Journal of Burn Care & Research最新文献_第9页

Cytokine storm in a massively burned pediatric patient. 一个严重烧伤的儿科病人体内的细胞因子风暴。

IF 1.5 4区医学

Journal of Burn Care & Research Pub Date : 2025-01-17 DOI: 10.1093/jbcr/iraf007

Mala Sharma, Lauren Roach, Ashleigh Bull, LeeAnne Flygt, Zuhair Ballas, Alex Kurjatko, Madhuradhar Chegondi, Lucy Wibbenmeyer

引用次数: 0

Carbohydrate and wound healing in critically ill burn patients: A retrospective cohort study. 危重烧伤患者的碳水化合物与伤口愈合：一项回顾性队列研究。

IF 1.5 4区医学

Journal of Burn Care & Research Pub Date : 2025-01-17 DOI: 10.1093/jbcr/iraf006

Asia Nakakura, Beth A Shields, Leopoldo C Cancio

{"title":"Carbohydrate and wound healing in critically ill burn patients: A retrospective cohort study.","authors":"Asia Nakakura, Beth A Shields, Leopoldo C Cancio","doi":"10.1093/jbcr/iraf006","DOIUrl":"https://doi.org/10.1093/jbcr/iraf006","url":null,"abstract":"Two randomized controlled trials conducted in acutely burned patients found clinical benefits with higher carbohydrate (60-65% of total energy), lower fat (12-15%) nutrition, to include faster wound healing, fewer wound infections, decreased hospital stay, and less pneumonia. The primary purpose of this study was to assess whether our change in practice to a higher proportion of carbohydrates (60%) with 25% of energy from protein, and 15% of energy from fat was associated with improved wound healing rates. Secondary outcomes evaluated included invasive fungal wound infections, ischemic bowel, sepsis, and mortality. Before February 2022, the use of a high-protein, relatively low-fat enteral formula (52% carbohydrate, 23% fat, 25% protein) combined with a protein modular was the standard practice (PRE-group) in our burn center. After, we implemented a higher carbohydrate feeding protocol (POST-group). In this study, patients in the POST-group were matched 2:1 by age, burn size, burn depth, inhalation injury, and gender to those in the PRE-group. There were 66 patients evaluated: 18% female, 42±13 years of age, burn size of 38±21%TBSA. There was a statistically significant difference in wound healing rates (0.7%±0.5%TBSA/day PRE vs. 1.1%±0.5%TBSA/day POST, p=0.037). There was also significantly less sepsis (70%PRE vs. 41%POST, p=0.021). There were no statistically significant differences between groups in ischemic bowel (0%PRE vs. 4%POST, p=0.159), invasive fungal wound infection rates (14%PRE vs. 5%POST, p=0.245), or mortality (16%PRE, 9%POST; p=0.447). We found a statistically significant increase in wound healing rates when administering a higher proportion of carbohydrate to our patients with severe burns.","PeriodicalId":15205,"journal":{"name":"Journal of Burn Care & Research","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006021","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

A Pilot Study on the Impact of Smoking on Adipose Derived Stem Cell Function in Burn Patients. 吸烟对烧伤患者脂肪干细胞功能影响的初步研究。

IF 1.5 4区医学

Journal of Burn Care & Research Pub Date : 2025-01-16 DOI: 10.1093/jbcr/iraf005

Paige Deville, Jenna Dennis, Olivia Warren, Cameron Fontenot, Genevieve Messa, Jeffrey E Carter, Herb A Phelan, Jonathan Schoen, Jeffery A Hobden, Robert W Siggins, Patrick M McTernan, Patricia E Molina, Alison A Smith

{"title":"A Pilot Study on the Impact of Smoking on Adipose Derived Stem Cell Function in Burn Patients.","authors":"Paige Deville, Jenna Dennis, Olivia Warren, Cameron Fontenot, Genevieve Messa, Jeffrey E Carter, Herb A Phelan, Jonathan Schoen, Jeffery A Hobden, Robert W Siggins, Patrick M McTernan, Patricia E Molina, Alison A Smith","doi":"10.1093/jbcr/iraf005","DOIUrl":"https://doi.org/10.1093/jbcr/iraf005","url":null,"abstract":"Adipose-derived stem cells (ADSCs) have an important role in the modulation of burned tissue repair through the release of paracrine factors that stimulate the wound healing response. In this study, we tested the hypothesis that smoking status alters the profile of paracrine factors secreted from ADSCs isolated from damaged adipose tissue. Adipose tissue was collected from adult patients (N=8) with severe burn injuries (>20% total body surface area) at the index operation. ADSCs were extracted and cultured in vitro. Supernatants were harvested 30 hours after plating and used for cytokine determinations by Multiplex assay. Fluorescence activated single cell sorting (FACS) confirmed their phenotype with markers CD 90, CD 166, and CD 73. Univariate analyses were performed to compare the two cohorts (Smokers vs non smokers). Higher amounts of anti-inflammatory cytokines IL-4 (p=0.03) and IL-10 (p=0.04) and pro-inflammatory cytokines TNF-alpha (p=0.03), IL-8, and IFN-gamma (p=0.03) were detected in burn patients who were current everyday smokers when compared to nonsmokers, or former smokers. No significant differences in supernatant concentrations of IL-17, IL-1 beta, TGF-alpha, IL-6, and IL-13 were observed (p>0.05). Mortality was higher in the smoker group when compared to non-smokers. The results from this study suggest that smoking status in patients with a major burn injury may alter the paracrine factors secreted from ADSCs, and on-going studies will increase sample size and refine experimental approach. Furthermore, these results support the need for studies examining the systemic effects of smoking status of patients suffering burn injuries impacts the wound healing.","PeriodicalId":15205,"journal":{"name":"Journal of Burn Care & Research","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006018","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Challenges in Geographic Access to Specialized Pediatric Burn Care in the United States. 在地理上的挑战获得专业儿科烧伤护理在美国。

IF 1.5 4区医学

Journal of Burn Care & Research Pub Date : 2025-01-16 DOI: 10.1093/jbcr/iraf002

Jacob M Dougherty, Eva S Blake, Christopher J Rittle, Zhaohui Fan, Mary A Hunter, Mark R Hemmila, Naveen F Sangji

{"title":"Challenges in Geographic Access to Specialized Pediatric Burn Care in the United States.","authors":"Jacob M Dougherty, Eva S Blake, Christopher J Rittle, Zhaohui Fan, Mary A Hunter, Mark R Hemmila, Naveen F Sangji","doi":"10.1093/jbcr/iraf002","DOIUrl":"https://doi.org/10.1093/jbcr/iraf002","url":null,"abstract":"Background: Geographical access to pediatric burn centers in the US is not well described. Patients may receive care at American Burn Association (ABA)-verified burn centers, unverified burn centers, or non-burn centers. A recent study indicated that most US counties do not have an ABA-verified pediatric burn center within 100 miles. However, access to unverified burn centers that provide care to pediatric burn patients was not considered. We studied access to all pediatric burn centers across different US regions, using American College of Surgeons (ACS) Committee on Trauma-verified pediatric trauma centers as a benchmark.Study design: An observational cohort study was conducted using 2022 US Census data. Individuals aged ≤14 years were included. Geographical location was determined by residence ZIP code. Pediatric burn centers were identified from the ABA directory. Pediatric trauma centers were identified by ACS verification status using the ACS Hospitals and Facilities directory. Population access to pediatric burn and trauma centers within 50, 100, and 300 miles of the home ZIP code was assessed.Results: Of US children, 62.1%, 83.5%, and 98.6% live within 50, 100, and 300 miles of a pediatric burn center. Access to ABA-verified pediatric burn centers is lower compared to access to ACS-verified pediatric trauma centers.Conclusions: Overall, the US population has limited access to pediatric burn centers compared to pediatric trauma centers. The services offered and outcomes should be studied to better understand differences in the quality of care provided by verified and unverified centers.","PeriodicalId":15205,"journal":{"name":"Journal of Burn Care & Research","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Intrathecal Baclofen Pump Wean and Risk of Exposure in a Large TBSA Burn Wound Patient: A Case Report. 大面积TBSA烧伤患者鞘内巴氯芬泵的脱落和暴露风险：1例报告。

IF 1.5 4区医学

Journal of Burn Care & Research Pub Date : 2025-01-15 DOI: 10.1093/jbcr/irae210

Lauren A Lautenslager, Melissa E Cullom, Deidra B Bedgood, Allison N Boyd, Leigh J Spera

{"title":"Intrathecal Baclofen Pump Wean and Risk of Exposure in a Large TBSA Burn Wound Patient: A Case Report.","authors":"Lauren A Lautenslager, Melissa E Cullom, Deidra B Bedgood, Allison N Boyd, Leigh J Spera","doi":"10.1093/jbcr/irae210","DOIUrl":"https://doi.org/10.1093/jbcr/irae210","url":null,"abstract":"Burn injuries in patients with significant pre-existing medical conditions provide unique challenges in both medical management and surgical planning. Spasticity, if left untreated, can be one of the most disabling consequences of a neurologic injury. Treatment is largely dependent on pharmacologic management with anti-spasmodic agents such as baclofen. Baclofen's effectiveness when taken orally is often limited by its systemic side effects, which mostly affect the central nervous system (CNS). Intrathecal baclofen (ITB) can circumvent these intolerable adverse effects while achieving symptom relief via a more targeted therapeutic route. However, abrupt cessation of chronic baclofen use can precipitate an acute life-threatening withdrawal syndrome. We present a case of a 47-year-old female who sustained 54% total body surface area (TBSA) full-thickness flame burns to the circumferential bilateral lower extremities, left arm, left anterior and posterior trunk, flank, and perineum. She had a pre-morbid C5 spinal cord injury resulting in spastic paraplegia for which she had an ITB pump implanted into her left abdominal wall for symptom management. This pump was directly beneath her operative burn wounds. We discuss the complex issues that were encountered throughout her care related to medication reservoir supply, life-threatening risk of baclofen withdrawal, pain-specialist availability, medical-legal barriers, and the multi-staged surgical plan for coverage, balancing proper wound debridement with risk of device exposure and infection. To our knowledge, this is the only case report detailing the cohort of obstacles that may be associated with these devices, specifically with burn patients.","PeriodicalId":15205,"journal":{"name":"Journal of Burn Care & Research","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142983578","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Serratia Infections in Burn Care. 烧伤护理中的沙雷菌感染。

IF 1.5 4区医学

Journal of Burn Care & Research Pub Date : 2025-01-13 DOI: 10.1093/jbcr/iraf004

David Wallace, Alan D Rogers

{"title":"Serratia Infections in Burn Care.","authors":"David Wallace, Alan D Rogers","doi":"10.1093/jbcr/iraf004","DOIUrl":"https://doi.org/10.1093/jbcr/iraf004","url":null,"abstract":"Serratia marcescens is an opportunistic nosocomial pathogen with significant implications for burn care due to its multidrug resistance, virulence, and ability to colonize hospital environments. This retrospective study, conducted at an American Burn Association Verified Burn Centre, reviewed 22 cases of S. marcescens infections from 2015 to 2020. Patients exhibited a mean total body surface area (TBSA) burned of 28% (range: 2-71%), with 68% sustaining burns >20% TBSA and 40.9% presenting with inhalation injuries. The pathogen was most commonly isolated from sputum (36%) and burn wound tissue (50%), with a mean time to positive culture of 8.7 days. Early-onset infections were associated with increased mortality, particularly in patients with major burns, as five out of seven such individuals succumbed to infection. The overall mortality rate was 23%, despite timely antibiotic administration. Targeted topical antimicrobials, such as Dakin's solution, nanocrystalline silver, and polyhexamethylene biguanide (PHMB), offer potential benefits but lack robust evidence for optimal use. Stronger clinical data are needed to guide their application and improve outcomes. These findings underscore the need for enhanced surveillance, refined treatment strategies, and research into S. marcescens management in burn care.","PeriodicalId":15205,"journal":{"name":"Journal of Burn Care & Research","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142970932","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Outcomes of Burn Injury in Organ Transplant Patients: A 12-Year Review. 器官移植患者烧伤后的疗效：12 年回顾

IF 1.5 4区医学

Journal of Burn Care & Research Pub Date : 2025-01-06 DOI: 10.1093/jbcr/irae212

Rebecca Hohsfield, David Orozco, Hilary Y Liu, Francesco M Egro

引用次数: 0

Prevalence of alcohol exposure in burns related injuries. 烧伤相关伤害中的酒精暴露流行率。

IF 1.5 4区医学

Journal of Burn Care & Research Pub Date : 2025-01-04 DOI: 10.1093/jbcr/irae214

Kathrin Orda, Georgina Lau, Lincoln M Tracy, Biswadev Mitra

{"title":"Prevalence of alcohol exposure in burns related injuries.","authors":"Kathrin Orda, Georgina Lau, Lincoln M Tracy, Biswadev Mitra","doi":"10.1093/jbcr/irae214","DOIUrl":"https://doi.org/10.1093/jbcr/irae214","url":null,"abstract":"The aim of this registry-based cohort study was to quantify the prevalence, injury characteristics, and outcomes of alcohol exposure in burn-related injuries. All patients ≥ 18 years presenting to The Alfred Emergency & Trauma Centre, a major trauma centre in Victoria, Australia between January 1, 2019 and December 31, 2022 and included in the Victorian Adult Burns Service registry were included. An explicit chart review was performed to verify retrieved data with alcohol exposure coded when documented in medical records, laboratory evidence of a blood alcohol concentration > 2mmol/L, or recorded in discharge ICD-10-AM codes. Among 1587 eligible patients, 251 (15.8%) had been exposed to alcohol prior to injury. Patients with alcohol exposure at the time of burn-related injury had higher rates of admission to the ICU (28% vs 16.4%, p < 0.001) and longer median hospital admission (10.1 vs 7.7 days, p < 0.001). The significant impact of alcohol exposure on the overall health burden of burn injuries highlight the need for standardised and robust alcohol testing protocols to support targeted strategies to reduce the burden of alcohol-related burn injuries.","PeriodicalId":15205,"journal":{"name":"Journal of Burn Care & Research","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142931652","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Vasoactive Agents in Burn Patients - Perspectives on Angiotensin-II. 烧伤患者的血管活性剂--血管紧张素 II 的前景。

IF 1.5 4区医学

Journal of Burn Care & Research Pub Date : 2024-12-13 DOI: 10.1093/jbcr/irae208

Scott W Mueller, Nicolas M Tran, Kevin D Betthauser, Mitchell S Buckley, Jeffrey Shupp, Arek J Wiktor, David M Hill

{"title":"Vasoactive Agents in Burn Patients - Perspectives on Angiotensin-II.","authors":"Scott W Mueller, Nicolas M Tran, Kevin D Betthauser, Mitchell S Buckley, Jeffrey Shupp, Arek J Wiktor, David M Hill","doi":"10.1093/jbcr/irae208","DOIUrl":"https://doi.org/10.1093/jbcr/irae208","url":null,"abstract":"Severe burn injury poses significant clinical challenges, often necessitating the use of vasoactive agents to maintain perfusion. This narrative review explores the current landscape of vasoactive agents in acute burn shock resuscitation and severe burn-injured patients who develop septic shock, with a particular focus on the potential role of the novel vasoactive agent, synthetic angiotensin-II (AT-II), in these settings. While catecholamines and vasopressin remain cornerstone therapies, adverse effects, variable patient response, and a new understanding of burn injury pathophysiology highlight the potentially evolving role of vasoactive agents in these clinical scenarios. A key system involved in blood pressure regulation, the renin-angiotensin-aldosterone system (RAAS), is often dysregulated in acute burn and septic shock. Contributory mechanisms and potential benefits of synthetic AT-II are discussed here within and form the physiologic rationale behind exogenous administration of synthetic AT-II in the context of available safety and efficacy data. To date, administration of synthetic AT-II administration has shown promise in improving hemodynamics and clinical outcomes in distributive shock populations; however, data in acute burn shock and burn patients who develop septic shock are lacking. In addition, a comprehensive understanding of the potential and future areas of research in burn shock and severe burn-injured patients is provided.","PeriodicalId":15205,"journal":{"name":"Journal of Burn Care & Research","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142818062","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Enoxaparin 40mg Twice Daily with Peak Anti-Xa Adjustments is Safe and Necessary to Achieve Therapeutic Chemoprophylaxis in Burn-Injured Patients. 依诺肝素40mg，每日2次，抗xa调节峰是安全的，是实现烧伤患者化疗预防治疗的必要条件。

IF 1.5 4区医学

Journal of Burn Care & Research Pub Date : 2024-12-11 DOI: 10.1093/jbcr/irae201

Desiree N Pinto, Sophia Lee, Cory Johnson, Rola Halabi, Tuan D Le, Lauren T Moffatt, Bonnie C Carney, Shane K Mathew, Melissa McLawhorn, Shawn Tejiram, Taryn E Travis, Jeffrey W Shupp

{"title":"Enoxaparin 40mg Twice Daily with Peak Anti-Xa Adjustments is Safe and Necessary to Achieve Therapeutic Chemoprophylaxis in Burn-Injured Patients.","authors":"Desiree N Pinto, Sophia Lee, Cory Johnson, Rola Halabi, Tuan D Le, Lauren T Moffatt, Bonnie C Carney, Shane K Mathew, Melissa McLawhorn, Shawn Tejiram, Taryn E Travis, Jeffrey W Shupp","doi":"10.1093/jbcr/irae201","DOIUrl":"https://doi.org/10.1093/jbcr/irae201","url":null,"abstract":"Burn injury results in hypercoagulability and an increased venous thromboembolism risk. However, the most effective chemoprophylaxis for burn-injured patients has yet to be elucidated. Therefore, this study aims to identify the safety and efficacy of a burn center's venous thromboembolism protocol modification which increased the dose of enoxaparin from 40mg daily to 40mg twice daily with peak anti-Xa level adjustments. It was hypothesized that this change would not increase bleeding complications and would decrease venous thromboembolism rates. All adult, burn-injured patients admitted to a regional burn center were retrospectively reviewed one year before and after the implementation of this protocol modification. There were no differences in demographics, injury characteristics, or hospital length of stay between the pre- (n=432) and post-protocol modification (n=407) groups. Bleeding complications did not increase in the post-protocol group, including intraoperative blood loss (50 vs 25cc), the total number of transfusions (9.0 vs 6.0 units), and GI bleeding events (0.7 vs 0.2%) (all p>0.05). Most patients receiving enoxaparin 40mg twice daily achieved an initial therapeutic level based on peak anti-Xa measurements (46.5%), yet the rate of venous thromboembolisms between pre- and post-protocol groups was not statistically different (1.4 vs 0.7%, p=0.5072). Factors associated with an initial sub- or supratherapeutic peak anti-Xa level were percent total body surface area, weight, body mass index, and creatinine clearance. Overall, this study demonstrated that a higher dose of enoxaparin (40mg twice daily) with peak anti-Xa level adjustments was safe in burn-injured patients and necessary to obtain therapeutic levels of chemoprophylaxis.","PeriodicalId":15205,"journal":{"name":"Journal of Burn Care & Research","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142807184","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0