Enteral Resuscitation: A Field-Expedient Treatment Strategy for Burn Shock during Wartime and in Other Austere Settings

IF 16.4 1区 化学 Q1 CHEMISTRY, MULTIDISCIPLINARY
Ian F. Jones, K. Nakarmi, Hannah B. Wild, K. Nsaful, Kajal Mehta, Raslina Shrestha, Daniel Roubik, Barclay T. Stewart
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Abstract

Burn injuries are a constant threat in war. Aspects of the modern battlefield increase the risk of burn injuries and pose challenges for early treatment. The initial resuscitation of a severely burn-injured patient often exceeds the resources available in front-line medical facilities. This stems mostly from the weight and volume of the intravenous fluids required. One promising solution to this problem is enteral resuscitation with an oral rehydration solution. In addition to being logistically easier to manage, enteral resuscitation may be able to mitigate secondary injuries to the gut related to burn shock and systemic immunoinflammatory activation. This has been previously studied in burn patients, primarily using electrolyte solutions, with promising results. Modern ORS containing sodium, potassium, and glucose in ratios that maximize gut absorption may provide additional benefits as a resuscitation strategy, both in terms of plasma volume expansion and protection of the barrier and immune functions of the gut mucosa. While enteral resuscitation is promising and should be used when other options are not available, further research is needed to refine an optimal implementation strategy.
肠内复苏:战时和其他恶劣环境下烧伤休克的现场快速治疗策略
烧伤是战争中的一种持续威胁。现代战场的某些方面增加了烧伤的风险,也给早期治疗带来了挑战。严重烧伤病人的初期复苏往往超出了前线医疗设施的可用资源。这主要是因为所需的静脉注射液的重量和体积。解决这一问题的一个可行办法是使用口服补液溶液进行肠内复苏。除了在后勤上更易于管理外,肠内复苏还可以减轻烧伤休克和全身免疫炎症激活对肠道造成的二次伤害。以前曾对烧伤患者进行过这方面的研究,主要是使用电解质溶液,结果很有希望。现代口服体液补充剂含有钠、钾和葡萄糖,其比例可最大限度地促进肠道吸收,作为一种复苏策略,在血浆容量扩张和保护肠道粘膜的屏障和免疫功能方面可能会带来更多益处。虽然肠道复苏很有前景,在没有其他选择的情况下应该使用,但还需要进一步的研究来完善最佳的实施策略。
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来源期刊
Accounts of Chemical Research
Accounts of Chemical Research 化学-化学综合
CiteScore
31.40
自引率
1.10%
发文量
312
审稿时长
2 months
期刊介绍: Accounts of Chemical Research presents short, concise and critical articles offering easy-to-read overviews of basic research and applications in all areas of chemistry and biochemistry. These short reviews focus on research from the author’s own laboratory and are designed to teach the reader about a research project. In addition, Accounts of Chemical Research publishes commentaries that give an informed opinion on a current research problem. Special Issues online are devoted to a single topic of unusual activity and significance. Accounts of Chemical Research replaces the traditional article abstract with an article "Conspectus." These entries synopsize the research affording the reader a closer look at the content and significance of an article. Through this provision of a more detailed description of the article contents, the Conspectus enhances the article's discoverability by search engines and the exposure for the research.
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