continuous modes at relatively higher than recommended doses has become standard practice in critically ill burn patients with AKI and is associated with a historically low mortality. The purpose of this cohort analysis was to determine if modality choice impacted survival in burn patients. Methods: After Institutional Review Board approval, a subset analysis was performed on de-identified data collected during a multicenter, observational study. All patients (n = 170) were 18 years or older, admitted with severe burn injuries and started on RRT. Comparisons were made utilizing χ2 or Fisher’s exact test. Kaplan-Meier plots were utilized to assess survival. Sample size determinations to aid future research were calculated utilizing χ2 test with a Yates Correction Factor. Results: Demographics and revised Baux were similar between groups. When continuous venovenous hemofiltration (CVVH) was compared to all other modalities, there was no statistically significant difference in survival (56 vs. 43%, p = 0.124). However, survival was significantly improved (54 vs. 37%, p = 0.032) in the subset of patients requiring vasopressors (n = 77). There was no statistically significant survival difference in patients with inhalation injury (38 vs. 29%, p = 0.638) or acute lung injury/acute respiratory distress syndrome (51 vs. 33%, p = 0.11). Discussion/Conclusion: Survival may be improved if CVVH is chosen as the preferred modality in burn patients with shock and requiring RRT. Differences in other subsets were promising, but analysis was underpowered. Further research should determine if modality choice provides survival benefit in any other subset of burn injury.

Clinical evidence based nano crystalline silver dressing rationality, efficacy and strategy in extensive burn patients survival

Extensive burns of more than 50% have high mortality and those over 90% have almost nil survival rate. All resuscitative measures fail as patient gets infected leading to burn wound sepsis causing septicemia and leading to mortality as the end clinical result. So we need clinically evidenced and rationally based burn dressing strategy to increase extensive burn patient survival. This is random retrospective selection of five patients in each two groups from second degree burn patients of more than 50 percent treated by collagen in one group and other by Nanocrystalline Silver dressings and observed for clinical evidence of patients survival keeping all resuscitative and treatment modalities as standard treatment protocol in all cases. The nano crystalline silver dressing is cost effective, rational and evidence based strategy. It is easy to use, has powerful anti bacterial effect, decreased frequency of dressing changes, shortened time of wound cleaning and painless dressing. It helps make the wound sterile for further treatment within a week. It is a great weapon in the hand of Burn Surgeon for rapid and better recovery of patients. This nano crystalline sustained release silver dressings are best suited to take care of burn wounds of more than 50%. Bacteriophages treatment is reserved for multiple drug resistant bacteria and had good recovery.

NLRP3 inflammasome activity is required for wound healing after burns

Survival of burn patients is contingent on effective wound healing, a complex process that requires coordinated responses of myeloid cells and inflammatory pathways. NLRP3, which serves as a platform for secretion of proinflammatory cytokines, is implicated as a central regulator of wound healing. However, its role during the acute dermal and epidermal regeneration in the context of burns is unknown. Wild-type (WT) and NLRP3-/- mice were exposed to a 30% TBSA scald burn. Gene expression was conducted via real-time polymerase chain reaction. Trichrome staining was used to assess collagen deposition and granulation tissue formation. F4/80 immunostaining compared macrophage infiltration. Flow cytometric analysis was used to characterize skin macrophage distribution and profile. NLRP3, IL1βand IL18 expression was upregulated in skin after burn, and these changes were nonexistent in NLRP3-/-. NLRP3-/- had decreased expression of proinflammatory cytokines, chemokines, inflammatory markers, and growth factors at 3 days (P < 0.05). NLRP3-/- burn skin demonstrated significantly less macrophage infiltration and higher expression of anti-inflammatory markers Arg1 and Fizz1 (P < 0.05) compared to WT. Trichrome staining showed decreased collagen deposition compared to WT. We show that NLRP3 is protective in burn wound healing, primarily through production of inflammatory mediators, macrophage recruitment, and polarization to a proinflammatory phenotype. Our findings highlight a central role of NLRP3 in wound healing through regulation of inflammation and macrophage polarization after burns.

Biologics in Acute Burn Injury.

There have been significant advances in the care of burns over the past decade. As a result of the improved survival of burn patients, attention has shifted to the optimized management of their wounds. Traditionally, autografts have been described as the gold standard treatment in cases of deep second- and third-degree burn wounds; however, they are limited especially in large surface area burns. As such, advancements have been made in the development of biologic dressings, which attempt to mimic the function of the lost epidermis and/or dermis. The ideal biologic dressing is nontoxic, lacks antigenicity, is immunologically compatible, and is sterile. Additionally, easy storage conditions, long shelf lives, and reasonable costs are key determinants of whether biologic dressings may truly be widely used in the clinical setting. Biologic dressings serve an important role as skin substitutes in the setting of acute burn injury. This review aims to summarize the multitude of available biologic dressings and their applications. METHODS: The PubMed and Google Scholar databases were searched for the following terms either alone or in combination: "burn injury," "biologic membrane," "skin substitutes," "biosynthetic dressings," and "acellular membrane."

Possibilities for more accurate prediction of thermal injury severity and determination of its impact on the body using the Abbreviated Burn Severity Index

INTRODUCTION: During the last decades, the chances of survival in burn patients have been progressively increasing, but the issue of prognosis of death after such injuries is still of great ethical, social, medical, and forensic interest. AIM: The purpose of our study was to examine and confirm the accuracy of the ABSI (Abbreviated Burn Severity Index) system in predicting the risk of death in thermal trauma by comparing its values with the actual risk reported. MATERIALS AND METHODS: In order to achieve this purpose, the medical records of burn patients admitted to the Clinic of Thermal Trauma, Plastic, Reconstructive and Aesthetic Surgery at the Naval Hospital of Varna for a five-year period (2011-2015) were studied and the death cases were analyzed. The mortality rate predicted by ABSI was compared to the actual death rate reported in the medical records. RESULTS: There was a significant difference in the mean values of ABSI in survivors and deceased: 4.65 and 11, respectively. All with an ABSI value less than 3 survived. For ABSI values up to 10, a slightly lower mortality was reported than the predicted. For the values ≥11 they matched. Despite these discrepancies, we believe that ABSI is suitable for calculating the risk of death in thermal trauma, especially in more severe burns, where the threat to life is higher. CONCLUSION: Three groups were differentiated with a sharp increase in the percentage of actually reported mortality. Their respective ABSI values can be taken as a reference for forensic medical practitioners in the classification of bodily injuries due to burns.

381 Pharmacokinetics and Pharmacodynamics of Voriconazole in Burn Patients: A Case Series

Optimizing pharmacokinetics (PK) and pharmacodynamics (PD) of antifungals used to treat burn-associated fungal infection may improve survival in burn patients. In this population, altered organ function, various physiologic changes, and use of continuous renal replacement therapy (CRRT) can affect PK/PD. The objective of this study was to measure PK/PD adequacy of voriconazole (VOR), a common antifungal, in burn patients. This was an IRB-approved, prospective, observational study of antimicrobial PK/PD in critically ill burn patients. One patient was treated concurrently with CRRT, while two patients had preserved renal function (non-CRRT). Venous or arterial blood was sampled at pharmacologic steady-state prior to dose administration, at 0, 0.5, 1, 2, 4, and 8 hours after the end of drug infusion, and prior to the next dose. Total drug plasma concentrations were determined by high-performance liquid chromatography (HPLC). PK/PD parameters were estimated by non-compartmental analysis (NCA) using WinNonLin (Certara, Inc). The VOR PK/PD target was defined as an AUC24:MIC ≥ 25. Three burn patients (one on CRRT, age 38 years, 29% TBSA; two non-CRRT, aged 24 and 50 years, 79.9 ± 7.6% TBSA) receiving VOR (3.6 ± 0.059 mg/kg IV q12h) were analyzed. VOR PK/PD parameters were determined (Table 1). The patient receiving CRRT (patient 3) had lower Cmax (1.5 vs. 10.7 ± 1.2) and AUC (13.5 vs. 92.5 ± 16.3), and higher CLss (17.8 vs. 5.7 ± 3) than non-CRRT patients. Patient 2 had lower Vss (44.8 vs. 396 ± 34.6), and patient 1 had higher t1/2 (35.1 vs. 11.8 ± 1.45) than other patients. PK/PD target was met for MIC ≤ 1 for all patients. PK parameters for VOR varied widely in three critically ill burn patients. Because VOR is hepatically metabolized, it is unknown whether this variability is due to CRRT, or individual in metabolic activity. Additional data are needed to guide dosage selection and understand the impact of CRRT in this patient population. Ensuring optimal PK/PD of antifungal agents in critically ill burn patients may improve survival in this population with many physiologic disturbances which can undermine the effectiveness of therapy.

Timing of Laparotomy and Closure in Burn Patients with Abdominal Compartment Syndrome: Effects on Survival

Survival of burn patients with abdominal compartment syndrome (ACS) is uniformly reported to be poor, averaging just 16% after laparotomy. We hypothesize that better outcomes can be achieved with a strategy of immediate laparotomy and early fascial closure. Patients with burn injury who were diagnosed with ACS between 2005 and 2016 were identified through a search of databases. Data were gathered from electronic medical records. Timing of laparotomy and closure were calculated for each patient. Patients were stratified into predefined groups based on timing of laparotomy, cause of ACS, patient age, and timing of abdominal closure. Survival rates were calculated and compared. Forty-six patients with burn injury and ACS were identified. Abdominal compartment syndrome developed during initial resuscitation in 27 patients, during perioperative resuscitation in 5 patients, and during an episode of sepsis in 13 patients. Overall survival was 56%. Mean time to laparotomy from diagnosis of ACS was 1 hour 8 minutes (SD 59 minutes). When ACS developed in patients during initial resuscitation, the mean time to laparotomy from hospital admission was 13 hours (SD 7 hours). Survival rate in this group was 70%, and survival rate in patients treated for ACS later in their hospital course was 33% (p= 0.03). Survival among patients whose laparotomy was closed within 48 hours was 100%, and survival among patients whose laparotomy was not closed within 48 hours was 48% (p= 0.01). Immediate laparotomy resulted in much higher survival rates than previously reported in burn patients with ACS. Survival was higher when ACS was diagnosed during initial resuscitation. Fascial closure within 48 hours was associated with improved survival compared with later fascial closure.

Discussion of: Seeing the forest beyond the trees: Predicting survival in burn patients with machine learning

Discussion of: Seeing the forest beyond the trees: Predicting survival in burn patients with machine learning