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Biomedical subjects

C M Larson

Publications and source records attributed to C M Larson.

6 recordsLinked to original sources
PubMed1990

A randomized trial of indirect calorimetry-based feedings in thermal injury.

To assess the superiority of indirect calorimetry (IC)-based enteral nutrition in burned patients, 49 adults with mean burns of 47% TBSA received feedings based either on the Curreri formula (CURR), or on IC, using enteral formulas with nonprotein calorie:nitrogen ratios of either 86:1, or 125:1. Intake in CURR patients was a mean 3,490 kcal/day, which exceeded resting energy expenditure (REE) by 43%, while IC patients received 3,530 kcal/day (1.2 x REE; p less than 0.05). Both groups maintained body weight and lymphocyte counts; survival was equal. Complications (diarrhea, nausea, hyperglycemia) were frequent in both groups, but their incidence did not differ. Patients fed the lower calorie:nitrogen ratio had greater cumulative nitrogen balance, with no increase in nitrogen excretion. It appears advisable to nourish burned patients with the minimal effective intake. While use of IC facilitates this goal, use of the Curreri formula provides acceptable approximation of caloric requirements in the early postburn period.

Adult↗
PubMed1990

The continuing challenge of burn care in the elderly.

Recent improvements in survival have stimulated interest in the care of elderly patients with burn injuries. We reviewed 278 patients aged 45 years and older treated during a 10-year period. The survival rate was 80% overall and 67% for patients over 75 years of age. Mortality rates correlated with patient age, burn size, presence of inhalation injury, number of complications of care, and fluid resuscitation requirements, but not with the number of preexisting medical problems. Burn wound excision and skin grafting were performed frequently and were well tolerated. During this period, hospital charges increased fourfold and were twice as great in nonsurvivors. Reimbursements based on diagnosis-related groups during the last 3 years of the review (75 patients) resulted in a total deficit of $1.2 million. Aggressive care for most elderly patients with burn injuries appears justified by the improved outcomes demonstrated. This has increased the difficulty of decisions regarding patient salvability and the allotment of resources. Elderly patients with burn injuries illustrate many contemporary dilemmas in patient care in this era of cost consciousness.

Aged↗
PubMed1989

The declining incidence of fatal sepsis following thermal injury.

Successful management of burned patients requires effective prevention and management of infectious complications. This study reviews the incidence of fatal sepsis in our burn center and attempts to analyze factors which may predict septic mortality. From January 1, 1978, through May 31, 1988, 1,913 patients were admitted, with a mean age of 24.8 +/- 0.5 years, a mean burn size of 17.7 +/- 0.4% total body surface area (%TBSA), and a mean 10.1 +/- 0.5% TBSA full-thickness injury. Nine per cent of patients sustained concurrent inhalation injuries. Overall mortality was 7.4%, and 1.6% of patients died from sepsis. Regression analysis showed that overall burn size, presence of inhalation injury, and the extent of full-thickness burn injury were significant independent predictors of death from sepsis, in decreasing order of relative importance. During the period 1983-1988, the incidence of septic mortality was 0.7%, which was significantly lower than the earlier half (1978-1982) of the study period (p less than 0.01). These data indicate that fatal infections are becoming increasingly uncommon after thermal injury. The reasons for this decline are probably multiple, and they include the widespread practice of early excision, and improvements in fluid resuscitation and the general medical care of burned patients.

Adolescent↗
PubMedDate not supplied

Complications of burn care in patients with neurologic disorders.

Patients with neurologic disorders are frequently burned in mishaps related directly to their diseases. Once burned, these patients face a mortality rate significantly greater than that of the burn population as a whole. To assess the impact of neurologic disease on burn care, we reviewed the records of 37 patients admitted to our burn center with burns and neurologic illness. Thirty-three patients (89%) sustained injuries directly related to their neurologic problems, the most frequent being bathtub scalds (29.8%) and scald/spills (24.3%). We compared 31 of these patients having nonextensive burn injuries (less than or equal to 25% total body surface area) to a control population with similar-sized burns from our burn unit during the study period. This comparison revealed significantly longer length of stay for the neurologically impaired sample. We presume that costs of care are also increased for this sample. The high frequency of burn injury among neurologically impaired persons, coupled with the greater difficulty in caring for them, suggests that this group should receive intensive burn prevention educational efforts.

Accidents, Home↗
PubMedDate not supplied

Lifestyle adjustments in elderly patients after burn injury.

Although survival of older burn victims has improved significantly in recent years, controversy remains over the care that should be given to this group and the functional recovery of survivors. To assess the impact of burn injury on lifestyle in the elderly, we conducted a mail-in survey among surviving patients ages 45 years or older who were treated in our burn center from 1978 to the middle of 1987. The survey asked questions about living arrangements, personal care, family relations, social life, work status, and outlook on the future. Of 168 surveys mailed, 109 were completed and returned (64.9%). Responders consisted of 82 men and 27 women with a mean age of 57.8 years (range, 45 to 92 years). Ninety-seven percent of patients were able to return home after discharge, but 27% of the oldest patients (ages greater than 75 years) required permanent placement in extended care facilities. With increased age there was an increased tendency toward dependence and the need for assistance in daily living; half of the oldest patients required assistance in daily living. Even so, most of the patients in this survey remained independent and maintained a positive outlook on the future. These results appear to justify a policy of aggressive treatment for elderly burn victims.

Activities of Daily Living↗