Topical chemotherapy and burn wound care.
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Administration, Topical↗
Biomedical subjects
A Luterman
Publications and source records attributed to A Luterman.
Nutritional support of the burned patient.
Patients with major thermal injury exhibit hypermetabolism as a result of neurohormonal alterations. Thus caloric requirements are exaggerated. Failure to provide supranormal caloric intake by both enteral and parenteral routes is associated with pronounced weight loss, delayed wound healing, decreased host resistance, and cellular dysfunction. Special dietary programs delivered early in the course of treatment must be utilized to prevent these complications of acute postburn malnutrition.
Body Temperature↗
Withdrawal from positive end-expiratory pressure.
A retrospective review was carried out involving 82 patients who required positive end-expiratory pressure (PEEP) therapy for acute respiratory insufficiency. One third of the attempts at reducing the level of PEEP were unsuccessful and led to reinstitution of the original or an increased level of PEEP. Premature lowering of PEEP resulted in significant deterioration in oxygenation which persisted for more than 24 hours after reinstitution of PEEP in a significant number of patients. In addition, one half of these patients required increased levels of PEEP (above prelowering levels) to achieve adequate oxygenation. PEEP lowering attempts were categorized as either successes or failures. A comparison was made between the prelowering respiratory measurements of these two groups. The discriminant criteria produced were (1) an improving oxygenation index (rising (PaO2/FIO2) and (2) a stable or improving effective compliance. Using these prelowering criteria, it was possible to distinguish between the successes and failures in 95% of cases. Based on the data collected, proposed guidelines for PEEP lowering are presented.
Adolescent↗
Burn injuries. Initial evaluation and treatment.
Treatment of burned patients begins at the scene of the accident, continues in the emergency department, and terminates in the burn center. The "burn team" of specialists includes the paramedic at the scene of the accident, the physician and nurses in the emergency room, and the burn center staff. Since the early stages of treatment often predetermine the final outcome, every physician or nurse who may someday be involved with the initial assessment and management of a severely burned patient should review a plan of evaluation and treatment. Thus, patient salvage from devastating burn injuries will continue to improve.
Adolescent↗
The role of fibrinogen degradation products in the pathogenesis of the respiratory distress syndrome.
Pulmonary dysfunction in awake rabbits was induced by intravenous infusion of a highly purified human fibrin split product (fragment D). The dose of infused fragment D was chosen to achieve observed plasma concentrations of fibrin split products in hospitalized patients with severe burns or trauma (about 100mug of FSP/ml of blood). Four hours after infusion, the animals displayed a clinical and pathological pattern which closely resembled post-traumatic acute respiratory distress syndrome, including hypoxia, hypocarbia, thrombocytopenia, increased pulmonary capillary permeability to albumin, interstitial edema, hypertrophy of alveolar lining cells, and intra-alveolar hemorrhage. In vivo production of fibrin split products by infusion of thrombin with induction of secondary fibrinolysis produced similar pulmonary changes, although intravascular clots and platelet aggregates also were prominent. Infusion of human fibrinogen and human albumin at identical doses failed to induce pulmonary dysfuction. The results suggest that fibrin split products (fragment D) alone are toxic to the respiratory system and may contribute to the development of acute respiratory distress syndrome in severely traumatized or burned patients.
Animals↗
Improvement of oxygen--carrying properties of stoma--free hemoglobin solution with acetrizoate sodium.
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Acetrizoic Acid↗
Effect of added elastances on the first loaded breath in man.
Tidal volume together with end-inspiratory pressure was measured in four seated healthy men, during normal breathing and during single inspirations taken from a series of rigid containers which provided added elastances (range: 5-70 cmH2O/l). Experiments were performed both during quiet breathing and during ventilation increased by added dead space. Added elastic loads always resulted in a decreased tidal volume. This decrease was partly compensated by increased pressure developed by the inspiratory muscles; being more so with greater added elastance, control ventilation, or both. Analysis of our results indicates that the load-compensatory response may be attributed to changes in mechanical impedance of the ventilatory pump, due to the mechanical arrangement and the intrinsic properties of the inspiratory muscles (force-length and force-velocity relationships), changes in respiratory frequency with increasing ventilation, and to vagally mediated load compensation.
Adult↗
A simple moisture chamber for the early treatment of corneal exposure in patients with facial burns.
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Adult↗
The suppressive effect of subeschar tissue fluid upon in vitro cell-mediated immunologic function.
UNLABELLED: Fluid administered during resuscitation translocates beneath the burn wound and is considered inert "third space" loss. This study was done to determine whether subeschar tissue fluid (STF) functions as an immunobiologic reservoir. Seven patients with a mean BSA burn of 55% underwent isotonic volume resuscitation and burn treatment with low penetration topical agents. STF was collected at the time of fascial excision. Chemical analysis of STF was similar to serum; bacterial cultures grew no organisms. Ten percent dilutions of STF and burn serum significantly blunted mitogen-induced blastogenic response compared to control serum. STF was significantly more suppressive than burn serum (P less than .03). CONCLUSIONS: 1. STF may act as both an immunologic barrier to microbial clearance in otherwise viable subcutaneous tissue and a reservoir for systemically reabsorbed immunosuppressive factors. 2. In addition to removing dead tissue, fascial excision may prove beneficial because it removes large amounts of immunosuppressive STF.
Adult↗
Registered nurses and burn care facilities. Factors associated with turnover rates.
The health care system in the United States is suffering from a severe shortage of registered nurses. Burn treatment facilities are no exception to this phenomenon. As a result of this shortage, institutions have begun hiring less trained personnel such as licensed practical/vocational nurses (LPNs/LVNs), nursing assistants, burn technicians, and nursing students to fill the void. This shortage is so significant that the American Medical Association (AMA) has proposed a new category of bedside care provider, a "Registered Care Technologist" (RCT). The purpose of this paper is to determine the magnitude of the registered nurse shortage in burn care facilities. A second purpose is to identify factors associated with high turnover rates and to document the reasons why registered burn nurses are leaving their positions.
Burn Units↗
Inhibition of lymphocyte blastogenesis caused by suppression of interleukin-2 receptor sites after thermal injury.
Burn patients often exhibit prolonged cell-mediated immune suppression. Of the mechanisms proposed to account for this, one invokes an inability on the part of T lymphocytes to undergo blastogenesis, clonal expansion, and differentiation--a process partially mediated by interleukin-2. Triplicate samples of 10% dilutions of burn serum from nine burn patients (three with greater than 60% burn) were analyzed for their ability to suppress mitogen-induced lymphocyte blastogenesis. A separate aliquot of stimulated cultured lymphocytes was tagged with a monoclonal antibody to interleukin-2 receptors. The serum of patients with greater than 60% burn was significantly more suppressive (as measured by depressed tritiated thymidine incorporation by cultured lymphocytes) than that taken from patients with smaller burns. In addition, serum from those with larger burns caused a marked reduction in the interleukin-2 receptor-labeling index, suggesting that it possesses factor(s) that directly or indirectly block T lymphocyte interleukin-2 receptor expression.
Adult↗
Transportation of immunosuppressive substances produced at the site of burn injury into the systemic circulation: the role of lymphatics.
Serum of patients with severe burns has the ability to suppress mitogen-induced lymphocyte proliferation. Edema fluid collected from the site of injury during resuscitation and at the time of fascial excision has also been shown to suppress this response. An animal model was designed to identify the onset time of the formation of suppressive factors, their potential site(s) of origin, and their route of entry into the systemic circulation. Femoral artery, saphenous vein, and lateral saphenous lymphatic vessels were cannulated in an anesthetized dog. Baseline samples were collected, the hind paw was subjected to scald injury, and samples were collected serially for up to 6 hours after burn injury. Tissue fluid beneath the scald injury was harvested at the end of the experiments. In the absence of significant serologic evidence for inhibition, lymph and tissue fluid exhibited early and prolonged suppression of mitogen-induced lymphocyte proliferation. We concluded that edema fluid capable of cell-mediated immune suppression forms early after thermal injury and that lymph generated from the site of burn injury is immunosuppressive.
Animals↗
Severe itching in the patient with burns.
After discharge, the patient with burns is often plagued with persistent, unrelenting itching. The purpose of this study was to document the incidence and severity of itching in discharged patients with burns, to determine factors that may help in prediction of the problem, and to study the effectiveness of Benadryl (Parke-Davis, Morris Plains N.J.), Atarax (Roerig Div. of Pfizer Inc., New York, N.Y.) and Polyhist Forte (Mikart Inc., Atlanta, Ga.) in relieving the symptom. All adult patients who were discharged to our outpatient clinic were entered into this prospective study. Patients were started on one of the three agents, and agents were changed monthly in a randomized fashion. Severity of itching was determined by a visual linear analogue scale. The study population had a mean age of 35.9 +/- 12.8 years, and a mean burn size of 19.1% +/- 15.3% total body surface area. Eighty-seven percent of discharged patients complained of itching. The average severity of the problem was 7.6 +/- 1.9. A significant difference (p less than 0.05) among groups was found when the population was analyzed for size of burn and duration of time to wound closure. Symptoms varied with anatomic area burned. One hundred percent of patients with leg burns and 70% of those with arm burns complained of itching. Facial burns did not cause itching in any of the patients. The agents that were tested produced complete relief in only 20% of patients, partial relief in 60%, and no relief in 20%. There were no differences in response to the three agents tested. All three of the drugs that were tested had similar onset of action.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Use of morphine sulfate (MS Contin) in patients with burns: a pilot study.
Morphine sulfate (MS Contin), a proven analgesic in the treatment of cancer pain and chronic benign pain, seems to be a good analgesic for the treatment of burn pain. MS Contin is morphine sulfate incorporated in a wax cellulose matrix delivery system. This wax cellulose delivery system gives MS Contin its duration of action. Ten patients were enrolled in an open-labeled, nonrandomized study. The study was designed to examine the analgesic efficacy of MS Contin in the burn population. Each patient remained in the study for 6 days. The efficacy of the analgesic regimen was subjectively measured by the visual pain scale. The MS Contin group was retrospectively compared with a group of patients who were given continuous intravenous infusions of morphine. The two groups were matched according to age, burn size, surgical procedures, and hospital stay. The analgesic qualities of MS Contin were comparable to those of continuous intravenous morphine sulfate infusions. MS Contin is a possible candidate for the treatment of patients with burn pain because of its analgesic qualities, oral dosing, and duration of action.
Adolescent↗
Hardiness, stress, and burnout among intensive care nurses.
The purposes of this study were to determine whether hardiness is a predictor of burnout and whether it can buffer the effect of stress on burnout. Thirty-one registered nurses who work in intensive care units completed the Hardiness test, the Nursing Stress scale, and the Tedium scale. Descriptive statistics, correlational statistics, t tests, analysis of variance, and hierarchical multiple regressions were used to analyze the data. Results indicated that hardiness and burnout had a significant inverse relationship (r = 0.66). Stress and the stress-hardiness interaction term accounted for 29% of the variance in burnout scores. This study found hardiness to be a predictor of burnout and a buffer in the stress-burnout relationship. Furthermore, the relationship between hardiness and stress was found to be stronger than that between stress and burnout. Further study is needed to verify that hardiness is a stress mediator in nursing and to determine how to best promote hardiness in nurses.
Adult↗
Wound healing in partial-thickness burn wounds treated with collagenase ointment versus silver sulfadiazine cream.
During burn care the wounds must be repeatedly debrided of adherent and loose debris until the decision is made to surgically excise and graft the wound or to await epithelialization. Though native proteolytic enzymes in the skin or those produced by colonizing bacteria can speed eschar separation, the use of exogenous enzymes for wound debridement may accelerate wound cleaning and healing. Collagenase digests native and denatured collagen in necrotic tissue. This multicenter trial of 79 patients with partial-thickness wounds compared the efficacy of collagenase ointment applied with polymyxin B sulfate/bacitracin powder with the efficacy of standard topical antimicrobial therapy (control) in which silver sulfadiazine cream (1%) was used to debride paired burn sites. Patients selected for the study had two noncontiguous, partial-thickness, comparably sized, and anatomically similar burn wounds. Ages of patients ranged from 5 to 60 years (mean 33 years). The total body surface area burned ranged from 2% to 30% (mean 13.6%). Mean burn sizes used for study treatment were 366 cm2 (26 to 2310 cm2) for collagenase sites and 355 cm2 (26 to 2394 cm2) for control sites. Sites on each patient were randomly assigned to treatment with either collagenase or control. Endpoints were time to clean wound bed (absence of retained debris) and time to healing (complete epithelialization). The sites treated with collagenase cleaned in less time (mean 9.3 days) than the control sites (mean 11.6 days). Similarly the collagenase sites healed faster than the control sites (mean 19 vs 22.1 days).(ABSTRACT TRUNCATED AT 250 WORDS)
Administration, Topical↗
Clinical evaluation of an acellular allograft dermal matrix in full-thickness burns.
A multicenter clinical study assessed the ability of an acellular allograft dermal matrix to function as a permanent dermal transplant in full-thickness and deep partial-thickness burns. The study consisted of a pilot phase (24 patients) to identify the optimum protocol and a study phase (43 patients) to evaluate graft performance. Each patient had both a test and a mirror-image or contiguous control site. At the test site, the dermal matrix was grafted to the excised wound base and a split-thickness autograft was simultaneously applied over it. The control site was grafted with a split-thickness autograft alone. Fourteen-day take rates of the dermal matrix were statistically equivalent to the control autografts. Histology of the dermal matrix showed fibroblast infiltration, neovascularization, and neoepithelialization without evidence of rejection. Wound assessment over time showed that thin split-thickness autografts plus allograft dermal matrix were equivalent to thicker split-thickness autografts.
Adolescent↗