Burns最新文献

{"title":"Tourniquet burns: Best practices for alcohol skin preparation.","authors":"John Warner-Levy, James D Bedford, Karl Walsh","doi":"10.1016/j.burns.2024.09.013","DOIUrl":"https://doi.org/10.1016/j.burns.2024.09.013","url":null,"abstract":"","PeriodicalId":50717,"journal":{"name":"Burns","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142367316","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"To BAL or not to BAL, that is the question\": Variations in smoke inhalation injury guidelines from burn units and centres in England, Scotland and Wales.","authors":"Ganesh Rajaratnam, Alexander J Baldwin","doi":"10.1016/j.burns.2024.09.012","DOIUrl":"https://doi.org/10.1016/j.burns.2024.09.012","url":null,"abstract":"<p><strong>Aim: </strong>To evaluate variations in diagnostic criteria and management recommendations for smoke inhalation injury (SII) amongst the burn networks of England, Scotland, and Wales.</p><p><strong>Methods: </strong>A descriptive cross-sectional study examining SII guidelines provided by adult burn units and centres in England, Scotland and Wales.</p><p><strong>Results: </strong>All 16 adult burn units and centres responded. Fourteen (87.5 %) had guidelines. Due to sharing of guidelines, ten unique guidelines were assessed. Diagnostic criteria showed variability with no universal criterion shared amongst guidelines. Bronchoscopy was recommended by 90 % of guidelines, but the timing varied. The use of bronchoscopic scoring systems was recommended by four guidelines. Bronchoalveolar lavage (BAL) was recommended by four, with considerable variation in frequency and choice of lavage fluid. All guidelines advised at least one nebulised agent: heparin (n = 8); N-acetyl cysteine (NAC) (n = 8); or salbutamol (n = 8). All guidelines included advice on carbon monoxide poisoning; however, carboxyhaemoglobin (COHb) cut-off levels for treatment varied (5 % [n-4], 10 % [n = 3], 15 % [n = 1]). All recommended high-flow oxygen. Seven (70 %) guidelines offered guidance on cyanide poisoning. Reduced/altered consciousness was the only consistent diagnostic criterion. Five (50 %) guidelines provided intubation guidance, emphasising the role of a 'senior clinician' as the intubator. Ventilatory guidance appeared in eight guidelines, focusing on lung protective ventilation (n = 8); oxygenation goals (n = 3); and permissive hypercapnia (n = 3). Within lung-protective ventilation, advice on tidal volume (6, or 6-8 ml/kg) and plateau pressures (>30 cmH2O) were presented most commonly (n = 7).</p><p><strong>Conclusion: </strong>This study has outlined the substantial variations in guidance for the management of SII. The results underscore the need for a national guideline outlining a standardised approach to the diagnosis and management of SII, within the limitations of the current evidence.</p>","PeriodicalId":50717,"journal":{"name":"Burns","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142367315","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Has the energy poverty crisis fuelled a rise in hot water bottle burn injuries within the United Kingdom?","authors":"Mr Howard Chu, Laveena Yarlagadda, Mr Christopher Wearn","doi":"10.1016/j.burns.2024.09.014","DOIUrl":"https://doi.org/10.1016/j.burns.2024.09.014","url":null,"abstract":"<p><strong>Introduction: </strong>There are an estimated 10 million hot water bottles (HWB) currently in use within the United Kingdom (UK), and HWB related burn injuries represent a significant resource burden to UK Burns Services. These injuries can be caused through a variety of mechanisms including scalds sustained when filling the bottle or scalds from leaking or rupture. The fuel poverty crisis started in February 2022 leading to an estimated six-fold increase in alternative sources of heating, in particular hot water bottles. In this study, we wish to understand the impact that this may have had upon burn injuries sustained by these products.</p><p><strong>Methods: </strong>All hot water bottle (HWB)-related injuries sustained January 2014 - February 2023 were retrieved from the UK International Burn Injury Database (IBID). Data were collected on patient demographics, injury mechanism, anatomical location, and clinical outcomes. The data were collated and analysed; statistical analysis was performed using R StudioTM. Patient levelling costs were also incorporated to enable translation of these data into healthcare costs.</p><p><strong>Results: </strong>A total of 5944 HWB-related burn injuries were recorded in the IBID database in England and Wales, from 2014 to 2023, with a mean of 594 (SD 146.2) burn injuries annually, costing an estimated £ 12.7 million. There were 423 burn injuries sustained from HWB in winter 2022 compared to 295 in winter 2021, representing a 43.4 % increase over one year, with a corresponding increase of 43.1 % in the number of patients managed in an outpatient setting. The largest increase in burn incidence between winter 2021 and winter 2022 was seen in children (0-16 years old) and older adults (greater than 65 years old) with a rise of 60.3 % (n = 41) and 68.5 % (n = 37) respectively.</p><p><strong>Conclusion: </strong>Our epidemiological study on hot water bottle (HWB)-related burn injuries within the United Kingdom has shown that the dramatic rise in fuel prices, which sparked the fuel poverty crises, has coincided with a 43.4 % increase in HWB burns incidence on the health service in that year alone. This alarming rise in HWB-related injuries highlights the continued need for targeted public awareness campaigns to ensure a safe and proper use of these devices.</p>","PeriodicalId":50717,"journal":{"name":"Burns","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142331740","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Randomized, controlled, within-patient, single-blinded pilot study to evaluate the efficacy of 12-weeks of endermotherapy with adult burn survivors.","authors":"Bernadette Nedelec, Zoë Edger-Lacoursière, Nathalie Gauthier, Elisabeth Marois-Pagé, Stéphanie Jean","doi":"10.1016/j.burns.2024.09.008","DOIUrl":"https://doi.org/10.1016/j.burns.2024.09.008","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Vacuum massage, or endermotherapy, is applied to scar tissue with the primary therapeutic goal of promoting structural or physiological changes. These changes are intended to enhance pliability, enabling the skin to possess the strength and elasticity required for normal mobility. The advantage of vacuum massage compared to therapist-generated manual massage is that it provides a standardized dosage using rollers and suction valves to mobilize the tissue. However, research documenting and supporting its impact on post-burn hypertrophic scar is lacking. Thus, this study was designed to objectively characterize the changes in scar elasticity, erythema, melanin, thickness, and transepidermal water loss immediately after a vacuum massage session and after a 12-week course of treatment compared to intra-individual matched control scars.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We conducted a prospective, randomized, controlled, within-patient, single-blinded clinical trial, initially designed as a fully-powered study but limited to a pilot study due to COVID-19 restrictions. Nineteen burn survivors consented to participate and 16 completed the study. Two homogeneous, intra-individual scars were randomized to usual care control or vacuum massage therapy plus usual care. Vacuum massage interventions were provided by a certified massage therapist three times per week for 12 weeks. Scar characteristics were evaluated every four weeks immediately before and after mechanical massage treatment. The evaluations included measurements of elasticity (Cutometer), erythema and melanin (Mexameter), transepidermal water loss (TEWL) (Tewameter), and thickness (high-frequency ultrasound). Linear mixed-model analyses were performed to test for immediate and long-term treatment effects.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The ANOVA analyses revealed a non-significant time:treatment interaction for elasticity, erythema, melanin, thickness, or TEWL. There was a significant increase in elasticity and erythema and a decrease in TEWL in both the control and treatment sites over time with consistent standard care. However, there was no statistically significant immediate or long-term treatment effect for any of the skin characteristics. Nonetheless, the mean participant satisfaction was 4/5 (SD = 1.5) and the mean participant perception of effectiveness was 8/10 (SD = 1.9).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;This pilot study did not find a treatment benefit of vacuum massage therapy for elasticity, erythema, melanin, thickness or TEWL, but it did find an improvement with time in elasticity, erythema and TEWL. Despite the lack of objective improvement of the treated scar site, participants were satisfied with the results and believed vacuum massage was very effective. Further high-quality research is required to better inform clinicians patient education and treatment decisions for this costly, burdensome treatment approach that has high participant satisfa","PeriodicalId":50717,"journal":{"name":"Burns","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142331780","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of length of hospital stay, total body surface area burned, and Carbapenem-Resistant Klebsiella pneumoniae infection in burn patients: A retrospective study.","authors":"Qiang Li, Xu Zhang, Yanhua Ding, Ya Sun, Jiangxia Zhang","doi":"10.1016/j.burns.2024.09.006","DOIUrl":"https://doi.org/10.1016/j.burns.2024.09.006","url":null,"abstract":"<p><strong>Background: </strong>The specific relationships between total body surface area burned (TBSA), length of stay (LOS), and carbapenem-resistant Klebsiella pneumoniae (CRKP) infection remain unclear. This study aimed to explore the relationship between TBSA and CRKP infection and to examine whether LOS mediates the association between TBSA and the risk of CRKP infection.</p><p><strong>Methods: </strong>We retrospectively collected the clinical data of adult burn patients admitted to Nanyang Nanshi Hospital between 2021 and 2023. We used multivariate logistic regression analysis to study the risk factors for CRKP infection; restricted cubic spline analysis to investigate the associations between TBSA, LOS, and CRKP infection; and mediation analysis to examine whether LOS mediated the association between TBSA and CRKP infection.</p><p><strong>Results: </strong>A total of 178 subjects were included in the study; 104 (58.4 %) were male, and the median age was 47 (33-59) years. Thirty-one (17.4 %) subjects developed CRKP infection. Both TBSA and LOS showed a linear positive correlation with the risk of CRKP infection. The LOS mediated the association between TBSA and incident CRKP infection, with a proportion of 17.6 %.</p><p><strong>Conclusion: </strong>The risk of CRKP infection linearly increased as TBSA or LOS increased, and LOS mediated approximately 20 % of the total association between TBSA and CRKP infection.</p>","PeriodicalId":50717,"journal":{"name":"Burns","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142331726","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the Editor regarding \"Effect of fluid resuscitation with albumin on mortality in patients with severe burns: A nationwide inpatient data analysis\".","authors":"Ayami Shigeno, Akinori Osuka","doi":"10.1016/j.burns.2024.09.007","DOIUrl":"https://doi.org/10.1016/j.burns.2024.09.007","url":null,"abstract":"","PeriodicalId":50717,"journal":{"name":"Burns","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142331777","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High-risk burn patients might be hospitalized more during the COVID-19 period than pre-COVID period.","authors":"Payman Salamati, Vafa Rahimi-Movaghar","doi":"10.1016/j.burns.2024.09.005","DOIUrl":"https://doi.org/10.1016/j.burns.2024.09.005","url":null,"abstract":"","PeriodicalId":50717,"journal":{"name":"Burns","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142331741","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Potential therapeutic effects of topical recombinant human erythropoietin on burn wound healing: A preliminary randomized double-blind controlled clinical trial.","authors":"Fatemeh Saghafi, Farhad Mohammadi, Farahnaz Hoseinzade, Maryam Jafarpoor, Mohammad Jalili Manesh, Adeleh Sahebnasagh","doi":"10.1016/j.burns.2024.09.004","DOIUrl":"https://doi.org/10.1016/j.burns.2024.09.004","url":null,"abstract":"<p><strong>Background: </strong>Burn injuries can cause significant mortality and morbidity. This study aimed to evaluate the efficiency of topical recombinant human erythropoietin (rhEPO) on enhancing burn wound healing.</p><p><strong>Methods: </strong>In this randomized double-blind controlled clinical trial, we enrolled 40 participants aged 18 years and older who were referred to a burn center during the first 24 h of burning. The participants with no concurrent comorbidities had superficial and deep second-degree burns, no respiratory burns, no face and perineum burns, no keloid formation, or a healed, fully epithelialized, hypertrophic burn scar. Topical rhEPO or nitrofurazone/Vitamin A was administered every other day, and the patients were scheduled for follow-up visits to receive wound cleansing, debridement, and dressing changes. Burn wound healing response to treatment was measured as the study main outcome.</p><p><strong>Results: </strong>At the second follow-up visit, all parameters were significantly lower in the rhEPO group compared with the control group except for itchiness. The results of the next two follow-up sessions were also the same. The total value of the modified Vancouver Scar Scale (VSS) at days 5, 7, and 14 was significantly lower in the rhEPO group compared with the routine of care group. Trial Registry Date: 2022-03-02, Trial Registry number: IRCT20190810044500N23 CONCLUSIONS: The results of the present study suggested that topical rhEPO is a potential option in burn wounds and patient satisfaction, without causing intolerable side effects.</p>","PeriodicalId":50717,"journal":{"name":"Burns","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142331778","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Illusory movements for immobile patients with extensive burns (IMMOBILE): A randomized, controlled, cross-over trial.","authors":"Bohumil Bakalář, Magdalena Švecová, František Duška, Marcela Grünerová-Lippertová, Tomáš Urban, Petr Waldauf, Robert Zajíček","doi":"10.1016/j.burns.2024.09.003","DOIUrl":"https://doi.org/10.1016/j.burns.2024.09.003","url":null,"abstract":"<p><strong>Introduction: </strong>Patients who have sustained extensive burns frequently exhibit substantial damage to skeletal muscle and associated complications. The rehabilitation of these patients can be challenging due to the nature of the injury and the subsequent complications. Nevertheless, there is a possibility that functional proprioceptive stimulation (illusory movements) may facilitate effective rehabilitation in patients with limited physiotherapy options. Nevertheless, this approach has yet to be tested in patients with burn injuries.</p><p><strong>Material and methodology: </strong>A prospective, randomised, crossover trial was conducted at a burn centre in a tertiary teaching hospital. The objective was to assess the effects of illusory movements on energy metabolism, insulin sensitivity, and skeletal muscle biology in adult critically ill patients with deep burns covering 30 % or more of the total body surface area. Two 30-minute daily sessions of functional proprioceptive stimulation were administered in addition to the standard physical therapy or physical activity regimen. Subsequently, the patients proceeded to the next stage of the trial, which involved a two-week crossover period.</p><p><strong>Measurements and main results: </strong>Daily indirect calorimetry and calculation of nitrogen balance. Skeletal muscle biopsies from vastus lateralis for high resolution respirometry and euglycemic clamps to assess whole body glucose disposal were performed three times: at baseline and then fortnightly after each intervention period. The intervention was feasible and well tolerated in both early and late stages of burn disease. It did not change energy expenditure (mean change -33 [95 % CI: -292;+227] kcal .24 h^-1, p = 0.79), nitrogen balance (+2.0 [95 % CI: -3.1;+7.1] g N .1.73 m^-2 BSA .24 h^-1), or insulin sensitivity (mean change of insulin-mediated glucose disposal -0.33 [95 % CI: -1.18;+0.53] mmol.h^-1). At the cellular level, the intervention increased the capacity of mitochondria to synthesize ATP by aerobic phosphorylation and tended to increase mitochondrial coupling. Functional capacities of fatty acid oxidation and electron transfer chain complexes I, II, and IV were unaffected.</p><p><strong>Conclusions: </strong>Compared to physical therapy alone, two daily sessions of functional proprioceptive stimulation in addition to usual physical therapy in patients with extensive burns did not change energy expenditure, insulin sensitivity, nitrogen balance, or energy substrate oxidation. At cellular level, the intervention improved the capacity of aerobic phosphorylation in skeletal muscle mitochondria. Clinical effects remain to be demonstrated in adequately powered trials.</p>","PeriodicalId":50717,"journal":{"name":"Burns","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142331776","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Doctor-patient dynamics: A critical analysis.","authors":"Shuang Ma, Xiu-Hang Zhang","doi":"10.1016/j.burns.2024.09.002","DOIUrl":"https://doi.org/10.1016/j.burns.2024.09.002","url":null,"abstract":"","PeriodicalId":50717,"journal":{"name":"Burns","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142378545","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}