Treatment Of Burn Patients Research Articles

GUIDELINES FOR THE APPLICATION OF ELECTROTHERAPY AND LASER THERAPY IN BURN PATIENTS

This article addresses the importance of electrotherapy and laser therapy in the treatment of burn patients, justifying their need due to the complexity involved in the recovery of these individuals and the recent advances in these therapeutic modalities. Burns cause deep damage to the skin and underlying tissues, generating complications such as intense pain, hypertrophic scars, and functional loss. Despite the conventional use of medications, grafts, and topical care, there is a growing demand for complementary treatments that accelerate healing, control pain, and promote more effective rehabilitation. The objective of this study is to review and analyze the effects of electrotherapy and laser therapy on the healing process, pain control, and functional recovery of burn patients. The methodology used was a literature review in scientific databases, including articles published between 2015 and 2023, focusing on research that examined the use of these therapies in the context of burns. The results indicate that electrotherapy favors tissue healing by increasing blood flow and stimulating cell regeneration, in addition to providing pain relief through transcutaneous electrical nerve stimulation (TENS). Laser therapy, in turn, accelerates healing by stimulating the production of ATP in cells, reducing inflammation and improving the quality of scars, minimizing the risk of hypertrophic scars and keloids. Studies that combine both therapies show a faster and more effective recovery, with a lower incidence of complications. The conclusion highlights that the combined application of electrotherapy and laser therapy presents significant benefits, being an effective alternative to optimize healing, reduce pain and improve the functionality of burn patients. Dissemination of these results is essential to improve clinical care and encourage future research that expands the use of these therapies in clinical practice.

Central Venous Catheter Use in Burn Patients: Complications and Preventive Measures

Summary: The use of a central venous catheter (CVC) is essential in the management of burn patients, especially due to the difficulty of venous access, the length of hospitalization, and the need for routine fluid replenishment and medication administration, particularly antibiotics. Aim of the study: The aim of this study is to identify the rate of complications associated with central venous catheters in the context of burn patients to discuss its indications and the benefit/risk ratio. Methods: This descriptive retrospective study was conducted in the Plastic Surgery Department of CHU Mohamed VI in Marrakech, involving patients who received a central venous catheter during their admission to the burn unit from March 2023 to March 2024. Data collection included basic demographic data, comorbidities, burn mechanism, burn depth, percentage of burned body surface area (BSA), central catheter location (subclavian, femoral, jugular), the site (healthy/burned), the duration of catheter placement, complications (infection and venous thrombosis), detection of germs during culture, and the length of hospital stay. Results: Infection and venous thrombosis were identified as the most frequent complications of CVC use. Further research is needed to evaluate the role of regular CVC changes (every 10 to 15 days after insertion) in preventing infections and to establish a clear anticoagulation protocol for preventing deep vein thrombosis (DVT). Conclusion: While CVCs can be a valuable resource in the treatment of burn patients, they are associated with significant risks, some of which may be life-threatening. The duration of CVC placement should be minimized, and blood cultures (preferably from the CVC tip) should be systematically sent after 10 days or at the first suspicion of complications to reduce the incidence and severity of CVC-related infections.

Platelet lysate in the treatment of burn patients, evaluation of its antimicrobial effect

Introduction. Platelets can interact directly with viruses, bacteria, fungi and protozoa through proteins with direct microbicidal properties that can generate an antimicrobial effect in burns. Objective. To characterize the antimicrobial effect of platelet lysate in the treatment of burn patients. Methods. Observational, descriptive, prospective longitudinal study in patients with type A and AB dermal burns, with less than 5% of the body surface burned. Platelet concentrate production was performed using internationally established methods. Microbiological study was performed before and after the cures with platelet lysate and bacterial growth was evaluated in two subsequent cultures. Results. The mean age of the patients is 52 years and type AB burns represented 75% of the total, being more frequent in upper and lower limbs. Staphylococcus aureus and pseudomona aeruginosa were the predominant germs that grew in the burns. After the first treatment with platelet lysate, a gradual decrease in positivity to germs was observed, until in the third treatment, no more bacterial growth was observed. Conclusions. Platelet lysate has a positive antimicrobial effect, by decreasing the growth of germs isolated during the treatment of dermal burns.

The Advanced Management of a Burn Patient

Burn injuries pose a serious public health issue, contributing to a considerable worldwide impact. These injuries can lead to intricate and perhaps fatal scenarios that necessitate sophisticated care procedures. This review examines the study of the occurrence, importance, and advanced treatment of individuals with burn injuries. We explore the theoretical framework, encompassing definitions, risk factors, complications, and diverse management strategies. The conversation focuses on the most recent developments in burn treatment, such as prompt removal of burn wounds, replenishing fluids, managing infections, and facilitating rehabilitation. The focus is placed on the changing field of burn care research and how it might lead to better results for patients. To summarize, this article emphasizes the significance of utilizing a variety of disciplines in the treatment of burn patients and the necessity for ongoing study to improve the well-being of those who have survived.

611 Comparison of Autologous Skin Cell Suspension to Conventional Surgical Treatment in Burn Patients

611 Comparison of Autologous Skin Cell Suspension to Conventional Surgical Treatment in Burn Patients

Prehospital medical care in pediatric burns: a literature review

The properly administered first aid is an important component in achieving better outcomes in the treatment of burn patients. One of the first stages of management of such patients is a pre-hospital one. The purpose of the study is to analyze the literature review on medical care for children with burns in the prehospital stage, to identify critical deviations and changes that require revision of the current recommendations. A review of trials and latest recommendations on providing medical care to burned children at the prehospital period was carried out. The search was done in PubMed, Medline, GoogleScholar, eLibrary databases, as well as in Yandex search system. Out of 8 168 sources, 17 publications were selected for the data analysis. The performed review has identified main challenges in providing the first aid to children with burns at the prehospital stage. Children will benefit from reaching the consensus between burn specialists and emergency medical providers before patients are taken to a burn center. These data should be used as the basis for future agreements between these specialists. Correctly placed accents on anesthesia, dressings, infusion therapy in children with burns before their arrival to the hospital dictate a need to revise the existing recommendations in our country.

In vivo visualization of burn depth in skin tissue of rats using hemoglobin parameters estimated by diffuse reflectance spectral imaging.

Burn injuries represent a global public health problem that kills an estimated 180,000 people annually. Non-fatal burns result in prolonged hospitalization, disfigurement, and disability. The most common, convenient, and widely used method for assessing burn depth is physical or visual examination, but the accuracy of this method is reportedly poor (60% to 75%). Rapid, correct assessment of burn depth is very important for the optimal management and treatment of burn patients. New methods of burn depth assessment that are inexpensive, simple, rapid, non-contact, and non-invasive are therefore needed. The aim of this study was to propose an approach to visualize the spatial distribution of burn depth using hemoglobin parameters estimated from spectral diffuse reflectance imaging and to demonstrate the feasibility of the proposed approach for differentiating burn depth in a rat model of scald burn injury. The new approach to creating a spatial map of burn depth was based on canonical discriminant analysis (CDA) of total hemoglobin concentration, tissue oxygen saturation, and methemoglobin saturation as estimated from spectral diffuse reflectance images. Burns of three different degrees of severity were created in rat dorsal skin by 10-s exposure to water maintained at 70°C, 78°C, and 98°C, respectively. Spectral images for dorsal regions were acquired under anesthesia immediately after burn injury and at 24h, 48h, and 72h after injury. Most areas of images in the group with skin exposed to 70°C water and 98°C water were classified as 70°C burn and 98°C burn, respectively. In contrast, no significant difference between areas classified as 78°C burn and 98°C burn from 24h to 72h was evident in the group with skin exposed to 78°C water, suggesting that burn depth was heterogeneous. The proposed approach combining diffuse reflectance spectral imaging and CDA appears promising for differentiating 70°C burns from 78°C burns and 98°C burns, and 98°C burns from 70°C burns and 78°C burns at 24 to 72h after burn injury in a rat model of scald burn injury.

Antimicrobial effect of platelet lysate in the treatment of burn patients

Introduction. Platelets can interact directly with viruses, bacteria, fungi and protozoa through proteins with direct microbicidal properties that can generate an antimicrobial effect in burns. Objective. To characterize the antimicrobial effect of platelet lysate in the treatment of burn patients. Methods. Observational, descriptive, prospective longitudinal study in patients with type A and AB dermal burns, with less than 5% of the body surface burned. Platelet concentrate production was performed using internationally established methods. Microbiological study was performed before and after the cures with platelet lysate and bacterial growth was evaluated in two subsequent cultures. Results. The mean age of the patients is 52 years and type AB burns represented 75% of the total, being more frequent in upper and lower limbs. Staphylococcus aureus and pseudomona aeruginosa were the predominant germs that grew in the burns. After the first treatment with platelet lysate, a gradual decrease in positivity to germs was observed, until in the third treatment, no more bacterial growth was observed. Conclusions. Platelet lysate has a positive antimicrobial effect, by decreasing the growth of germs isolated during the treatment of dermal burns

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.

Amphetamine Positivity Prior to Burn Surgery Does not Adversely Affect Intraoperative Outcomes.

The treatment of burn patients using amphetamines is challenging due hemodynamic liabilty and altered physiology. Wide variation exists in the operative timing for this patient population. We hypothesize that burn excision in patients admitted with amphetamine positivity is safe regardless of timing. Data from two verified burn centers between 2017 and 2022 with differing practice patterns in operative timing for amphetamine-positive patients. Center A obtains toxicology only on admission and proceeds with surgery based on hemodynamic status and operative urgency, whereas Center B sends daily toxicology until a negative test results. The primary outcome was the use of vasoactive agents during the index operation, modeled using logistic regression adjusting for burn severity and hospital days to index operation. Secondary outcomes included death and inpatient complications. A total of 270 patients were included, and there were no significant differences in demographics or burn characteristics between centers. Center A screened once and Center B obtained a median of four screens prior to the surgery. The adjusted OR of requiring vasoactive support intraoperatively was not associated with negative toxicology result (P = .821). Having a body surface area burned >20% conferred a significantly higher risk of vasoactive support (adj. OR 13.42 [3.90-46.23], P < .001). Mortality, number of operations, stroke, and hospital length of stay were similar between cohorts. Comparison between two verified burn centers indicates that waiting until a negative amphetamine toxicology result does not impact intraoperative management or subsequent burn outcomes. Serial toxicology tests are unnecessary to guide operative timing of burn patients with amphetamine use.

Modeling of metamaterial based incision patterns for generating high expansions in skin grafts

BackgroundSplit-thickness skin grafting is a widely used treatment for burn patients. It requires removing a small portion of healthy skin, making parallel incisions on it, stretching it, and surgically implanting it into the burn site. Although skin graft mesher companies claim to significantly expand the size of the skin graft, in reality, the amount of expansion achieved is much smaller. MethodsThis study aimed to improve the expansion potential of skin grafts by designing new incision patterns with auxetic properties, using a skin simulant material and additive manufacturing. The mechanical properties and digital image correlation was used to analyze the strain, effective Poisson's ratio, local strains, void area, and meshing ratio of the auxetic skin graft simulants. FindingsThe results showed that the Y-shaped skin graft simulant had the highest effective negative Poisson's ratio, largest areal expansions, lowest maximum induced stresses and strains, and uniform strain distribution properties, making it the best choice for generating high expansions in skin grafts. IntrepretationThe study found that the expansions were highly strain sensitive, with higher auxeticity observed at lower strains. The novel findings with auxetic skin graft simulants are expected to provide valuable insights for developing skin grafts with higher expansion potential in the future.

A 10-Year Single-Burn Center Review of Free Tissue Transfer for Burn-Related Injuries.

Skin grafting is the mainstay treatment in burn patients. However, in the scenario of soft tissue deficit along with exposure of critical structures, free flap is the only reconstructive option to provide adequate coverage. The aim of the study is to review indications and surgical outcomes of burn patients requiring free tissue transfer. A retrospective cohort study was conducted to review all patients who underwent free tissue transfer for burn-related injuries between March 2012 and June 2023. A total of 13 patients required a free flap for their reconstruction. Eleven flaps were performed during the acute care and 2 were performed for delayed reconstruction. Patients were 69% males and 31% females, with a mean age of 45.5 ± 16 years and a mean BMI of 25.4 ± 6.5. The mean follow-up was 13.5 ± 13.9 months. Indications for free tissue transfer were bone exposure (92%) and severe neck burn contracture (8%). Overall complications rate was 54%. Complications included free flap loss (15%), hematoma (15%), vein thrombosis of the anastomosis (15%), infection (8%), amputation (8%), and wound healing issues (23%). Overall, 38% of the patients required re-operations including venous anastomosis revision, hematoma evacuation, debridement, skin grafting, and debulking. Although sometimes free flap remains the only reconstructive option in severe burn-related injuries, it is only rarely used. However, they carry a high risk of complications and should be considered only as the last resort for limb or life-threatening situations.

Study on integrated treatment of severe burn in batch patients

Objective: To explore the burn treatment and first aid flow mode in batch patients.Methods: A retrospective analysis was performed on the treatment experience of 10 or more patients in the group burn accident admitted to the Third Affiliated Hospital of Inner Mongolia Medical University from 2008 to 2020, in order to acquire the general information (e.g., age, sex [male and female], injury causes and factors, total burn surface area, inhalation injury and compound injury), the time when each first-aid rescue team was in place; the reception time of the triage group; specialist rescue start time; treatment process and treatment outcome in patients with severe burns, such as the establishment time of deep venous access.Results: 67 cases (n = 68) of patients were cured and the curative ratio was 98.5%. The average time from the rescue order of the commander-in-chief to the placement of each medical group was 8.8 minutes, the average reception time of the triage group was 4.5 minutes, the average specialist rescue start time was 18.6 minutes, and the average establishment time of deep vein access for patients with severe burns was about 11.3 minutes.Conclusions: Scientific and reasonable pre-hospital emergency triage and treatment for burn patients can be achieved by implementing integrated treatment.

Burn Injury Management, Pathophysiology and Its Future Prospectives

For intensive care physicians, burns are a frequent and challenging patient complication. Specialist facilities prioritise patient stabilisation, infection prevention, and functional rehabilitation to the greatest extent possible. Researchers have been focusing on burns for decades, and thanks to their efforts, the mortality rate for burn patients, especially young patients and those with moderate burns, has been steadily declining. However, the intensivist often faces challenges that make it hard to provide care and stabilise patients. There may be unique complications associated with burn wounds that necessitate either delayed treatment or prolonged rehabilitation. Improvements in patient stabilisation and treatment have resulted from advances made in burn wound care thanks to research. This article discusses recent advances in the treatment of burn patients, focusing on the pathophysiology of burns and the management of burn wounds.

Evaluation of the effectiveness of empirical and computational methods for determining volumes of blood loss in the surgical treatment of burned patients

Relevance. The problem of determining intraoperative blood loss in combustiology remains relevant today. With the variety of existing methods of its assessment, the issue of optimizing transfusion therapy remains debatable. Intention. To evaluate effects of the eschar excision area on the complete blood count and to compare results of computational methods for determining volumes of blood loss with actual volumes of blood exfusion. Methodology. 73 burned patients were included in the retrospective study. Early surgical excision with simultaneous autodermoplasty was performed in all patients. To achieve the study purposes, the intervention areas were compared with changes in hemoglobin, hematocrit, volume and number of red blood cells. The prospective study included 20 volunteers who donated 450 ml of the whole blood. In this group, donated volumes were compared with calculated volumes of blood loss (according to PG. Budny and G.D. Warden). The data obtained were processed via Microsoft Office Excel 2007 and IBM SPSS Statistics 20.0 using descriptive, parametric and nonparametric statistics. Results and Discussion. According to the retrospective analysis, actual areas of excision were not consistently related to the changes in complete blood count in the postoperative period. Based on the results of prospective analysis, we were able to reveal correlations between actual volumes of blood loss and changes in hemoglobin concentrations in somatically healthy volunteers (by PG. Budny). There were no similar correlations between volumes of blood loss and decreased hematocrit (by G.D. Warden). Conclusion. According to the results of the study, we couldn't confirm the effectiveness of empirical methods for determining volumes of blood loss in burned patients. The PG. Budny formula gives representative results of blood loss volumes in healthy volunteers. However, the effectiveness of this method in combustiology requires further research.

32 Effect of Oral Ketamine on Analgesia During Burn Wound Care

IntroductionPain and anxiety can be difficult to control in the burn patient. Ketamine, a NMDA receptor antagonist can be utilized, however intravenous (IV) dosing requires increased monitoring. In contrast, oral ketamine (O.K.) is reported to have fewer side effects, and can be administered without a higher level of care. Little is known about dosing and efficacy of O.K. in the treatment of burn patients. We sought to examine the use of O.K. in our burn population.MethodsThis was a cross-sectional comparative quality improvement study conducted at our ABA verified burn center from January 2021through September 2021. Inclusion criteria were in patients experiencing refractory pain and anxiety after receiving fentanyl and midazolam during wound therapy one day prior to first O.K. administration, along with completion of pre-post patient assessment surveys. Patients were administered 50mg-150mg of ketamine in an oral suspension mixed with 30mL-120mL juice. Effectiveness of the O.K. was measured using pre-post patient surveys, pre-post IV pain medication usage, and subjective staff evaluation of pre-post tolerance of debridement. Baseline demographics were recorded, along with adverse events. O.K. was deemed effective by improved survey scores, improved tolerance to debridement, and reduction in IV medication requirements. Students T-test was performed to determine significance.ResultsA total of 71 patients were given O.K, and 32 met inclusion criteria. Baseline demographics included: 19 male (59%), median age 36 years (range14-66), median TBSA 9.9% (range 1.6%-33.2%). O.K. reduced mean fentanyl use by 33% (pre 199.2mcg- post 123.5mcg, p< 0.01) and mean midazolam use by 39% (pre 1.4mg - post 0.7mg, p< 0.01). On a scale of 1-10 (1 best, 10 worst) mean pain scores improved 38.8% (pre 8 – post 4.6, p< 0.01), anxiety by 36.6% (pre 6.5 – post 3.5, p< 0.01), and overall experience by 37.5% (pre 5.9 – post 3, p< 0.01). Mean O.K. effective dose was 50mg. Staff noted O.K. improved the patient’s ability to tolerate debridement; uncooperative and inconsolable patients participated in their own wound care, and reported to prefer tub time with O.K. One patient experienced psychotomimetic effects, while one patient requested discontinuation due to increased anxiety 4 hours after O.K. administration.ConclusionsO.K. appears to be efficacious in improving pain and anxiety during wound care while being well tolerated by patients. It also subjectively improved the wound care therapy experience.

The Comparative Study of Efficiency of Hyaluronic Acid Based Dressings and Atraumatic Dressings in Local Treatment of Partial-Thickness Burns

Partial-thickness burns (II degree according to ICD 10) remain a significant problem in combustiology. New approaches to the treatment of burn patients are associated with a group of modern dressings or skin substitutes based on natural biopolymers. Hyaluronic acid (HA) based polymers which is a natural component of the extracellular matrix, are promising.Aims of study. А comparative study of the effectiveness of an atraumatic wound dressing based on a polyamide mesh and hyaluronic acid based wound dressings in the treatment of partial-thickness burns.Material and methods. The work is based on the observation of 215 patients who were hospitalized in the Burn Department of the Far Eastern Medical Center in 2014–2018. All patients underwent surgical treatment of burn wounds - dermabrasion on days 2–3. To close of the postoperative wound, two types of dressings were used: based on hyaluronic acid (HA), n=61 and atraumatic dressings (AD), n=154. The effectiveness of treatment was assessed in terms of the healing time of burns, the severity of the general and local inflammatory response, and the quality of the restored skin.Results. In the treatment with HA based dressings, burns healed five days faster; the wound healing time up to 21 days was noted in 90.2% of cases, with the use of AD — only in 57.1% of cases. HA dressings required replacement half as often as AD. With the use of HA dressings, the local and general inflammatory response to the burn wound developed less frequently and was managed faster. Resistant microorganisms and colonies with abundant growth, were found in the main group one and a half times less often than in the comparison group. When using HA dressings, the restored skin is much less likely to suffer from hypertrophy and scarring.Conclusions. Treatment with HA-based wound dressings in patients with partial-thickness burns are more effective than treatment with traditional atraumatic dressing. Biopolymer skin substitutes is optimal for the treatment of partial-thickness burns in the postoperative period, since the frequency of dressings and the likelihood of secondary microbial contamination of wounds decreases, the degree of contamination of wounds with microflora decreases, and favorable conditions are created for the wound process.

Tilapia skin: technological advance in the treatment of burns?

Introduction: Burn is one of the greatest aggressions the body can suffer. The approach varies according to the degree of the burn, since the use of chlorhexidine, silver sulfadiazine, debridement of necrotic tissue, biosynthetic dressings and artificial skins. However, these latter two have high costs, so several studies have emerged with the objective of seeking more viable options, such as the use of Nile Tilapia skin in burns, due to its healing properties. That said, the present article has as a guide question: Is this new method, in fact, a technological advance as important for the treatment of burned patients as it appears to be? Objective: To analyze the use of Nile Tilapia skin in patients with burn injuries, as well as to compare with other pre-established techniques. Methods: This is an integrative bibliographic review with a qualitative approach. Data were collected through PubMed databases and Virtual Health Library (VHL), from 2015 to 2020. Results: The articles indicate a good prognosis to the use of Nile Tilapia skin in relation to the other options in force for the treatment of burns, with a significant advantage in reducing the number of dressings required, for better adhesion to the wound. Moreover, it presents microscopic characteristics similar to human skin, such as high tensile strength and breakage extension, reducing reepithelialization time and pain intensity, as well as reducing treatment costs. Conclusion: In view of the findings of the literature reported in the present review, it is concluded that studies with nile tilapia skin proves to be a revolutionary modality with benefits in the treatment of patients with superficial and deep skin lesions. Therefore, the researchers concluded, answering the guide question, that the new method is, yes, an important advance in the field of burn treatment, because it's employability is confirmed, besides demonstrating an advantage over some of the main preexisting alternatives.

Clinical application of extracorporeal membrane oxygenation in the treatment of burn patients with acute respiratory distress syndrome: a retrospective analysis and systematic review

Objective: To analyze the clinical effect of extracorporeal membrane oxygenation (ECMO) in the treatment of burn patients with acute respiratory distress syndrome (ARDS). Methods: The retrospective observational study and the systematic review were applied. From March 2014 to July 2020, five burn patients with ARDS received ECMO treatment in the First Affiliated Hospital of Army Medical University (the Third Military Medical University). All the five patients were male, aged from 40 to 62 years. The average total burn surface area was 58.8% total body surface area (TBSA) and four cases had severe inhalation injury. Patient's ECMO starting time, duration and mode, and whether successfully weaned or the cause of death, and others. were recorded. Furthermore, the changes of oxygenation and infection before, during, and after utilizing ECMO were analyzed. PubMed and Web of Science from the establishment of each database to August 2021 were searched using "Extracorporeal Membrane Oxygenation", "ECMO", "burn", "inhalation" as the search terms and "Title/Abstract" as the field to retrieve the clinical articles that meet the selection criteria . Basic information were extracted from the articles, including sample size, gender, age, total burn area, inhalation injury, the indication of ECMO, the start and lasting time of ECMO, ECMO mode, rate of successful weaning, complications of ECMO, mortality, the combined application of continuous renal replacement therapy (CRRT). Results: Five patients started venovenous ECMO on an average of 10.2 days after injury and lasted an average of 180.4 hours. Three out of 5 patients were weaned successfully with one patient survived. Four patients died of multiple organ dysfunction syndrome (MODS) and septic shock. Compared with those before ECMO treatment, the arterial oxygen partial pressure (PaO2) and oxygen saturation in arterial blood (SaO2) of three successfully weaned patients obviously increased during and after ECMO treatment. The fraction of inspired oxygen (FiO2) decreased below 50% and PaO2/FiO2 ratio increased above 200 mmHg (1 mmHg=0.133 kPa) during and after ECMO. Furthermore, lactic acid and respiratory rate decreased, basically. Compared with those before ECMO, PaO2 and SaO2 in the other two patients during ECMO, who failed to be weaned, continuously decreased while lactic acid increased. Before and during ECMO, the PaO2/FiO2 ratios of unsuccessfullg weaned cases were less than 200 mmHg, and partial pressure of carbon dioxide in arterial blood (PaCO2) were more than 40 mmHg. Compared with those before ECMO, there were no significant changes in body temperature during and after ECMO, which were less than 38 ℃. Compared with those before ECMO, the leucocyte number (the index without this in unsuccessfully weaned cases was omitted, the same as below) in four patients showed a significant decrease during ECMO, but rose after removal of ECMO. The proportion of neutrophils in three patients were slightly higher during ECMO than before ECMO, and did not change significantly after removal of ECMO. Compared with those before ECMO, platelet counts in three patients were significantly reduced during ECMO, and all five patients during ECMO were below normal levels. Compared with those before ECMO, the procalcitonin levels in four deaths were significantly increased during ECMO. Catheter culture of microorganism was performed in three successfully weaned patients, all of which were negative. A total of 13 literature were included, ranging from 1990 to 2019. The sample size in 6 studies was less than 10, and the sample size in 4 studies was between 10 and 20, and only 2 literatures had a sample size larger than 50. ECMO was applied in 295 burn patients with overall mortality of 48.8% (144/295), including 157 adults and 138 children. The most common indication of ECMO was severe ARDS. Among 157 adult burn patients (95 males and 65 females), 36 cases had inhalation injury. The average burn area was 27%-37%TBSA in 5 reported studies and was more than 50%TBSA in 2 reported studies. The most common mode was venovenous ECMO. ECMO treatment began 26.5 hours to 7.4 days after injury and lasted from 90 hours to 18 days, and the rate of successful weaning ranged from 50% to 100%. The most common complications were bleeding and infection. The mortality was 52.9% (83/157). MODS and sepsis were the leading causes of death. Among 138 pediatric burn patients (77 boys and 61 girls), 29 patients had inhalation injury. The average burn area was 17%-50.2%TBSA in 3 studies. ECMO treatment lasted from 165.2 hours to 324.4 hours. Bleeding was the most common complication. The mortality was 44.2% (61/138). Conclusions: ECMO is an effective strategy for the salvage treatment of burns complicated with ARDS. Furthermore, the prevention and treatment of bleeding, infection and organ dysfunction should be emphasized during the use of ECMO. More importantly, evidence-based guidelines for burns are urgently needed to further improve the clinical effect of ECMO.

Features of Providing Emergency Medical Care to Patients with Thermal and Chemical Injuries during the Spread of COVID-19: Providing Antiviral Protection for Medical Workers and Developing Practical Treatment Protocols

In modern conditions, the burden on the staff of medical institutions has increased many times. This is due to the fact that for more than a year and a half, the planet has been overwhelmed by waves of the coronavirus pandemic. Having come from China, this virus spread like lightning across the planet, causing an economic crisis, violation of the usual foundations of human life, etc. However, despite the undulating incidence of COVID-19 and a significant number of cases, other diseases and medical emergencies also occur, and doctors need to provide patients with the necessary assistance.&#x0D; It should be said that, despite the high level of protective measures in medical institutions, the provision of emergency medical care to patients is associated with a certain risk for doctors, since assistance should be provided to such patients immediately, and it is not always possible to quickly assess whether they are carriers of the virus, unfortunately. For this reason, the risk of infection to medical workers providing emergency care to patients, especially surgical ones, is extremely high.&#x0D; During the epidemic, the treatment of burn patients who have not confirmed the absence or presence of a coronavirus infection, the processes of establishing intravenous access, endotracheal intubation or tracheostomy, wound treatment and surgical intervention are the points of risk of infection. The introduction of an effective, appropriate degree of protection and the development of practical medical procedures will increase the level of protection of the medical worker and reduce the risk of infection with COVID-19.&#x0D; The aim of the work is to investigate the features of providing antiviral protection for medical workers and to study the existing practical treatment protocols for providing emergency medical care to patients with thermal and chemical injuries during the spread of COVID-19.