ISSN:0022-5282    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

Daily caloric requirements in patients with major burns are frequently estimated using the Curreri formula (25 × body weight (kg) + 40 × % BSA burned). In nonburned patients modifications of the Harris-Benedict formulas have been used to estimate energy requirements. These equations have not been validated against measured energy expenditures in burned patients.Thirty-five patients with second- and third-degree burns covering from 10 to 75% of the body surface area underwent assessments of energy expenditures by indirect calorimetry and by the Curreri and Harris-Benedict formulas. The mean energy expenditure calculated from the Harris-Benedict formulas (BEE) underestimated the mean measured energy expenditure (MEE) by 23% (p< 0.001), while the mean energy expenditure calculated from the Curreri formula (CEE) overestimated the mean MEE by 58% (p< 0.001). There were significant correlations between the MEE, BEE, and CEE. In patients with burns greater than 20% of the body surface area, the correlation between MEE and BEE was higher than that found with the Curreri formula.

ISSN:0022-5282    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

The development of cataracts, a well-known complication of electrical injury, remains poorly understood. We reviewed 113 patients suffering major electrical injuries and identified seven patients who suffered 13 cataracts, an incidence of 6.2%. Six of the seven patients were injured with high (>l000-v) voltage current, while one man was injured by a 440-v source. All patients suffered true 'entrance and exit' wounds, but only three such injuries involved the head or neck. Cataracts first presented as decreased visual acuity 1 to 12 months postinjury. Ten of the 13 cataracts progressed to a point where surgery was required, from 3 to 27 months postinjury. Surgical therapy resulted in excellent return of vision in every case, although one patient was lost to followup and developed a late retinal detachment.Electrical cataracts remain a serious potential complication of electrical injury. Awareness by burn team members is essential in providing optimal treatment to victims of electrical injury.

ISSN:0022-5282    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

Twenty-six adults more than 60 years old with burns ≥30% of the body surface area were resuscitated using hypertonic lactated saline (HLS). Hemodynamic parameters of resuscitation were measured in ten of the patients using a Swan-Ganz catheter.In spite of signs of hemodynamic stability, these patients demonstrated mean cardiac indices (CI) below their age-corrected norms and pulmonary capillary wedge pressures (PCWP) below 5 mm Hg through 24 hours, yet 92% of the patients produced normal or super-normal volumes of urine.Hemodynamic monitoring may be helpful for precise fluid replacement in extensively burned elderly patients; however, a normal CI and PCWP may not be the appropriate endpoint for resuscitation of the elderly when using HLS. This review supports the concept that HLS resuscitation of critically burned older patients is both safe and efficacious, leading to an 81% survival of this severely compromised group well past the resuscitation phase of injury.

ISSN:0022-5282    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

Silver sulfadiazine-resistant organisms are arising at an irregular rate and may eventually interfere with wound management. To counter this problem several new antibacterial agents were tested in combination with silver sulfadiazine. Only sodium piperacillin (Pipracil, Lederle) exhibited synergism with silver sulfadiazine both in vitro (against various species of organisms) and in burned animals. The MIC of AgSD and Pipracil was 50 nmole/ml and 250 nmole/ml, respectively, but a combination of 6 nmole/ml of AgSD and 7.5 nmole/ml of Pipracil inhibited the growth ofPseudomonas aeruginosa.In burned mice infected with either AgSD-resistant or sensitive strains, the mortality in groups receiving combinations of topical Pipracil and silver sulfadiazine was 0–10%; in contrast, treatment with Pipracil or silver sulfadiazine alone resulted in much higher mortality. Thus it would appear that a combination of silver sulfadiazine and Pipracil, each of which have long been used in patients topically and parenterally, may prove valuable in patients with burn wound infections related to or caused by organisms resistant to silver sulfadiazine.

ISSN:0022-5282    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

The use of indirect calorimetry in assessing and monitoring nutritional support in burn patients is reported. Twenty-nine patients with a mean burn size of 35% TBSA were monitored with 228 measurements of resting energy expenditure (REE), calculations of respiratory quotient (RQ), and substrate metabolism. Daily weights, nitrogen balance determinations, and routine laboratory tests were also obtained. Oxygen consumption (V;O2) was 186 ± 39 ml/min/M2, corresponding to REE of 2,506 ± 543 kcal/day. REE varied during the course of wound healing, demonstrating a biphasic course. Metabolic rate was also significantly increased with the performance of routine procedures such as dressings and surgery. Measurements of REE were a mean 76% of predictions based on the Curreri formula, and 1.47 times basal energy expenditure (BEE) calculated by the Harris-Benedict equation. Neither formula provided for the great variations observed in daily, and individual, measurements of REE. During the study, patients consumed 2,900 ±811 kcal/ day, which exceeded REE by 1.14. This was associated with mean weight loss of 3.2% (range, −16 to 9%). RQ was ≤ 0.85 in 9% of determinations, but exceeded 1.0 24% of the time. Protein accounted for 17 ± 3% of total metabolism, corresponding to a calorie:nitrogen ratio of 128:1. Practically, however, provision of this much protein proved difficult.Routine use of indirect calorimetry permits tailoring of nutritional support for burn patients, and is valuable in the early detection of significant under- or overnutrition.

ISSN:0022-5282    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

Herpesvirus infections are commonly seen in immunosuppressed patients and may account for considerable morbidity and some mortality. We prospectively studied 52 patients with severe burn injuries in order to determine the prevalence of viral infections in this group of patients. Serologic testing was done each week to diagnose primary and reactivation infections. Twenty-seven of 52 patients (52%) became infected with either herpes simplex virus (HSV) or cytomegalovirus (CMV) or both. HSV infection was assocated with older age, tracheal intubation, facial burn, inhalation injury, length of hospitalization, and the presence of full-thickness burn. CMV infection was associated with duration of hospitalization and full-thickness burn.Transfusion of blood products was not correlated with an increased incidence of primary or reactivation CMV infections. There was a significant correlation between the presence of these viral infections and bacterial sepsis (p≤ 0.05). There was no significant association of HSV or CMV infections with mortality.

ISSN:0022-5282    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

Previous reports have stressed the immunosuppressive effects of major surgical procedures. In this study, 30 adult patients with a mean burn size of 42.8% TBS A and a mean age of 31.9 years underwent 78 surgical excision and grafting (E/G) procedures. The mean surface area excised was 2,373 cm2, with a mean blood transfusion requirement per E/G of 3,355 cc or 1.4 cc/cm2.The suppressive effect of burn serum was assayed in mixed lymphocyte cultures. Before E/G, burn serum caused a mean 42.2 ± 3.3% suppression of normal lymphocyte blastogenesis; serum suppressive activity following E/G was reduced to 29.1 ± 2.9% (p≤ 0.005). The mean duration of improvement in lymphocyte function was 5.0 days. E/G procedures which achieved complete burn wound closure were more effective in restoring lymphocyte immunocompetence.E/G has a significant beneficial effect on restoring lymphocyte responsiveness in burn patients. Preliminary evidence suggests that this effect is related to blood transfusions.

ISSN:0022-5282    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

Our purpose was, in general, to determine the effect of a body burn on the pulmonary response to endotoxemia and, specifically, to determine whether increased thromboxane (TxA2) production by the burn wound was responsible for the accentuated lung injury. Thirty-two unanesthetized sheep with lung and soft tissue lymph fistulae were studied. Twelve sheep were given a sublethal dose of intravenousE. coliendotoxin (2 μg/kg). A characteristic two-phase injury was noted as evidenced by early pulmonary hypertension and hypoxia and later increased lung permeability. TxA2was significantly increased in lung lymph as well as aortic plasma relative to venous plasma, indicating the lung to be the source. Twelve of 12 sheep survived. Five of 13 sheep died from endotoxemia when given 3–5 days after a 25% total body surface (TBS) burn and five of seven died with endotoxin (2 μg/kg) and a 50% burn. Physiologic parameters were at preburn levels before endotoxin. Animals died both during the early phase from hypoxia and the later phase due, in large part, to increasing pulmonary dysfunction. Absolute levels of TxA2were not increased in the postburn animals, nor was there a clear release of TxA2 from burn tissue to explain the accentuated response. Prostacyclin levels were, however, less elevated in postburn animals in response to endotoxin, thereby altering the TxA2/PGI2ratio in favor of TxA2. However, a cause and effect relationship between the increased lung injury and TxA2remains undetermined. Lymph flow or lymph protein content was not altered in burn tissue in response to endotoxin.

ISSN:0022-5282    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

The Abbreviated Injury Scale and the Injury Severity Score are important tools for grading the severity of injury to trauma patients. The Trauma Chart provided is a simple and concise guide for scoring and recording this useful information. The chart is useful in both a large wall-mounted form and in the reduced two-page form included in this article.

ISSN:0022-5282    

出版商:OVID    

年代:1985

数据来源: OVID