The Journal of burn care & rehabilitation最新文献

{"title":"Respiratory care of the burn patient.","authors":"J. McCall, T. Cahill","doi":"10.1097/01.BCR.0000162150.32733.23","DOIUrl":"https://doi.org/10.1097/01.BCR.0000162150.32733.23","url":null,"abstract":"","PeriodicalId":22626,"journal":{"name":"The Journal of burn care & rehabilitation","volume":"58 1","pages":"200-6"},"PeriodicalIF":0.0,"publicationDate":"2005-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80523128","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Altering metabolism.","authors":"Clifford T Pereira,&nbsp;Kevin D Murphy,&nbsp;David N Herndon","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>A significant proportion of the mortality and morbidity of severe burns is attributable to the ensuing hypermetabolic response. This response can last for as long as 1 year after injury and is associated with impaired wound healing, increased infection risks, erosion of lean body mass, hampered rehabilitation, and delayed reintegration of burn survivors into society. Pharmacologic and nonpharmacologic strategies may be used to reverse the catabolic effect of thermal injury. Nonpharmacologic strategies include early excision and wound closure of burn wound, aggressive treatment of sepsis, elevation of the environmental temperature to thermal neutrality (31.5 +/- 0.7 degrees C), high carbohydrate, high protein continuous enteral feeding, and early institution of resistive exercise programs. Pharmacologic modulators of the postburn hypermetabolic response may be achieved through the administration of recombinant human growth hormone, low-dose insulin infusion, use of the synthetic testosterone analog, oxandrolone, and beta blockade with propranolol. This review article discusses these modulators of postburn metabolism.</p>","PeriodicalId":22626,"journal":{"name":"The Journal of burn care & rehabilitation","volume":"26 3","pages":"194-9"},"PeriodicalIF":0.0,"publicationDate":"2005-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25097919","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The burn edema process: current concepts.","authors":"Robert H Demling","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Massive tissue edema after thermal injury is a well-recognized entity. Although this process is responsible for the patient's large fluid needs during resuscitation and also for local problems, such as a compartment syndrome, there have been no effective treatment modalities introduced into clinical care to control the degree of edema. A review of what is now known about the edema process is presented here, including attempted prevention and treatment modalities. The pathogenesis involves changes in most of the physical forces controlling fluid flux across the capillary and also how fluid accumulates in the interstitium. Increased capillary permeability to protein is but one of these changes. The presence of an initial profound negative interstitial pressure \"sucking\" fluid into the tissues and a marked increase in interstitial space compliance are equally important components. A host of mediators, especially oxidants, have been reported to cause these physical changes, and some mediator inhibitors appear to be of benefit, especially antioxidants. However, few clinical trials, aimed at decreasing edema, have been performed. With these new insights into the edema process, future prevention and treatment modalities can be developed.</p>","PeriodicalId":22626,"journal":{"name":"The Journal of burn care & rehabilitation","volume":"26 3","pages":"207-27"},"PeriodicalIF":0.0,"publicationDate":"2005-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25097812","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reliability testing of a new scar assessment tool, Matching Assessment of Scars and Photographs (MAPS).","authors":"Margot Masters,&nbsp;Margaret McMahon,&nbsp;Birgit Svens","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>A new scar-assessment tool, the Matching Assessment of Scars and Photographs (MAPS), which uses a set of reference photographs, a numeric scale, and location technique, was tested for its reliability in two stages. First, using five adults, three raters assessed 32 burns scars twice within 3 days. Subsequently, reliability was tested during a 6-month time frame, emphasizing the process of localizing test areas as scars changed and raters forgot the previous assessment. Three raters, from a pool of five, each made three assessments on 29 scars in seven subjects, on average 8 weeks apart. Inter-rater reliability was tested, using Kendall's Tau C and intraclass correlations, respectively, for stages 1 and 2. Agreement was good for border height (0.63-0.70 and 0.78), moderate to good for thickness (0.60-0.74 and 0.81), and good for color (0.55-0.71 and 0.79), whereas for surface it was fair (0.25-0.38 and 0.40). The localization technique was reliable (accuracy within 3 mm) in 93% to 96% of recordings. The MAPS tool is considered ready for clinical use.</p>","PeriodicalId":22626,"journal":{"name":"The Journal of burn care & rehabilitation","volume":"26 3","pages":"273-84"},"PeriodicalIF":0.0,"publicationDate":"2005-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25098377","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of cytotoxicity and antimicrobial activity of Acticoat Burn Dressing for management of microbial contamination in cultured skin substitutes grafted to athymic mice.","authors":"A. P. Supp, A. Neely, D. Supp, G. Warden, S. Boyce","doi":"10.1097/01.BCR.0000162152.28330.6C","DOIUrl":"https://doi.org/10.1097/01.BCR.0000162152.28330.6C","url":null,"abstract":"Cultured skin substitutes (CSS) have become a useful adjunctive treatment for closure of burn wounds, but CSS are avascular and remain susceptible to microbial destruction longer than split-thickness skin grafts. Irrigation of CSS grafted to burn wounds with a topical antimicrobial solution (TAS) has been shown to promote engraftment of CSS, but TAS usage has potential limitations. Acticoat Burn Dressing (Acticoat; Westaim Biomedical, Exeter, NH) is a silver-coated barrier dressing reported to exhibit antimicrobial activity and to reduce infection in partial-thickness and full-thickness wounds. This study evaluated the cytotoxicity of Acticoat with CSS and the efficacy of Acticoat for the management of microbial contamination in CSS grafted to full-thickness wounds in athymic mice. The cytotoxicity of Acticoat was assessed in preliminary studies after 1 week of exposure to CSS during in vitro maturation or healing on wounds in athymic mice. Histologies were analyzed and cellular viability in the CSS was determined by MTT conversion on days 0, 1, and 7 of Acticoat exposure. At 1, 2, 3, and 4 weeks after grafting, wounds were traced, and areas of healing CSS were calculated by image analysis. At 4 weeks, wound biopsies were evaluated and scored for engraftment of human cells. In a subsequent study, wounds were inoculated with strain SBI-N of Pseudomonas aeruginosa at 1 x 10(5) cfu/wound before the application of CSS or inoculated onto the surface of Acticoat. At 4 weeks, swab cultures were collected from the surface of CSS and scored for the presence of SBI-N. Statistical significance was accepted at the 95% confidence level (P <.05). The data show that exposure in vitro of CSS to Acticoat was cytotoxic within 1 day, but 1 week of exposure in vivo did not injure CSS or inhibit wound healing. Contaminated wounds treated with Acticoat healed similarly to control treatments, with comparable rates of engraftment, and detection of SBI-N on the surface of only one graft. No SBI-N was detected on CSS after inoculation onto the surface of Acticoat. These results suggest that Acticoat may be suitable as a protective dressing to reduce environmental contamination of CSS, if used in conjunction with additional antimicrobials to control organisms present in the wound.","PeriodicalId":22626,"journal":{"name":"The Journal of burn care & rehabilitation","volume":"68 1","pages":"238-46"},"PeriodicalIF":0.0,"publicationDate":"2005-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91360477","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pattern of dysphagia recovery after thermal burn injury.","authors":"C. Dubose, M. Groher, G. Mann, D. Mozingo","doi":"10.1097/01.BCR.0000162124.60643.BB","DOIUrl":"https://doi.org/10.1097/01.BCR.0000162124.60643.BB","url":null,"abstract":"Providing nutritional support after thermal burn injury is a critical element in achieving successful patient outcomes. The medical records of 28 patients admitted to an acute care burn unit and referred to speech pathology for a swallowing evaluation were reviewed for patterns of dysphagia care. Results revealed a strong positive linear relationship between percent body burns (r = .71), number of days with a tracheostomy (r = .85), number of days on the ventilator (r = .94) and days to oral feeding. These data can be used for comparison with other models of care, such as early identification and intervention for dysphagia by the speech pathologist during the acute phase of recovery.","PeriodicalId":22626,"journal":{"name":"The Journal of burn care & rehabilitation","volume":"12 1","pages":"233-7"},"PeriodicalIF":0.0,"publicationDate":"2005-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87975996","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of moist exposed burn ointment on burns.","authors":"Hong-Qi Zhang,&nbsp;Tsui-Pik Yip,&nbsp;Irene Hui,&nbsp;Vincy Lai,&nbsp;Ann Wong","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>In this study, we sought to test the medical efficacy of a Chinese medical herb product, moist exposed burn ointment (MEBO), on wound healing rate and infection control in burn injury. Standardized deep burn wounds were created on the back skin of rats by applying a hot brass bar for 12 to 18 seconds. MEBO was applied four times per day and compared with petroleum jelly, silver sulfadiazine, and dry exposure therapy. Under such a controlled setting, although MEBO had a better wound healing rate than the dry exposure treatment, it did not show the medical advantage statistically, as has been claimed, over the other two treatments (P > .05), either in terms of wound healing rate or bacterial control. We conclude that the MEBO is not suitable for deep burn wound treatment, particularly when infection is a concern.</p>","PeriodicalId":22626,"journal":{"name":"The Journal of burn care & rehabilitation","volume":"26 3","pages":"247-51"},"PeriodicalIF":0.0,"publicationDate":"2005-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25097815","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A case report of phaeohyphomycosis caused by Cladophialophora bantiana treated in a burn unit.","authors":"B. Arnoldo, G. Purdue, K. Tchorz, J. Hunt","doi":"10.1097/01.BCR.0000162143.29628.A7","DOIUrl":"https://doi.org/10.1097/01.BCR.0000162143.29628.A7","url":null,"abstract":"Black molds are a heterogeneous group of fungi that are distributed widely in the environment and that occasionally cause human infection. The spectrum of disease includes mycetomas, chromoblastomycosis, sinusitis, and superficial, cutaneous, subcutaneous, and systemic phaeohyphomycosis. Cladophialophora bantiana, an agent of phaeohyphomycosis, causes rare infections mainly of the central nervous system. Extracerebral involvement is uncommon, and only a few cases have been reported. We present the case of a 32-year-old immunosuppressed female who developed a cutaneous phaeohyphomycosis from C. bantiana. The patient was treated in a burn unit with wound care, surgical excision, grafting, and itraconazole. Patients with complex fungal infections represent yet another population with specialized needs that are adequately met in a verified burn center.","PeriodicalId":22626,"journal":{"name":"The Journal of burn care & rehabilitation","volume":"101 1","pages":"285-7"},"PeriodicalIF":0.0,"publicationDate":"2005-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80429992","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Methamphetamine laboratory explosions: a new and emerging burn injury.","authors":"Ariel P Santos,&nbsp;Ashley K Wilson,&nbsp;Carlton A Hornung,&nbsp;Hiram C Polk,&nbsp;Jorge L Rodriguez,&nbsp;Glen A Franklin","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The proliferation of clandestine methamphetamine laboratories (meth labs) as a result of the growing popularity of the drug has resulted in an increasing incidence of burn injuries associated with laboratory accidents. We undertook this study to characterize these injuries. Fifteen consecutive patients were identified and case-matched by age and TBSA to 45 control subjects. Most meth lab patients were men, Caucasian, unemployed, and positive for polysubstance abuse. Resuscitation requirements were 1.8 times greater in these patients. There was a higher incidence of inhalational injury corresponding to higher intubation and tracheostomy rate and longer ventilator days among meth lab patients. The rate of nosocomial pneumonia, skin graft loss, and mortality were not different between the two groups. Meth lab injury is unique and requires more critical care resources. It also is associated with lack of insurance coverage and poor follow-up after injury. This injury has a significant impact not only on patients but also on the healthcare system.</p>","PeriodicalId":22626,"journal":{"name":"The Journal of burn care & rehabilitation","volume":"26 3","pages":"228-32"},"PeriodicalIF":0.0,"publicationDate":"2005-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25097814","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A case report of phaeohyphomycosis caused by Cladophialophora bantiana treated in a burn unit.","authors":"Brett D Arnoldo,&nbsp;Gary F Purdue,&nbsp;Kathryn Tchorz,&nbsp;John L Hunt","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Black molds are a heterogeneous group of fungi that are distributed widely in the environment and that occasionally cause human infection. The spectrum of disease includes mycetomas, chromoblastomycosis, sinusitis, and superficial, cutaneous, subcutaneous, and systemic phaeohyphomycosis. Cladophialophora bantiana, an agent of phaeohyphomycosis, causes rare infections mainly of the central nervous system. Extracerebral involvement is uncommon, and only a few cases have been reported. We present the case of a 32-year-old immunosuppressed female who developed a cutaneous phaeohyphomycosis from C. bantiana. The patient was treated in a burn unit with wound care, surgical excision, grafting, and itraconazole. Patients with complex fungal infections represent yet another population with specialized needs that are adequately met in a verified burn center.</p>","PeriodicalId":22626,"journal":{"name":"The Journal of burn care & rehabilitation","volume":"26 3","pages":"285-7"},"PeriodicalIF":0.0,"publicationDate":"2005-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25098376","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}