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Biomedical subjects

David W Mozingo

Publications and source records attributed to David W Mozingo.

12 recordsLinked to original sources
PubMed2006

Effect of blood transfusion on outcome after major burn injury: a multicenter study.

OBJECTIVE: To delineate blood transfusion practices and outcomes in patients with major burn injury. CONTEXT: Patients with major burn injury frequently require multiple blood transfusions; however, the effect of blood transfusion after major burn injury has had limited study. DESIGN: Multicenter retrospective cohort analysis. SETTING: Regional burn centers throughout the United States and Canada. PATIENT POPULATION: Patients admitted to a participating burn center from January 1 through December 31, 2002, with acute burn injuries of >or=20% total body surface area. OUTCOMES MEASURED: Outcome measurements included mortality, number of infections, length of stay, units of blood transfused in and out of the operating room, number of operations, and anticoagulant use. RESULTS: A total of 21 burn centers contributed data on 666 patients; 79% of patients survived and received a mean of 14 units of packed red blood cells during their hospitalization. Mortality was related to patient age, total body surface area burn, inhalation injury, number of units of blood transfused outside the operating room, and total number of transfusions. The number of infections per patient increased with each unit of blood transfused (odds ratio, 1.13; p<.001). Patients on anticoagulation during hospitalization received more blood than patients not on anticoagulation (16.3+/-1.5 vs. 12.3+/-1.5, p<.001). CONCLUSIONS: The number of transfusions received was associated with mortality and infectious episodes in patients with major burns even after factoring for indices of burn severity. The utilization of blood products in the treatment of major burn injury should be reserved for patients with a demonstrated physiologic need.

Adult↗
PubMed2004

Temporal patterns of gene expression in murine cutaneous burn wound healing.

The global changes in gene expression in injured murine skin were characterized following a second-degree scald burn. Dorsal skin was harvested from uninjured and from burned mice at 2 h and at 3 and 14 days following immersion in 65 degrees C water for 45 s. Gene expression was surveyed using an Affymetrix U74Av2 GeneChip, and patterns of gene expression were analyzed using hierarchical clustering and supervised analysis. Burn injury produced significant alterations in the expression of a number of genes, with the greatest changes seen 3 and 14 days after the scald burn. Using a supervised analysis with a false discovery rate of 1% or 5%, differences in the expression of 192 or 1,116 genes, respectively, discriminated among the unburned skin and the three time points after the burn injury. Gene expression was primarily a transient and time-dependent upregulation. The expression of only 24 of the 192 discriminating genes was downregulated after the burn injury. No gene exhibited a sustained increase in expression over the entire 14 days following the burn injury. Gene ontologies revealed an integrated upregulation of inflammatory and protease genes at acute time intervals, and a diminution of cytoskeletal and muscle contractile genes at 3 or 14 days after the injury. Following a second-degree scald burn, global patterns of gene expression in the burn wound change dramatically over several weeks in a time-dependent manner, and these changes can be categorized based on the biological relevance of the genes.

Animals↗
PubMed2004

Wound bed preparation and a brief history of TIME.

Management of chronic wounds has progressed from merely assessing the status of a wound to understanding the underlying molecular and cellular abnormalities that prevent the wound from healing. The concept of wound bed preparation has simultaneously evolved to provide a systematic approach to removing these barriers to natural healing and enhancing the effects of advanced therapies. This brief review of wound bed preparation traces the development of these concepts and explains how to apply systematic wound management using the TIME acronym - tissue (non viable or deficient), infection/inflammation, moisture (imbalance) and edge (non advancing or undermined).

Bandages↗
PubMed2003

Burn injuries.

PURPOSE OF REVIEW: To summarize new advances and research findings that relate to the treatment of burn victims. RECENT FINDINGS: Recent advances in burn resuscitation and critical care reflect a better understanding of the acute phase pathophysiology of severe burns. Aggressive management of the unstable burn airway is always the most important clinical priority. Emphasis has been placed on the early identification of inhalation injury and its impact on fluid resuscitation, as well as on a protective lung strategy to reduce the development of pulmonary edema, acute lung injury and pneumonia, and to reduce the risk of barotrauma. New blood markers, such as serum cholinesterase and inflammatory cytokines, have been introduced to assist in the prognosis of morbidity and mortality, beyond the traditional vital signs. At this time, however, these are available only for research purposes. Finally, early burn wound excision and coverage with new biodegradable materials results in less pain and more rapid healing for the patient. SUMMARY: The combination of innovative approaches and a dedicated burn team is expected to continue to improve survival in the next few years even in the most severe cases.

Journal Article↗
PubMed2002

Indices of antioxidant status in rats subjected to wood smoke inhalation and/or thermal injury.

The present study investigated antioxidant status in lavage fluid, lung, liver, heart and kidney in a rat model to simulate an inhalation injury as might be encountered by firefighters and burn victims. Anesthetized rats received either a 20% total body surface area (TBSA) full thickness scald or a sham burn. After a 5 h recovery period, half of the animals in the burn or sham burn groups were exposed to cooled western bark (fir and pine) smoke for 16.25 min. The remaining rats in each group breathed room air. At 1, 12, 24, 48 and 96 h after exposure to the smoke, five rats from each of the four groups were euthanatized and lungs were lavaged by infusing three 5 ml aliquots of normal saline for evaluation of airway cellular content and lung wet to dry weight ratios to estimate lung water content. A second series of five rats/group per time point were euthanatized at the above times and lung, liver, kidney and heart were removed for evaluation of tissue antioxidant enzyme activities and for thiobarbituric acid reactive substances (TBARS) concentrations, as well as for lung histology. Smoke exposure resulted in average plasma carboxyhemoglobin (COHb) of 19+/-2% in the two smoke exposed groups and produced areas of erosion of the tracheal surface, resulting in loss of epithelium and exposed basement membrane. Lung water content was not significantly different among the four groups during the 96-h experimental period. Lung TBARS levels were 2-3-fold higher at 12 h in smoke exposed rats compared with controls. These levels peaked at 24 h and remained significantly elevated at 48 h compared to controls. TBARS were also elevated in liver, but not in heart or kidney in response to burn or combined injury. Minor effects on lung antioxidant enzyme activities were observed after smoke inhalation. These data suggest that smoke inhalation, independent of burn injury, induces an oxidant stress that persists for at least the first 48 h after smoke exposure.

Animals↗
PubMed2002

Effects of heparin and lisofylline on pulmonary function after smoke inhalation injury in an ovine model.

OBJECTIVE: This study evaluates the effects of heparin alone and in combination with lisofylline, 1-(5-R-hydroxyhexyl)3,7-dimethylxanthine, on severe smoke injury. DESIGN: Prospective animal study with concurrent controls. SETTING: An animal laboratory. SUBJECTS: Eighteen 1-yr-old female sheep, weighing 24-32 kg. INTERVENTIONS: After smoke exposure and tracheostomy, animals were divided into three groups. Group S (n = 6) received nebulized saline through an endotracheal tube every 4 hrs for 48 hrs. Group H (n = 6) received 10,000 units of nebulized heparin every 4 hrs. Group LH (n = 6) was treated with nebulized heparin and intravenous infusion of lisofylline (10 mg x kg(-1) x hr(-1)) for 48 hrs after a bolus injection (20 mg/kg). Animals initially breathed room air spontaneously. If PaO2 was <50 torr and PaCO2 >60 torr, animals were mechanically ventilated. Sheep were killed 48 hrs postinjury. MEASUREMENTS AND MAIN RESULTS: Blood gases were measured serially. At 48 hrs, ventilation perfusion distribution mismatching was analyzed by using the multiple inert gas elimination technique. Lung malondialdehyde was determined. The postinjury increase in alveolar-arterial oxygen tension gradient (LH, 36.7 +/- 3.5 vs. S, 89.0 +/- 24.6 torr at 48 hrs) was significantly attenuated in those animals receiving LH. The percentage of pulmonary shunt, Qs/Qt (LH, 20.8 +/- 4.9 vs. S, 36.6 +/- 4.6%), and the percentage of animals that required ventilation (LH, 0 vs. S, 67%) were significantly reduced in LH. Multiple inert gas elimination technique study showed that the true shunt fraction was decreased in LH. Lung malondialdehyde was significantly less in LH (LH, 0.33 +/- 0.06 vs. S, 0.56 +/- 0.09 nmol/mg protein). There was no significant difference in any of these variables between H and S. CONCLUSION: Treatment with heparin alone did not attenuate pulmonary dysfunction after severe smoke injury. Combined treatment with nebulized heparin and systemic lisofylline had beneficial effects on pulmonary function in association with a decrease in blood flow to poorly ventilated areas and less lipid peroxidation.

Analysis of Variance↗
PubMedDate not supplied

Analysis of gene expression patterns in human postburn hypertrophic scars.

Hypertrophic scars cause cosmetic disfigurement and limited mobility in burn patients. To better understand the molecular pathophysiology of hypertrophic scar formation, microarray analyses were performed on normal skin and hypertrophic scars from four burn patients. Microarray analyses were determined in an effort to identify genes whose expression discriminated between normal skin and mature, hypertrophic scars. Surgical biopsies were obtained from two pediatric and two adult patients 6 to 15 months after burn injury. Total RNA was isolated from the samples and subjected to microarray analysis using the Affymetrix U95Av2 GeneChip. Results from this analysis revealed 31 probe sets representing genes that were consistently up-regulated at least two-fold in hypertrophic scar specimens from all four patients and four probe sets that were down-regulated. The significance analysis of microarrays algorithm also identified 35 probe sets whose increased expression resulted in the hierarchal clustering of the hypertrophic scar and normal tissue, seven of which were identical to the six genes identified by paired analyses. These six genes all displayed elevated levels of expression in the scar tissue. Proteins encoded by the genes identified included germline oligometric matrix protein, matrix metalloproteinase-16, collagen type 1alpha, pleiotrophin, and thrombospondin-4. Although the results presented here suggest that there may be unique patterns of gene expression in hypertrophic scars that may be important in the evaluation and treatment of hypertrophic scarring, the results must be confirmed with larger datasets.

Adult↗
PubMedDate not supplied

The Pope Air Force Base aircraft crash and burn disaster.

This report describes the initial hospital and burn center management of a mass casualty incident resulting from an aircraft crash and fire. One hundred thirty soldiers were injured, including 10 immediate fatalities. Womack Army Medical Center at Fort Bragg, North Carolina, managed the casualties and began receiving patients 15 minutes after the crash. As a result of repetitive training that included at least two mass casualty drills each year, the triage area and emergency department were cleared of all patients within 2 hours. Fifty patients were transferred to burn centers, including 43 patients to the US Army Institute of Surgical Research. This constitutes the largest single mass casualty incident experienced in the 57-year history of the Institute. All patients of the US Army Institute of Surgical Research survived to hospital discharge, and 34 returned to duty 3 months after the crash. The scenario of an on-ground aircraft explosion and fire approximates what might be seen as a result of an aircraft hijacking, bombing, or intentional crash. Lessons learned from this incident have utility in the planning of future response to such disasters.

Accidents, Aviation↗
PubMedDate not supplied

The use of hydrogen peroxide for achieving dermal hemostasis after burn excision in a patient with platelet dysfunction.

As a topical hemostatic agent, hydrogen peroxide (3%) has been applied to tangential excisions of burn patients. Hydrogen peroxide provides an adjunct to topical epinephrine for hemostasis and clinically has been most useful in patients with known platelet dysfunction. Hydrogen peroxide should be irrigated from the wound bed before the placement of skin grafting because of its potential to inhibit wound healing. In our experience, hydrogen peroxide (3%) soaks have not resulted in complications related to corrosive damage, oxygen gas formation, or lipid peroxidation that are associated with high concentrations of hydrogen peroxide (30%). We also have experienced excellent skin graft take at the wound bed after using hydrogen peroxide.

Aged, 80 and over↗
PubMedDate not supplied

The use of collagen-glycosaminoglycan copolymer (Integra) for the repair of hypertrophic scars and keloids.

Integra dermal matrix (Integra Life Sciences Corp., Plainsboro, NJ) was introduced in 1981, and its use in acute surgical burns is well established. However, Integra also has been found to be useful in the surgical treatment of scars. The Integra neodermis is placed at the time of scar excision and then overgrafted several weeks later with a very thin (6/1000-inch) skin graft. The stabilized matrix appears to resist recurrence better than traditional skin grafts, which have a reported recurrence rate of 59%. Many surgeons have had anecdotal success using Integra for both hypertrophic and keloidal scars. This case series presents several patients who underwent reconstructive surgery with the use of Integra to treat their debilitating scar formation. None of the patients developed significant scar morbidity at the donor site when the skin was harvested for grafting during the second stage of the procedure. All patients had documented success with improved appearance, range of motion, and skin quality.

Adult↗
PubMedDate not supplied

Pattern of dysphagia recovery after thermal burn injury.

Providing nutritional support after thermal burn injury is a critical element in achieving successful patient outcomes. The medical records of 28 patients admitted to an acute care burn unit and referred to speech pathology for a swallowing evaluation were reviewed for patterns of dysphagia care. Results revealed a strong positive linear relationship between percent body burns (r = .71), number of days with a tracheostomy (r = .85), number of days on the ventilator (r = .94) and days to oral feeding. These data can be used for comparison with other models of care, such as early identification and intervention for dysphagia by the speech pathologist during the acute phase of recovery.

Burns↗