ISSN:0273-8481    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Morphine sulfate (MS) pharmacokinetics was evaluated in seven patients with a mean body surface area burn of 21.5% to ascertain a rational basis for the management of pain in patients with burns. Treatments included a MS constant rate infusion followed by an oral MS solution (MS-OS) (5 to 15 mg administered every 3 hours) and then a 30 mg MS-controlled release tablet (MS-CR) every 8 hours. Each treatment was separated by a washout period when sampling of morphine was done. The apparent terminal half-life for MS-OS was 3 hours, which is similar to that of patients without burns, but the apparent terminal half-life for the MS-CR in patients with burns was substantially longer at 14.7 hours. The mean time to reach peak concentration for MS-CR was delayed relative to MS-OS 1.4 versus 0.5 hours, and the peak concentration was attenuated. The mean release time of the MS for the CR tablet is about 15 hours. The renal clearances of the MS-CR (114 ml/min) and MS-OS (147 ml/min) were less than the measured creatinine clearance (177 ml/min) but greater than the creatinine clearance (106 ml/min) predicted for a healthy individual. The prolonged release of MS-CR makes the MS-CR a good choice in the management of pain in patients with burns on an 8- to 12-hour dosing schedule, even though the patient might exhibit an increased clearance.

ISSN:0273-8481    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

A dorsal skin flap chamber model was developed for analysis of the microvascular response to moderate intensity local thermal burns. Fluorescein isothiocyanate tagged 70,000 d dextran was introduced to visualize the extravasation and interstitial transport of macromolecules at the burn site. Contact burns 0.5 cm in diameter were affected by touching a thermostated metal rod onto the exposed epidermal side of die chamber preparation. All burns were of 5-second duration at temperatures between 55° C and 70° C. Postburn leakage of the fluorescein-labeled probe was monitored at numerous sites in the preparation on a fluorescent microscope equipped with a low-light-level intensified silicon intensifier target video camera and recorded on tape for subsequent quantitative analysis. Selected scenes were digitized and subjected to a sequence of computer-image processing operations to extract quantitative information about the concentration distribution and net accumulation of dextran in the interstitial space as a function of postburn time. A diffusion model based on cylindrical geometry was fit to the concentration profile data at each site analyzed, and an apparent diffusion coefficient describing the interstitial transport process was determined. The interstitial transport increased with burn temperature up to a threshold of 70° C, where other factors resulted in significant reduction in the loss of fluorescent macromolecule from the vasculature.

ISSN:0273-8481    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Metabolic and temperature data were collected for 56 patients with burns managed with four wound care protocols. Group I (n=7) treated with dressings and variable ambient temperature selected for patient subjective comfort; group II (n=7) managed without dressings and variable ambient temperature for patient comfort; group III (n=6) no dressings, ambient temperature of 25° C and the output of electromagnetic heaters adjusted for patient comfort; group IV (n=36) dressings and ambient temperature of 28° C. All groups were cold challenged: groups I and II by sequentially lowering ambient temperature, group III by decreasing die electromagnetic heater output, and group IV by removing dressings with ambient temperature remaining at 28° C. Only groups II and IV demonstrated correlation between percent body surface area burn and heat production. The slope of the regression for group IV neutral was significantly less than that for group IV cold and group II neutral and cold. The relationship between percent body surface area burn and rectal temperature for groups I, II, and III neutral was equal to .03° C increase in rectal temperature per 1% body surface area burn (Y=37 + 0.03; r=0.74; df 18; p<0.01) and was not significantly different when cold. This predicts a 1.5° C increase in rectal temperature for a patient with a 50% body surface area burn who does not have sepsis. The average slope of the combined regression for bandaged groups I and IV for percent increase in heat production per 1° C increase in rectal temperature is 17% neutral and cold. This proportionality constant is real and should be considered additive to the increment in heat production driven by increased heat loss.

ISSN:0273-8481    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Proteolytic (caseinolytic) activity in burn wound exudates was screened over the range pH 5.3 to 8.4. Although activity was greatest at pH 8.4 in four of seven exudates, individual differences indicated that different proteases predominate in the local environment of the wound. Paired exudate and serum samples were compared with regard to fibrin degradation products and three protease inhibitors: antithrombin III, a1-protease inhibitor, and a2-antiplasmin. Fibrin degradation products concentration was higher in exudates than in paired sera, indicating the wound as the source of circulating fibrin degradation products rather than intravascular coagulation followed by fibrinolysis. In contrast, all three protease inhibitors exhibited higher concentrations in serum than in the paired exudate. The serum/exudatc ratio for AT III differed significantly from that for a1-protease inhibitor and a2-antiplasmin, and the ratio of two inhibitors in serum differed from the ratio of the same two inhibitors in the exudate in two of three comparisons. These findings emphasize the importance of exudate examinations as a reflection of events in the wound itself. The importance of microenvironments is invoked to account for the significant exudate fibrin degradation products titers, which are seen despite the presence of antithrombin III, which could inhibit coagulation, and the presence of a2-antiplasmin, which could inhibit fibrin degradation.

ISSN:0273-8481    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Posterior skin graft donor sites furnish large areas of skin for wound coverage, but the sites frequently are management problems. The wounds tend to become moist and to develop excessive drainage and fluid accumulation that may interfere with adherence of dressings, including our preferred donor site dressing, Biobrane II (red label, large pore). We studied the use of specialty airflow beds for improving the outcome of posterior donor sites. We evaluated 50 patients aged 1 to 69 years (mean 29.45 years) with posterior skin graft donor sites of the back, thigh, or buttocks that were covered with Biobrane II. Sites ranged in size from 3% to 13% body surface area (mean 8.34%). Forty patients were placed on a FluidAir Plus bed, and 10 were placed on air-filled pillow therapy beds (five on KinAir III, five on Therapulse) (Kinetic Concepts, Inc.) All patients were kept in the supine position. We evaluated six criteria: drainage, fluid accumulation under Biobrane, infection, days until Biobrane separated, days until epithelialization, and days of specialty bed usage. We related these criteria to nursing-care actions that interfere with airflow and prevent the drying action of the bed, such as use of a “linen saver” under the patient in the area of the donor site, a foam wedge under the back, and dressings applied over the Biobrane. Most donor sites had no complications. Donor site infections developed in six patients. Five of these patients had fluid accumulation under the Biobrane, necessitating early removal. Fluid accumulated under the Biobrane in 21 patients; nine of these incidences were related to a nursing-care action that impeded airflow. When fluid accumulation and/or infection occurred, the patient was continued on one of the airflow beds. Mean time until donor site healing occurred was 13.78 days, and mean duration of bed use was 11.1 days. Use of specialty beds provides satisfactory healing of extensive posterior donor site wounds.

ISSN:0273-8481    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

To investigate the role of hydrotherapy in the treatment of patients with burns, a survey was conducted of the use of hydrotherapy in Canada and the United States as part of an intensive investigation into the causes of Pseudomonas aeruginosa infections in burn injury. Results of the survey conducted indicate that hydrotherapy continues to be an important part of burn wound care in most (94.8%) burn centers in North America. Of the burn centers that use hydrotherapy, 81.4% continue to immerse patients, 82.8% perform hydrotherapy on all patients with burns regardless of total body surface area, and 86.9% continue with hydrotherapy throughout the entire phase of the patient's hospitalization. Routine culturing of the hydrotherapy equipment is standard procedure in 49.7% of the units surveyed, and culturing of die water supply to the equipment on a regular basis is done in only 18.6% of those burn units regularly using hydrotherapy. Pseudomonas aeruginosa was identified as the most common, major cause of sepsis in 52.9% of the burn units surveyed, Staphylococcus auretts in 25.5%, and Candida albicans in 5.2%. This survey demonstrates the extensive use of hydrotherapy in North American burn units and the concern for serious infections in patients with burns from gram-negative organisms such as Psendomonas species. With the increasing number of reports of Pseudomonas infections related to the use of hydrotherapy equipment, the importance for further investigation into burn wound care with and without hydrotherapy, infection rates, and cost analysis appears to be indicated.

ISSN:0273-8481    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Among 39 patients with burns evaluated a mean of 12 months after hospital discharge, 38% met DSM-III-R criteria for post-traumatic stress disorder (PTSD) for at least 1 month. With proposed DSM-IV criteria, 43% met criteria for past or current PTSD. Analysis of specific symptom clusters of PTSD revealed that 74% of patients had been affected by a reexperience symptom for at least 1 month, but only 30% were currently experiencing flashbacks. No correlation was found between several clinical correlates (TBSA, length of hospitalization, and age) and development of PTSD. There was no correlation between presence of a DSM-III-R psychiatric diagnosis at the time of hospitalization and later development of PTSD and no correlation between whether or not a psychiatric diagnosis emerged during hospitalization and later development of PTSD. Finally, patients who had injuries that they could not prevent were no more likely to experience PTSD.

ISSN:0273-8481    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Burn injury inhibits lipoprotein lipase, which leads to an impeded clearance of triglycerides from the plasma and an increase in serum triglycerides. Intestinal brush border lipase, which hydrolyzes triglyceride to free fatty acids and is essential for absorption of triglycerides from the gastrointestinal tract, could also be inhibited by burn injury. In thermally injured rats, the absorption and oxidation of enterally administered14C-palmitate triglyceride, brush border lipase activity, and small-intestinal and colonic content of fat were determined. Absorption of14C-palmitate triglyceride and production of14CO2were reduced 50% 18 hours after injury (p <.01). In addition, brush border lipase activity was reduced 50% (p <.01). Because brush border lipase function is essential to the proper absorption of enterally administered fat, inhibition of intestinal lipase could be an important factor in enteral diet effectiveness.

ISSN:0273-8481    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

This is the first study of of posttraumatic stress symptoms in parents (24 mothers and one father) of children with burns. The purpose of the study was to determine what factors relate to parental posttraumatic stress disorder (PTSD). Because the sample is all modiers, except for one father, the conclusions are about mothers. Through use of the Structured Clinical Interview for DSM-III-R, symptoms were determined as occurring from the time of the burn injury until 1 month before the interview (past), 1 month before the interview only (present), or from die date of the burn trauma up to and including 1 month before the interview (past and present). By Structural Clinical Interview criteria, 52% of die mothers had past PTSD, with four (31%) of those mothers having present PTSD symptoms. Eleven mothers and the one father reported neither past nor present PTSD. Multiple regression analysis revealed that larger burns were more strongly related to present PTSD symptoms than were proximity, social support, or perceived stress. Additional findings indicated that mothers with more than one child burned and those mothers who were burned diemselves met diagnostic criteria for PTSD. Implications are that posttraumatic stress symptoms can be disruptive to a mother feeling capable of caring for her child with burns after the injury. Individual and group therapy during and after a child's hospitalization may be useful for mothers to reduce stress and to develop better coping skills.

ISSN:0273-8481    

出版商:OVID    

年代:1994

数据来源: OVID