摘要:

Ninety-five patients died at the University of Washington Burn Center from 1980 to 1985. Fifty-seven patients (60%) survived more than 3 days. Thirty-five of these patients underwent excision and grafting. The major causes of death were pneumonia, burn wound sepsis, and sepsis from multiple sources. Thus infection was die cause of death in 26 (74%) of these 35 patients. The other 22 patients who survived longer than 3 days did not undergo excision and grafting before death. The primary cause of death was pneumonia. Infection was die cause of death in 12 patients of this group (55%) and thus was die major cause of death in 62% of all patients who survived more than 3 days. Although early wound closure may affect overall mortality, it does not appear to materially change die pattern of the causes of death in those that die after 3 days of hospitalization.

ISSN:0273-8481    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Hetastarch is a synthetic polysaccharide colloid that has been used clinically in the management of multiple trauma, hypovolemic shock, and postoperative cardiac patients. Our objective was to determine whether hetastarch is a safe alternative to blood products in burn shock resuscitation. Twenty-six patients received hetastarch during the colloid phase of resuscitation and were compared to matched historical controls who received either albumin or fresh frozen plasma. Clinical and laboratory parameters were measured on admission and for 4 days after the burn. There was no significant difference in hemodynamics, respiratory status, incidence of bleeding, or renal or liver function among the three colloid groups. The advantages of hetastarch include immediate availability, no dependence on human blood donor population, no risk of serum-transmitted diseases, and lower cost. It can be safely recommended for those patients who object to blood products for resuscitation, in those situations where human donors are few, and when cost is a consideration.

ISSN:0273-8481    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Hypovolemia following major thermal injury results from increased capillary permeability with subsequent loss of fluid into the interstitium. Investigations of burn shock have demonstrated die release of circulating factors that effect these fluid shifts. Previous studies have suggested that this process can be altered by the performance of plasma exchange in patients who fail to respond to conventional resuscitation. This study evaluated the effect of plasma exchange during burn shock. Twenty-two adult subjects were randomly assigned to one of two groups. The control group received standard fluid resuscitation guided by die Parkland formula; the treatment group received the same resuscitation in addition to a course of plasma exchange. Seventeen subjects, eight from the control group and nine from the plasma exchange group, completed die study. Control subjects had a mean age of 37 years, a mean burn size of 52.3% total body surface area, and a mean full-thickness injury of 24.6% total body surface area. Plasma exchange patients had a mean age of 38 years, a mean burn size of 49.4% total body surface area, and a mean full-thickness injury of 37.3% total body surface area (p< 0.01 compared to the control group). Completion of resuscitation was accomplished earlier in die plasma exchange group (20.2 hours versus 30.8 hours;p< 0.05). There was no difference in the total amount of fluid required to achieve resuscitation. The mean urine output during resuscitation was greater for die plasma exchange group (p< 0.01). Performance of plasma exchange during the second 8-hour period after the burn did not alter die course of burn shock in this study group.

ISSN:0273-8481    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

The experimentally induced smoke inhalation injury in sheep is in many respects similar to that observed in smoke-injured humans. Our sheep model allows us to describe a sequence of morphologic changes that may be divided into four fairly discrete although overlapping phases. The magnitude of the destructive process and the length and characteristics of each phase are related to the severity of the injury and the superimposed complications. The availability of this animal model may allow the experimental manipulation of each of the four described phases to investigate physiopathologic and therapeutic implications toward the prompt normalization of pulmonary function.

ISSN:0273-8481    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

The effects of cotton smoke injury on the phosphatidylcholine composition of pulmonary surfactant material were studied. While under halothane anesthesia, 18 ewes were intubated using a double-lumen tube. In six sheep the left lung was exposed to smoke; in another six sheep the right lung was exposed to smoke. A sham group of six sheep was insufflated with air instead of smoke. Twenty-four hours later the animals were killed, and alveolar lavage fluid was obtained from both lungs. Phospholipid material was separated, and its relative phosphatidylcholine composition was determined. In the smoke-treated lungs this composition was not different statistically when compared with the contralateral and the sham-exposed lungs. These findings suggested that smoke inhalation has no effect on the composition of the phosphatidylcholine fraction in the alveolar lining layer 24 hours after injury.

ISSN:0273-8481    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

We measured airway blood flow in unanesthetized sheep under control conditions and after lung injury induced by inhalation of cotton smoke. Blood flows in trachea, carina, main stem bronchi, intraparenchymal bronchi, and whole lung were measured by injection of radioactive microspheres. In 10 control sheep mean blood flow (± SD) was trachea, 17.2 ± 10.5; main stem bronchi, 17.5 ± 7.6; and whole lung (parenchyma inclusive of all small intraparenchymal airways), 20.5 ± 11.9 ml min-1/100 gm tissue weight. After injury, measurements were made 8 to 30 hours after smoke inhalation when respiratory distress was evident by arterial oxygen tensions of less than 60 mm Hg. Inhalation injury had little effect on cardiac output or blood flow to peripheral tissue. However, after inhalation injury airway blood flow (n = 6) was increased nine times in trachea, eight times in main stem bronchi, twelve times in intraparenchymal bronchi, and two times in whole lung. The increased airway blood flow resulted from a selective vasodilation of the airway vasculature because arterial driving pressures were unchanged by inhalation injury. Other investigators have shown that the microvascular permeability of the bronchial circulation is remarkably sensitive to inflammation, and the present experiments suggest that a selective vasodilation of the airway vasculature is another aspect of the airway response to inflammation. Increased airway blood flow through a leaky microvasculature may increase capillary filtrate from the bronchial circulation and contribute to the pulmonary edema of inhalation injury.

ISSN:0273-8481    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Victims of smoke inhalation with and without burns and burn patients with respiratory insufficiency for reasons other than smoke at a regional burn unit are profiled in terms of age, burn size, length of stay, and mortality. The diagnostic characteristics of patients with an inhalation injury (N = 108) are listed; 7% of all patients (N = 52) have known smoke exposure with equivocal evidence for injury to the airway or pulmonary parenchyma. The degree of respiratory (visceral) failure experienced by patients with inhalation injury is not uniformly severe. Many of the clues to this diagnosis are indirect and not always related to the severity of pulmonary injury. Timing and degree of visceral failure control the severity of the injury, which increases progressively from that in patients with a burn only (parietal injury) through those with a visceral injury only (smoke without burn), those with both smoke and burn, to those with a burn and uniformly severe respiratory failure on the basis of sepsis.

ISSN:0273-8481    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

The analgesic properties and systemic absorption of topical lidocaine in the treatment of partial-thickness burns were evaluated by applying a 5% lidocaine cream to the burn wound at a concentration of 1 mg/cm2. The plasma lidocaine level was measured in 24 patients 15, 30, 60, 120, and 240 minutes after application. Systemic analgesics were given 30 minutes before application of the lidocaine cream. The Visual Analog Scale was used to record pain intensity in 30 patients just before and 30 minutes after application of the lidocaine cream. The maximal area treated was 28% total body surface area partial-thickness burn with application of 4.5 gm of lidocaine, resulting in a plasma level of 5.8 μg/ml. The plasma lidocaine level was constant during the 4-hour experiment and was associated with a significant decrease in pain. No infectious, allergic, or cardiovascular complications were observed. Our results indicate that topical lidocaine cream offers significant pain relief of long duration without associated systemic side effects.

ISSN:0273-8481    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

The purpose of this article is to introduce a form to facilitate the Social Security disability determination process for persons with burn injury. This form, “Burn Injury Discharge Status for Social Security Disability Determination,” has been developed by the Committee on Rehabilitation of the American Burn Association (ABA) and has been tentatively approved by the ABA Board of Directors. Issues with respect to the Social Security disability determination process and die development, rationale, and use of the form arc discussed.In 1983 the ABA Committee on Rehabilitation, chaired by Dr. Roger Salisbury, was charged with the task of developing burn rehabilitation outcome criteria to better determine levels of disability. The long-term goal of this project was to counteract what appeared to be a significant national problem with respect to burn patients obtaining Social Security disability benefits.It is estimated by Frank et al.1that 60,900 persons are admitted to die hospital for treatment of thermal injury each year, and 8111 of these admissions will die. Thus approximately 52,800 persons survive burn injury annually. If only 5% of these survivors sustained disability for more than 1 year that precluded return to work, there would be 2640 persons who would seemingly be eligible for Social Security benefits. However, data supplied to Dr. Salisbury by die Regional Social Security Office in New York City indicated that on a national basis, 362, 130, and 52 persons with burn injury were allowed benefits in 1981, 1982, and 1983 respectively. These numbers represent less than 1% of die total number of disability claims allowed by Social Security from 1981 to 1983. Information on the number of burn-related applications for Social Security benefits was unavailable.It is possible that the above data could be skewed in either direction because of die Social Security coding system used, die possibility that some burn patients may have received disability benefits under a code other than that for burn causation, and the accuracy of estimates of persons who would be eligible. A brief overview of the Social Security disability determination process should clarify the problem and point to issues to be addressed to rectify it.

ISSN:0273-8481    

出版商:OVID    

年代:1989

数据来源: OVID

ISSN:0273-8481    

出版商:OVID    

年代:1989

数据来源: OVID