Third-degree Burns Research Articles

Role of Topical Insulin Management in Burns Patient Management

Thermal burn injuries impose significant physical and psychological distress, particularly in underdeveloped regions. Facilitating early wound healing is paramount to mitigate ensuing complications. Insulin, easily accessible, has emerged as a potential agent for expediting wound recovery. This study endeavors to assess the therapeutic efficacy of topical insulin in second and third-degree burn injuries. The research involved a 42-year-old male who was admitted with alleged history of suicidal burns involving his trunk, bilateral thigh, and bilateral axilla. The patient was initially managed with iv fluids and dressing done with insulin solution applied topically daily. Data collection encompassed demographic details, tissue culture findings, wound discharge, pain intensity, granulation tissue formation, and wound contraction.

Enhanced Third Degree Burn Wound Healing by Hypoxic Mesenchymal Stem Cells' Secretome: IL-10 Upregulation and TNF-α/PGE2 Suppression

Background: Severe third-degree burns pose a notable obstacle in clinical settings, frequently leading to hindered healing of wounds and the development of scars. In this research, we explored how the secretome of hypoxic mesenchymal stem cells (HS-MSCs) could be improved the healing of burn wounds. Methods: In this study, we used 20 male Wistar rats that induced third degree wound by metal 80 exposure for 10 s. These rats divided into 4 groups: Healthy, control, HS-MSCs 100 µL, and HS-MSCs 200 µL groups. We injected the HS-MSCs, which carry various beneficial molecules like IL-10, TGF-β, PDGF, and VEGF, directly into the skin in a third-degree burn rat model on day 1 after burn induction, and harvest on day 14. Results: Our research discovered that using HS-MSCs resulted in a dosage-related rise in IL-10, an anti-inflammatory cytokine, alongside a notable decrease in TNF-α and PGE2, pro-inflammatory cytokines. These effects quickened the healing process by improving re-epithelialization and minimizing scar formation. Conclusions: Our findings indicate that HS-MSCs show promise as a treatment for severe burns by potentially controlling inflammation and fostering a regenerative healing process. More investigation is needed to understand the exact mechanisms and to explore how HS-MSCs could be applied in clinical treatments. HIGHLIGHTS HS-MSCs suppress inflammation and promote regenerative healing in severe burns HS-MSCs accelerated re-epithelialization and reduced scarring GRAPHICAL ABSTRACT

Photobiological response of mast cells to green and red light-emitting diodes (LEDs) in cutaneous burns.

This study assessed the effects of red and green LEDs on mast cells (MCs) in third-degree burns in 75 Wistar rats, divided into control, red LED (RED), and green LED (GREEN) groups. Animals were irradiated daily with RED (630 nm, 300 mW, 0.779 W/cm2, 9 J/cm2, 30 s) and GREEN (520 nm, 180 mW, 0.467 W/cm2, 60 J/cm2, 30 s). Histological sections stained with toluidine blue were analyzed for total and subtype MCs. Standardized MC counting was performed across the viable lesion area, considering lesion margins, through intact connective tissue and the integrity of skin appendages. No statistically significant differences in MCs 2 (with released granules and intact cell border) were found between groups. Irradiated groups showed increased total MCs at 7, 14, and 21 days (p < 0.05), with a decrease in MCs 1 (intact MCs) at all time points compared to control (p < 0.05). Significant changes in MCs 3 (with massive degranulation and partial or complete disintegration of the cell border) degranulation were noted in RED at 7, 14, and 21 days (p < 0.009) and in GREEN at 14 (p < 0.009) and 32 days (p < 0.028). Results suggest red and green LEDs modulate MC recruitment and degranulation in third-degree burns.

Encapsulation of Mentha aquatica methanol extract in alginate hydrogel promotes wound healing in a murine model of Pseudomonas aeruginosa burn infection

Burn injuries are the fourth most prevalent devastating form of trauma worldwide. Among the most extensively explored materials, composite dressings with alginate loaded with herbal extract can be mentioned. This research aimed to develop a sodium alginate (SA)-based hydrogel encapsulated with Mentha aquatica (MA) methanol extract and investigate its therapeutic efficacy in the infected burn mouse model. SEM, FTIR, in vitro extract release, HPLC, mechanical test, contact angle, swelling, degradability, and temperature response properties were used to analyze the hydrogel scaffold's physicochemical structure. Additionally, the antibacterial activity and MIC level of the extract, cell cytotoxicity, and macroscopic and microscopic analysis of the wound healing process were done using Masson's trichrome and hematoxylin-eosin staining. The physicochemical properties of the SA hydrogel encapsulated with MA extract were verified. The lowest inhibitory dose of the extract was determined to be 12.5 mg/ml. Application of SA/MA hydrogel to localized wounds of deep third-degree burns demonstrated faster tissue regeneration, collagen recovery, and eradication of bacterial infection. This research focused on the design and the preparation of a novel and effective biomaterials-based medical product, which has the potential to rehabilitate infected and injured skin tissue; therefore, it can be a promising candidate for wound dressing applications.

Airway management for patients with tracheal stenosis and severe scar contracture of the face and neck via bronchoscopy: a case report

Both anaesthesiologists and surgeons experience challenges in managing airway stenosis and scar contracture in the face and neck. Herein, we report the case of a 38-year-old woman (BMI 23.1 kg/m2, third-degree burns covering 40% of her body, an American Society of Anaesthesiologists physical status III) with an unusual case of airway constriction. This patient had a predictable difficult airway (mouth opening of 2 cm, bilateral nostril scar hyperplasia, Mallampatti score III, scarring of the head and neck, and severe tracheal stenosis). Tracheal stenosis measuring 5.5 mm in width as observed 8 cm below the glottis, and the bronchoscope could not pass through it. After two failed attempts at laryngeal mask insertion, we decided to instead insert a custom-made tracheal tube under the guidance of a fiberoptic bronchoscope. The operation was successful, and the patient was transferred to the intensive care unit (ICU).

Mortality Risk Factors in Appalachian Burn Patients: A 13-Year Retrospective Study.

Introduction Burn injuries pose a significant public health challenge globally, with Appalachia facing unique obstacles due to its rugged terrain, economic disparities, and limited access to healthcare. Understanding mortality risk factors specific to Appalachian burn patients is crucial for optimizing treatment approaches in this underserved population. Materials and methods A retrospective analysis of burn patient data from Cabell Huntington Hospital's burn intensive care unit (BICU) over 13 years was conducted. Patient recordswere reviewed, and demographic and clinical variables were analyzed using descriptive statistics and logistic regression models. Results Among 1,104 Appalachian burn patients treated at Cabell Huntington Hospital's BICU between January 2010 and June 2023, advanced age, larger total body surface area (TBSA) burned, inhalation injuries, chronic obstructive pulmonary disease (COPD), and third-degree burns were significant predictors of mortality. Advanced age (p < 0.001, OR: 1.07), larger TBSA burned (p < 0.001, OR: 1.1), inhalation injuries (p < 0.001, OR: 8.34), COPD (p < 0.001, OR: 2.64), and third-degree burns (p < 0.001, OR: 6.45) were significant predictors of mortality. Gender, smoking history, diabetes mellitus (DM), and body mass index did not significantly differ between survivors and deceased patients. Discussion/conclusion Our findings underscore the importance of tailored interventions for Appalachian burn patients. Advanced age, pre-existing comorbidities, and burn severity significantly impact mortality risk, emphasizing the need for comprehensive care strategies. Specialized burn centers play a critical role in managing complex burn injuries in underserved regions. Addressing mortality risk factors identified in this study is essential for optimizing burn care outcomes in Appalachia. Tailored interventions and collaborative efforts are needed to improve survival rates and promote health equity for burn patients in underserved regions. Future research should explore additional factors influencing burn outcomes and assess disparities in access to specialized care services.

Impact of Candidemia on Survival Rates in Major Burn Patients: A Retrospective Study from the South of Türkiye

Abstract Objective In severely burned patients, fungal infections are among the most devastating complications. Candidemia is an important cause of mortality with an increasing incidence despite advances in burn care management. Higher affected body surface area, long intensive care unit (ICU) stay, flame burn, third-degree burn, and previous bacterial infections were associated with the development of candidemia. Candidemia in patients with major burns admitted to an ICU of a tertiary burns center is investigated. Methods Patients hospitalized in the ICU of Adana City Training and Research Hospital from July 1, 2017, to November 10, 2020, were included. The demographic and clinical variables, the Candida species isolated from blood cultures and their antifungal susceptibilities, need for grafting, complications, and rate of mortality are evaluated retrospectively. Patients were grouped as “candidemia” or “noncandidemia” according to whether or not they experienced Candida bloodstream infection. Results A total of 371 patients were included; the mean age was 22.02 ± 20.9 years. Most patients were male (69.5%). The percentage of burned surface area was 25.93 ± 17.6. The mean ICU stay was 16.95 ± 16.3 days. There were 90 candidemia episodes in 69 patients. The most commonly isolated Candida species were C. parapsilosis, C. tropicalis, and C. albicans. The mortality rates in the candidemia and noncandidemia groups were 24.6 and 5.6%, respectively (p &lt; 0.001). Conclusion Adhering to isolation rules, early wound debridement and closure, avoidance of catheters where possible, and avoidance of the early use of broad-spectrum antibiotics are important measures in reducing candidemia in patients with major burns. Candidemia was associated with greater burn surface areas, duration of hospital stay, and larger numbers of interventional procedures. However, previous bacterial infection receiving prolonged antibiotic therapy was the greatest risk factor of candidemia. Culture results are important to select the antifungal agent with high susceptibility, but results are not rapidly available. There is need for early clinical prediction measures to inform early and effective antifungal treatment.

Peculiarities of Early Surgical Treatment of Patients With Deep Burns Using Biological Dressings

Background: Early necrosectomy with immediate or delayed skin grafting is the gold standard in treatment of burn injuries. Despite all advances in active surgical treatment of burn patients, the optimal time of necrosectomy as well as methods and timing of skin grafting remain the subject of debate among burn surgeons. Reliability and practicality of methods to determine the viability of affected skin tissues act as a limiting factor to advances in surgical strategies for early treatment of burn injuries.Objective: To improve methods of early surgical treatment of patients with deep burns using biological dressings.Materials and methods: Our study analyzed treatment outcomes of 34 patients (age, 18 to 60 years) diagnosed with third-degree burn wounds of different localizations involving 5%-20% of body surface area (according to ICD-10). Group 1 included 18 (53%) patients who underwent skin grafting right after surgical removal of necroses; biological dressings (Chitopran) were applied. Group 2 comprised 16 (47%) patients who also underwent early surgical treatment (autografting), but autografts were covered with synthetic dressings (Voskopran).Results: We found that in group 1 the average time to engraftment after skin grafting followed by Chitopran application was 5.0 (5.0-6.0) days. In group 2, the average time to engraftment after skin grafting followed by Voskopran application was 6.0 (6.0-6.3) days. The statistical data demonstrated that biological dressings had an advantage over synthetic ones in terms of time to engraftment.Conclusions: We can conclude that biological dressings have an advantage over synthetic ones in surgical treatment of partial thickness and deep burn wounds.

Corticosteroid-loaded chitosan-based in-situ forming gel combined with microneedle technology for improvement of burn eschar wound healing

Burn is one of the most common skin injuries and accounts for 300,000 deaths annually. Debridement and antibiotic therapy are major burn treatments, however, as debridement is not always possible and many drugs have poor penetration into necrotic tissue, permeation enhancement is acquired. Another challenge is the short duration of topically applied drugs. This study aims to address both problems by combining in-situ forming gels and microneedles.A chitosan-based in-situ forming gel of hydrocortisone was applied to human burn eschar using microneedles. The formulation was optimized using Design-Expert software. Formulation characterization was done in terms of gelling time and temperature, thermal analysis, release phenomenon, rheology, texture analysis, and stability. Finally, animal studies on mice burn wound treatment were conducted. Results showed that optimized formulation controlled the drug release, and wherever microneedle was used, drug permeation and flux increased (P-value < 0.05). In all ex-vivo and in-vivo stages, gel plus microneedle (length of 1.5 mm and application mode of 2) produced the best results concerning increased flux and faster recovery of burn eschar. In conclusion, the in-situ forming gel with appropriate texture, quality, and stability in combination with microneedle can be a good candidate for the controlled release of drugs in third-degree burn eschars.

Propellant-free foam formulation with tamanu oil microemulsion and nanocurcumin for enhanced burn healing

Several commercial topical formulations are currently available to treat burns, including ointments, gels, and creams. However, these options come with a major drawback as they require a strong dispersing force to apply the drug to large areas of the skin, which can cause pain and discomfort to already sensitive burns. Conversely, foam is a soft, porous, easy-to-spread dosage form that does not require direct contact with the wound, making it an excellent option for treating sensitive, painful, and extensive burns. In this study, we aimed to develop a novel non-propellent foamed microemulsion-based system of tamanu oil and nanocurcumin for effective, safe, and fast-acting treatment of burns. We successfully formulated a stable and homogeneous microemulsion containing tamanu oil, nanocurcumin, and Labrasol/Plurol Oleique CC 497 (6:1) as surfactant/cosurfactant. The final formulation resulted in a stable, transparent, pale-yellow, and homogeneous microemulsion with a pH value of 5.05 and a density of 1.01 g/cm3. The foam generated by the non-propellent foam dispenser had a density of 0.08 g/cm3 and the foam completely broke after 30 min. In the third-degree burn mice model, the percentage of wound area reduction after 21 days of treatment was 86.67 ± 2.89% for the novel non-propellent foamed system, which was comparable to Silvirin cream (positive control) and significantly higher than saline (negative control). We believe that our propellant-free foam containing tamanu oil and nanocurcumin exhibits a promising candidate for wound healing, especially burn injuries.

Preclinical Assessment of MicroMatrix® + Cytal® and Integra® DRT in a Porcine Third-Degree Burn Model

Preclinical Assessment of MicroMatrix® + Cytal® and Integra® DRT in a Porcine Third-Degree Burn Model

The Impact of Platelet Transfusion on Prognosis in Adult Burn Patients with Thrombocytopenia: A Propensity Score Matching Analysis

Background and ObjectivesThrombocytopenia is common among burn patients. Platelet transfusion is frequently administered to increase platelet counts. However, it is not clear whether platelets affect the outcome after transfusion among adult burn patients with thrombocytopenia or not. Our aim is to explore whether platelet transfusion affects the prognosis of adult burn patients with thrombocytopenia. Materials and MethodsWe undertook a retrospective analysis of 368 adult burn victims with thrombocytopenia from the Department of Burn at the First Affiliated Hospital of Nanchang University, China, from January 2014 to July 2021. Propensity score matching (PSM) was utilized to reduce the selection bias and confounding factors. After PSM, both platelet transfusion group and no platelet transfusion group had 46 patients. Our primary outcome was 30-day all-cause mortality. ResultsLogistic multivariate regression analysis showed that third-degree burn area [β=-0.040, odds ratio (OR) =1.052, 95% confidence interval (CI) =1.015-1.091] and platelet transfusion (OR =2.227, 95% CI =0.473-10.483) were independent risk factors (P<0.05). KaplanMeier risk curve analysis showed that the 30-day mortality of patients in the platelet transfusion group and no platelet transfusion group were 47.8% and 19.6%, respectively (P<0.05) ConclusionPlatelet transfusion was an independent risk factor for 30-day mortality in adult burn patients with thrombocytopenia.

Burn-Related Violence Against Women in the United States: Findings From the ABA Burn Registry.

Violence against women is a global public health problem. Centers for Disease Control and Precention (CDC) data show 41% of US women have experienced intimate partner violence. Burn-related violence against women is an extremely confronting form of physical violence. The aim of this study was to describe the frequency, demographics, injury characteristics, and outcomes of women admitted to US burn centers who have experienced burn violence compared to those with accidental burn injuries. 2008-2018 data were comparative statistics were used to describe/compare groups. 54 523 women met study inclusion criteria. 956 (2%) experienced burn violence. Women who experienced burn violence had a younger median [IQR] age (36 [27,48] vs 47 [32,61], P < .0001), were Black/African American (44.5% vs 22.4%, P < .0001), were covered by Medicaid (38.8% vs 21.6%, P < .0001), had a higher median [IQR] %TBSA extent (6.0% [3,15.2] vs 3.0% [1,7.3], P < .0001), a higher proportion with third-degree burns (35.4% vs 28.9%, P < .0001), and a higher proportion with TBSA > 20% (18.2% vs 6.7%, P < .0001). Scald/flame injuries were the most frequent mechanism of injury. Women who experienced violence had a higher median [IQR] length of hospital stay (7.0 [2,18] vs 4.0 [1,11] days, P <.0001), Intensive Care Unit (ICU) stay (8.5 [2,27] vs 4 [2,13] days, P < .0001), and mortality rate (5.7% vs 4.3%, P < .04). The frequency of women who sustained burn violence appears small yet experience worse outcomes. Clinicians should be aware of these demographic/clinical characteristics to provide optimal care to this vulnerable population.

A novel causative factor of injury: Severe burns related to fires and explosions of lithium-ion batteries of electric motorcycles

Severe burns related to fires and explosions of lithium-ion batteries of electric motorcycles have not been reported to date. We retrospectively studied 419 patients admitted to our burn intensive care unit from January 2016 to December 2021. Of these 419 patients, 26 (22 male, 4 female; median age, 42 years) had burns related to lithium-ion battery fires and explosions, and all of their injury characteristics were similar to those of traditional flame burns. Lithium-ion battery-related burns were the eighth most common cause of burn injuries among all hospitalized patients. The 26 patients comprised 10 unemployed and 16 employed individuals. Twenty-three patients were injured at home during the battery charging process, and three were injured outdoors (one by a fire while the electric motorcycle was stationary and the others two by a fire while riding the motorcycle). The burn sites were distributed over the whole body; the burn area ranged from 10 % to 100 % of the total body surface area, and the burn depth ranged from superficial second-degree burns to third-degree burns. Twenty-three patients had inhalation injuries, and ten underwent prophylactic tracheostomy and intubation. Multiple operations were required for wound repair. Although convenient, lithium-ion electric motorcycles can also cause severe burns. To prevent these injuries, we must increase public safety awareness and education, develop new battery energy storage systems and battery management systems, and ensure the safety of batteries. Consumers should be aware of the potential dangers of lithium-ion batteries and comply with related security measures.

The prognostic relevance of full-thickness burns on ABSI

IntroductionThe Abbreviated Burn Severity Index (ABSI) by Tobiasen, which is commonly used to estimate the mortality risk of severely burned patients, calculates an additional point for the existence of full-thickness (third-degree) burns. [1] However, the score does not consider the extent of the body surface affected by third-degree burns. To understand whether there is a way to improve ABSI prediction power, this study aims to determine the influence of full-thickness burns on survival rates and how it affects the predictive precision of the ABSI. Material and methodsIn this study, the statistical evaluation of 2538 patients collected prospectively in the context of the German Burn Registry was carried out. A linear regression analysis was carried out to show the prognostic relevance of full-thickness burns. Age, sex, total body surface area burned (TBSA), and the presence of inhalation injury were also observed as further influencing factors. ResultsAmong the 2538 patients meeting our inclusion criteria, full-thickness burns were found in 1233 patients. In patients with a TBSA below 20 %, the extent of full-thickness burns is not relevant to the prognosis in terms of survival probability (p = 0.124). With more than 20 % TBSA, the extent of third-degree burns is of significant relevance (p = 0.000). In patients without full-thickness burns and calculated ABSI values ≥ 12 the survival rate of 46 % was noticeably better than the predicted survival rate of < 10 % according to the ABSI Score, whereas the predicted survival rate in patients with third-degree burns (< 10 %), closely matched the observed survival rate of 11 %. ConclusionFor patients with a TBSA < 20 %, the presence of full-thickness burns is not relevant for survival. In contrast to this observation, the percentage of full-thickness burns is of crucial prognostic importance for patients with a TBSA of > 20 %. By adjusting the ABSI and taking into account the exact percentage of third-degree burns, an improvement in the prognostic precision of the score could be achieved.

Efficacy and safety of recombinant human granulocyte-macrophage colony-stimulating factor hydrogel in treating second- or third-degree burn wounds in children: a systematic review and meta-analysis.

The efficacy and safety of recombinant human granulocyte-macrophage colony-stimulating factor (rhGM-CSF) hydrogel in adults with deep partial-thickness burns have been confirmed. However, the clinical safety and efficacy analysis of rhGM-CSF in pediatrics is lacking, and the results are questionable. Therefore, a meta-analysis was conducted to evaluate the efficacy and safety of rhGM-CSF hydrogel in children with second- or third-degree burn injury to provide evidence-based medicine for clinical application. Articles on rhGM-CSF hydrogel for the treatment of pediatric burn wounds were retrieved from PubMed, Embase, WOS, Cochrane Central Registry of Controlled Trials, Chinese Biomedical Literature Database (CBM), China Science and Technology Journal Database (CSTJ), China National Knowledge Infrastructure (CNKI) and Wanfang from the inception of the databases to March 2024. Two reviewers screened articles and extracted the following data: general characteristics, intervention and treatment course, outcome measure. The meta-analysis was conducted using Revman 5.4 software. Eight reports (336 patients: experimental 175, control 161) were ultimately included in the meta-analysis, which showed that the experimental group (rhGM-CSF hydrogel ± other therapy) was superior to the control group (treatments without rhGM-CSF hydrogel) in terms of the wound healing rates at day 7 [mean difference (MD) =13.63, 95% confidence interval (CI): 7.25 to 20.00, P<0.001], day 14 (MD =15.59, 95% CI: 12.50 to 18.69, P<0.001), and day 21 (MD =7.47, 95% CI: 7.36 to 7.58, P<0.001), and the wound healing time (MD =-3.10, 95% CI: -3.50 to -2.71, P<0.001), and the differences were statistically significant. For the risks of bias, one study had a "high risk" in allocation sequence concealment, and the others were classified as "low risk" and "unclear risk". rhGM-CSF hydrogel is significantly effective in improving the wound healing rate and shortening the wound healing time in children with second- or third-degree burns.

Penyuluhan Kesehatan Tentang Penanganan Dan Pertolongan Pertama Pada Perawatan Luka Bakar di Desa Gulo Kecamatan Darul Hasanah Kabupaten Aceh Tenggara

In Indonesia, the prevalence of burns according to the Ministry of the Republic of Indonesia in 2013 was 0.7%. It is feared that continuous administration of antibiotics will cause an accumulation of side effects that can be detrimental to health. The goal of on-site first aid is to save lives and prevent pain from getting worse. Burns are characterized by all injuries except third-degree burns, which appear as white or dark brown burned areas on the skin and can cause shock and infection. Community service methods: socialization, dissemination of knowledge, demonstration, implementation, monitoring and evaluation. This activity will be carried out on Monday, April 22 2024 starting at 10.00 WIB in Gulo Village, Darul Hasanah District, Southeast Aceh Regency. There were around 52 people attending. Participants want to take part in activities, participants want to demonstrate first aid management for burns and pre-hospital care, active participants in the question and answer session.

Reverse circumcision foreskin advancement flap for reconstructing penile shaft skin defects in adults with burn injuries in the perineal region

AimGenital burns are rare injuries. Reconstruction of penile skin defects should consider cosmetic and functional outcomes. Skin grafts can develop scar contractures and carry hair follicles, causing unwanted results. These downsides remain unsolved issues. This work aimed to describe a new foreskin advancement flap method for completely reconstructing penile shaft skin defects in severely burned patients. Materials and methodsFrom 2021 to 2023, four patients with third-degree burns in the genital area were enrolled in this investigation. We describe a series of cases with deep burns to the penile shaft and surrounding area that needed debridement and reconstruction using a novel technique called “reverse circumcision,” which consists of tangential excision of the penis and a foreskin advancement flap without longitudinal cuts with less morbidity, preservation of function, and a better aesthetic appearance. The patients had an average follow-up of nine months. ResultsThe reverse circumcision technique was established for patients with severe burns in the genital area. The four patients were satisfied with the postoperative results and the aesthetic results of the procedure without reporting any complications. No scarring or contractures were observed on the glans or penile shaft after surgery. ConclusionsCompared with other flap methods, the use of a reverse circumcision foreskin advancement flap was more straightforward, feasible, and effective. In adults, the foreskin tissue completely covers the penile shaft skin defect. It is a viable reconstructive surgical technique that is easily reproducible and has excellent aesthetic and functional results. For this surgical technique, tissue transfers, bulky regional flaps, or skin grafts were not needed.

The Impact of Burns Involving Over 50% of Total Body Surface Area - a Six-Year Retrospective Study.

Severe burns pose significant therapeutic challenges due to their complex pathophysiology, the potential for life-threatening complications, long-term sequelae and the need for a multidisciplinary approach. In this retrospective study, we aimed to comprehensively analyze burns involving over 50% of the total body surface area (TBSA) treated in our institution over six years. We performed a retrospective study including 91 patients. The following epidemiological and clinical characteristics were documented: age, sex, comorbidities, admission modality, mechanism of injury, TBSA burned, burn depth, presence of inhalation injury, outcome, length of stay and associated costs. In the study group, subjects had a mean age of 54.4 years (24-93), with a male-to-female ratio of 2.5:1. The median percentage of TBSA burned was 70% (50-99%) and 93.4% of patients had third-degree burns. Inhalation injury was present in 71.4% of patients. Flame burns occurred in 90.1% of patients. Prediction scores were assessed, with 60.4% of patients having an ABSI score above 12. Mortality in our study group was 84.61% and 39.5% of patients died in the first week after burn injury. The most frequent systemic complications were respiratory complications (95.6%), followed by cardiocirculatory (93.4%), metabolic (84.6%), hematological (74.7%), renal (64.8%), hepatic (59.3%) and infectious complications (38.4%). Managing major burns is a highly complex process, which requires specialized care and infrastructure to improve outcomes. Extensive burns, especially over 50% TBSA, have high morbidity and mortality, with factors like age, severity and inhalation injury affecting prognosis. A multidisciplinary approach is essential for treatment, addressing not only the burns but also systemic complications to prevent multiple organ dysfunction syndrome and death.

Inter-individual variability of aerobic capacity after rehabilitation exercise training in children with severe burn injury

IntroductionSevere burn trauma damages resting and exercise cardiac function that may affect long term cardiovascular health. The implementation of rehabilitation exercise training (RET) soon after hospital discharge improves cardiorespiratory fitness; however, it does not fully restore aerobic capacity and presents large inter-individual variability. We tested the hypothesis that the inter-individual variability of aerobic capacity for responders (R) compared to nonresponders (NR) would differ for exercise frequency and intensity. MethodsThirty-three children (11 female, [mean±SD] 12 ± 3 years, 145 ± 18 cm, 40 ± 11 kg, 49 ± 31 BMI percentile) with severe burns (49 ± 15 % total body surface area burned, with 35 ± 22 % third-degree burns) completed a 6-week RET program. Cardiorespiratory fitness (peak VO2) was measured before and after RET. Frequency (session days/week), intensity (% peak heart rate), time (min/session), and volume (min/week) were compared between responders and non-responders. Significance was set at p < 0.05. ResultsSixty-four percent of the study population improved peak VO2 after RET whereas 36 % showed no improvements. Using a 2-way factorial ANOVA (group [G] × week [WK]), we found that exercise frequency and session time were similar and increased slightly over 6 weeks between R and NR (main effect for WK; P < 0.002). Exercise volume was significantly lower on week 2 for NR compared to R (G × WK interaction, P < 0.028). Exercise intensity over 6-weeks was significantly lower in the NR compared to the R group (G × WK interaction, P < 0.022). ConclusionsExercise intensity and volume may be important contributors for improving the interindividual response to exercise training for peak VO2. These data suggest that the appropriate dose-response requirement for exercise intensity may be > 80 % peak heart rate and exercise volume of > 150 min per week. Further understanding of the exercise prescription will provide insights important for cardiovascular rehabilitation in children with severe burns. Subject codeInter-individual Variability, Exercise, Pediatrics, Exercise Training