摘要:

Previous studies suggest that many patients with burns receive inadequate analgesia. A secondary analysis of the 1992 to 1999 National Hospital Ambulatory Medical Care Survey (a national, weighted sample of emergency department [ED] encounters) was performed to estimate national analgesia prescribing patterns in ED patients with burns. In 1999, there were 21,103 patient encounters sampled from 376 EDs, resulting in an estimated 102.8 million ED visits in 1999. One hundred thirty-eight patients in the sample (0.7%) had burns for an estimated 827,000 annual burns. Patient mean age was 28 years. Forty-three percent were female, 25% were children under 18 years of age, and 81% were white. Pain assessments were performed in about half of the patients, and only half of the patients received analgesics. Analgesia administration did not differ by year, sex, age, race, ethnicity, geographic location, or insurance payment type, yet it was more likely with increased pain. We conclude that many patients with burns do not have documentation of pain assessment or analgesia administration while in the ED.

ISSN:0273-8481    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Because there is no ideal therapy for burns infected withPseudomonas aeruginosa, there is sufficient need to investigate the efficacy of alternative antipseudomonal interventions. Honey is an ancient wound remedy for which there is modern evidence of efficacy in the treatment of burn wounds, but limited evidence for the effectiveness of its antibacterial activity againstPseudomonas. We tested the sensitivity of 17 strains ofP. aeruginosaisolated from infected burns to two honeys with different types of antibacterial activity, a pasture honey and a manuka honey, both with median levels of activity. All strains showed similar sensitivity to honey with minimum inhibitory concentrations below 10% (vol/vol); both honeys maintained bactericidal activity when diluted more than 10-fold. Honey with proven antibacterial activity has the potential to be an effective treatment option for burns infected or at risk of infection withP. aeruginosa.

ISSN:0273-8481    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Gastrointestinal complications in burn patients include ileus, constipation, hemorrhage from ulcerations, ischemic bowel, and rarely, perforations. Patients with hypotensive episodes and sepsis are at risk for developing ischemic bowel disease. There have been three reports in the literature of cecal perforation in burn patients. We present an additional case and review of the literature.

ISSN:0273-8481    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:0273-8481    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:0273-8481    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Early enteral support is believed to improve gastrointestinal, immunological, nutritional, and metabolic responses to critical injury; however, this premise is in need of further substantiation by definitive data. The purpose of this prospective study was to examine the effectiveness and safety of early enteral feeding in pediatric patients who had burns in excess of 25% total body surface area. Seventy-seven patients with a mean percent total body surface area burn of 52.5 ± 2.3 (range 26–91), percent full thickness injury of 44.7 ± 2.8 (range 0–90), and age ranging from 3.1 to 18.4 (mean 9.3 ± 0.5) were randomized to two groups: early (feeding within 24 hours of injury) vs control (feeding delayed at least 48 hours postburn). Nutrient intake was measured daily, indirect calorimetry was performed biweekly, and blood and urine samples were obtained for the assay of cortisol, glucagon, insulin, gastrin, epinephrine, norepinephrine, dopamine, triiodothyronine, tetraiodothyronine, albumin, transferrin, prealbumin, retinol-binding protein, glucose, nitrogen balance, and 3-methylhistidine throughout the study period. Three protocol violations occurred, and two patients were transferred to another hospital; these patients were excluded from the study. No patient in either group experienced tube feeding aspiration. No differences were evident in infection, diarrhea, hospital length of stay, or mortality outcomes. A higher incidence of reportable adverse events coincided with early feeding (22 vs 8%), but this was not statistically significant. The delayed feeding group demonstrated a significant caloric deficit during postburn week (PBW) 1 (P< .0001) and PBW2 (P= .0022). Serum insulin (P= .0004) and triiodothyronine (P=.0162) were higher in the early fed group during PBW1. A decrease in 3-methylhistidine output (suggesting a decrease in protein breakdown) was also evident during PBW1 (P= .0138). No other significant trends in study outcome variables were noted. In conclusion, provision of enteral nutrients shortly after burn injury reduces caloric deficits and may stimulate insulin secretion and protein retention during the early phase postburn. These data, however, do not necessarily reaffirm the safety of early enteral feeding, nor do they associate earlier feeding with a direct improvement in endocrine status or a reduction in morbidity, mortality, hypermetabolism, or hospital stay. Future studies are needed to establish precise feeding implementation times that maximize clinical benefit while minimizing morbidity in the critically injured burn patient.

ISSN:0273-8481    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Severe burn injury results in profound metabolic derangements. Recently, we have shown that vitamin D metabolism is disturbed after burn injury. Vitamin D is essential for calcium and phosphorus homeostasis and skeletal bone integrity. The role of vitamin D on magnesium homeostasis is not well understood. The purpose of this study was to assess the effects of vitamin D deficiency on serum electrolytes. Forty-one pediatric burn patients with a mean (± SEM) total body surface area burn of 53.1 ± 2.9% and full-thickness injury of 44.2 ± 4.1% were studied from July 1996 to December 2000. The mean age of the patients was 6.5 ± 0.8 years. Patients were studied for 6 weeks after admission to the hospital. Blood samples were obtained weekly for serum 25-hydroxycholecalciferol (25D), 1,25-dihydroxycholecalciferol (1,25D), and daily for calcium, magnesium, and phosphorus. Total intravenous (IV) replacement of calcium, magnesium, and phosphorus was also quantitated retrospectively. Bivariate and multivariate correlational analysis was used for statistical comparison. For the study duration, multivariate analysis demonstrated a positive correlation between 25D and serum calcium (r= .47,P< .05) and 1,25D and calcium (r= .27,P< .05). Overall, calcium had a positive correlation with phosphorus and a negative correlation with IV calcium replacement (ie, patients with lower calcium received more IV replacement). During the initial week of hospitalization (week 0), decreased 25D (mean 11.6 ng/ml; normal range 15–57 ng/ml) and 1,25D (mean 13.9 pg/ml; normal range 15–75 pg/ml) did not correlate with any other measured variable. In week 1, 1,25D (mean 15.2 ng/ml) had a positive correlation (r= .410,P< .05) with calcium (mean 7.70 mg/dl). Hypovitaminosis D observed in burn injury correlates with serum calcium and phosphorus abnormalities. Early after injury (<1 week) there was no observed correlation between vitamin D and other variables possibly because of the effects of burn shock. After 1 week, vitamin D appears to significantly effect phosphorus homeostasis. The relationship between vitamin D and magnesium is not well established. These results may indicate a role for vitamin D replacement therapy during the initial phase of burn resuscitation.

ISSN:0273-8481    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Very little has been published on treating acute pain in children younger than the age of 3 for burns or any other trauma etiology. This study prospectively monitored the pain behavior and opioid analgesic intake of 31 pediatric burn patients (mean age = 23.71 months; SD = 15.75). Twelve of those children were randomized to conditions in which they either received opioid analgesics pro re nata (ie, as needed, pain contingent) or on a regular basis. The two groups did not show differences in demonstrable pain but, interestingly, they received equivalent does of opioid analgesics. As such, the pro re nata group was likely medicated largely on a regularly scheduled basis. For most of the remaining (nonrandomized) subjects, physicians ordered regularly scheduled opioid analgesics, suggesting that this practice has become largely institutionalized in the study setting. Information on pediatric opioid analgesic dosing and pain measurement strategies for nonverbal subjects can be derived from the findings.

ISSN:0273-8481    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Early tracheostomy (ET) has been claimed to reduce ventilator support or intensive care unit or hospital length of stay in intensive care unit patients. This study was performed to assess the potential benefits of ET in burn patients. From October 1996 to July 2001, we evaluated all intubated and acutely burned adults using a formula to predict the probability of prolonged ventilator dependence. We randomized each patient with a probability of prolonged ventilator dependence more than 0.5 to ET, performed on the next operative day, or to conventional therapy (CON), which consisted of continued endotracheal intubation as needed, with tracheostomy (TRACH) performed on postburn day (PBD) 14 if necessary. During this period, 44 patients were randomized, 23 to CON and 21 to ET. Groups did not differ in age, total burn size, or inhalation injury, although ET patients had larger full-thickness burns. ET patients underwent TRACH at a mean of PBD 4 vs PBD 14.8 for CON patients (P< .01). ET patients had a significant improvement in PaO2/FiO2ratios within 24 hours following TRACH (139 ± 15 vs 190 ± 12;P< .01). There were no differences in ventilator support, length of stay, incidence of pneumonia, or survival. However, six CON patients (26%) were successfully extubated by PBD 14 compared with one ET patient (P< .01). Although tracheostomy offers some advantages in terms of patient comfort and security, routine performance of ET in burn patients does not improve outcomes, nor does it result in earlier extubation. This may be partly caused by the comfort and convenience of tracheostomy.

ISSN:0273-8481    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Recent studies confirm that thromboembolic complications in burn patients are higher than previously reported. Swelling, pain, and erythema are not useful indicators of deep venous thrombosis (DVT) in burned extremities. We propose that D-dimer levels may be useful in determining which patients would benefit from further screening for DVT. Thirty adult hospitalized burn patients were screened for DVT with duplex ultrasound on admission and then weekly until discharge. D-dimer levels were measured at the same intervals. Seven patients developed 11 cases of DVT. The mean time to DVT diagnosis was 6.7 days. D-dimer levels were elevated in 86% of DVT patients at week 1, with a negative predictive value of 94%. The evaluation of elevated D-dimer levels at week 1 may be a useful screening tool for detecting DVT in the burn population.

ISSN:0273-8481    

出版商:OVID    

年代:2002

数据来源: OVID