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Biomedical subjects

J R Saffle

Publications and source records attributed to J R Saffle.

90 records · Page 5Linked to original sources
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Evaluation of topical therapeutic ultrasound to improve response to physical therapy and lessen scar contracture after burn injury.

This study compared results of patients who received standard burn physical therapy and topical ultrasound with patients who received standard care alone to investigate the effect of topical therapeutic ultrasound on range of motion and pain in patients with burns. Fourteen burned extremities were studied. Eight joints were randomized to treatment with ultrasound followed by 10 minutes of passive stretching. Six joints received placebo ultrasound treatments and stretching. All treatments were performed every other day throughout a 2-week study period. Joint range of motion was measured before and after each treatment, and patients estimated the pain of the procedure. Patients and therapists were blinded to the treatment group. Analysis of the data revealed no differences in range of motion or perceived pain between the two groups. The effect of ultrasound on range of motion and pain was not predictable. We conclude that patients are not likely to improve from ultrasound treatment at our protocol parameters.

Adult↗
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Recent outcomes in the treatment of burn injury in the United States: a report from the American Burn Association Patient Registry.

This article reports outcomes of 6417 patients treated during 1991-1993 in 28 burn centers. Data were gathered by use of the ABA's computerized patient registry. Mean burn size was 14.1% total body surface area. There were 6087 survivors (95.9%); mortality rate among patients with inhalation injury was 29.4%. A probit analysis was used to construct a series of survival curves; the LA50 (which is defined as the burn size lethal to 50% of patients) for young adults was 81% total body surface area. Mean length of hospital stay was 13.5 days. Total mean charges were $39,533, with resource utilization related to clinical comorbidity factors and length of stay. No reliable method could be found to predict survival on admission. Mean charges for the most intensive diagnosis-related group (No. 472) exceeded $198,000 per patient. Pooled data and related summary statistics used in this study have some limitations, which are discussed. Additional accurate information regarding the outcomes of thermal injury treatment is needed by the burn care community.

Adolescent↗
PubMedDate not supplied

Self-inflicted patient burns: suicide versus mutilation.

Though suicide by burning is well-described, little information is available regarding patients who mutilate themselves by burning without suicidal intent. We reviewed 31 patients admitted from 1980 to 1991 with self-inflicted burns to describe differences between self-mutilation and attempted suicide (AS). In 16 patients who had mutilated themselves, mean burn size was 1.6% TBSA (range 0.3% to 9.0% TBSA) compared with 35.4% TBSA in the 15 patients who had attempted suicide (range 11.5% to 90% TBSA; p < 0.0001). Twelve of 15 patients who had attempted suicide used flammable liquids for self-immolation, whereas patients who had mutilated themselves often used techniques that they could control, including scalding, chemicals, and contact injuries. Most patients in both groups and previous histories of psychiatric disorders. Self-mutilators had a high incidence of personality disorders (56%), whereas the AS group more frequently suffered from depression (47%). Nine (56%) patients who had mutilated themselves had previous self-inflicted burns, compared with only one patient in the AS group. Mean lengths of stay, number of surgeries, and hospital and physician charges were higher for the AS group. Case examples of both types of injuries are presented. Burn care professionals should be familiar with syndrome of self-mutilation by burning. Patients often present with puzzling injuries and require psychiatric treatment in addition to burn care.

Adult↗
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Influence of allogeneic blood transfusion on natural killer cell activity in burn-injured mice.

Allogeneic blood transfusion (Allo/BT) and burn injury modify the cellular immune response in patients under a variety of circumstances. We designed this study to investigate the influence of Allo/BT, burn injury, and the combination of the two on in vivo natural killer (NK) cell activity in a murine model. This study demonstrated significant enhancement of in vivo NK cell activity in noninjured BALB/c mice receiving Allo/BT from C3H mice when compared to both the control and syngeneic blood transfusion group at posttransfusion day 5. When burn-injured mice were compared to sham-stressed mice, the burn-injured mice showed significant suppression of in vivo NK cell activity. Furthermore, in this strain combination model, Allo/BT modulated the suppressive effect of burn injury on in vivo NK cell activity at posttransfusion day 5 and postburn day 7.

Analysis of Variance↗
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Return to work as a measure of outcome in adults hospitalized for acute burn treatment.

Rehabilitation of patients with burn injuries is receiving renewed interest because survival has improved, and health reform has mandated outcomes assessment. To determine factors affecting return to work, a survey was conducted among 234 employed patients treated from 1986 through 1993. The mean burn size was 13.3% total body surface area. Patients returned to work in a mean of 14.3 weeks; a number initially returned to light-duty or part-time jobs as a "bridge" to full-time employment. Length of hospitalization, number of surgeries, total and full-thickness burn size, and subjective assessments by patients of their functional ability correlated with time off work. Patients with health insurance were more likely to resume work than was expected, whereas those covered by Medicaid and those involved in injury-related lawsuits were less likely to return to work. It is hoped that this information can be used to design interventions aimed at improving this outcome of burn treatment.

Acute Disease↗
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Resuscitation of thermally injured patients with oxygen transport criteria as goals of therapy.

Resuscitation from shock based on oxygen transport criteria has been widely used in trauma and surgical patients, but has not been examined in thermally injured patients. To study the possible efficacy of this type of resuscitation, the oxygen transport characteristics of burn resuscitation were studied in nine adults, of whom six had inhalation injuries, with a mean burn size of 45% total body surface area and a mean age of 33.4 years, who were resuscitated based on oxygen transport criteria. Pulmonary artery balloon flotation catheters were placed and hemodynamic and oxygen transport parameters (Fick method) were measured hourly for 6 hours. Patients received fluid boluses in addition to resuscitation calculated by the Parkland formula, until the pulmonary artery wedge pressure reached 15 mm Hg, after which dobutamine infusions (5 micrograms/kg/min) were initiated. Cardiac index increased from 2.51 to 6.57 L/min/m2 (p < 0.05), whereas systemic vascular resistance fell from 1534 to 584 dyne sec/cm5 (p < 0.05). Oxygen delivery (DO2I) and oxygen consumption (VO2I) indexes increased significantly during the study period (573 +/- 47 to 1028 +/- 57, and 132 +/- 8 to 172 +/- 16 ml/min/m2, respectively; p < 0.05). VO2I appeared dependent on DO2I at levels of DO2I less than 800 ml/min/m2. In this study, depressed cardiovascular function in patients with burn injuries responded to volume loading and inotropic support much as it does in patients with shock of other etiologies. Whether oxygen transport-based resuscitation is effective in improving survival or the incidence of multiple organ failure is unknown and will need to be evaluated in randomized trials.

Adult↗
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Chemical paralysis reduces energy expenditure in patients with burns and severe respiratory failure treated with mechanical ventilation.

Predictive formulas often overestimate energy requirements, particularly in patients being treated with mechanical ventilation, resulting in significant overfeeding. The purpose of this study was to quantify the effect of chemical paralysis on energy expenditure in patients with burn injuries receiving ventilation treatment, and compare measured energy expenditure with estimates of energy expenditure based on predictive formulas. The study was a retrospective review of 14 patients with burn injuries treated with mechanical ventilation that required chemical paralysis to reduce inspiratory pressures or improve oxygenation. Indirect calorimetry was performed before, during, and after paralysis. Measured energy expenditure (MEE) was compared with the energy predictions of the Harris-Benedict (HBEE) and Curreri (CEE) estimates. During paralysis, mean MEE was significantly lower than pre- or postparalysis (19.65 +/- 1.65 versus 26.00 +/- 2.42 and 29.49 +/- 2.83 kcal/kg/24 hr, respectively). Mean HBEE (2031 +/- 145 kcal/24 hr) approximated MEE pre-(1989 +/- 350 kcal/24 hr) and postparalysis (2237 +/- 269 kcal/24 hr), but overestimated MEE during paralysis (1532 +/- 208 kcal/24 hr; p < 0.05). Mean CEE (2957 +/- 229 kcal/ 24 hr) estimates significantly overestimated MEE before, during, and after paralysis (1989 +/- 350, 1532 +/- 208, and 2237 +/- 269, respectively p < 0.05). Predictive formulas significantly overestimate measured energy requirements in these patients. Indirect calorimetry should guide nutrition support in patients requiring prolonged mechanical ventilation.

Adult↗
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A multicenter review of toxic epidermal necrolysis treated in U.S. burn centers at the end of the twentieth century.

Toxic epidermal necrolysis (TEN) is a potentially fatal disorder that involves large areas of skin desquamation. Patients with TEN are often referred to burn centers for expert wound management and comprehensive care. The purpose of this study was to define the presenting characteristics and treatment of TEN before and after admission to regional burn centers and to evaluate the efficacy of burn center treatment for this disorder. A retrospective multicenter chart review was completed for patients admitted with TEN to 15 burn centers from 1995 to 2000. Charts were reviewed for patient characteristics, non-burn hospital and burn center treatment, and outcome. A total of 199 patients were admitted. Patients had a mean age of 47 years, mean 67.7% total body surface area skin slough, and mean Acute Physiology and Chronic Health Evaluation (APACHE II) score of 10. Sixty-four patients died, for a mortality rate of 32%. Mortality increased to 51% for patients transferred to a burn center more than one week after onset of disease. Burn centers and non-burn hospitals differed in their use of enteral nutrition (70 vs 12%, respectively, P < 0.05), prophylactic antibiotics (22 vs 37.9%, P < 0.05), corticosteroid use (22 vs 51%, P < 0.05), and wound management. Age, body surface area involvement, APACHE II score, complications, and parenteral nutrition before transfer correlated with increased mortality. The treatment of TEN differs markedly between burn centers and non-burn centers. Early transport to a burn unit is warranted to improve patient outcome.

APACHE↗
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Current management of purpura fulminans: a multicenter study.

Seven burn centers performed a 10-yr retrospective chart review of patients diagnosed with purpura fulminans. Patient demographics, etiology, presentation, medical and surgical treatment, and outcome were reviewed. A total of 70 patients were identified. Mean patient age was 13 yr. Neisseria meningitidis was the most common etiologic agent in infants and adolescents whereas Streptococcus commonly afflicted the adult population. Acute management consisted of antibiotic administration, volume resuscitation, ventilatory and inotropic support, with occasional use of corticosteroids (38%) and protein C replacement (9%). Full-thickness skin and soft-tissue necrosis was extensive, requiring skin grafting and amputations in 90% of the patients. One fourth of the patients required amputations of all extremities. Fasciotomies when performed early appeared to limit the level of amputation in 6 of 14 patients. Therefore, fasciotomies during the initial management of these patients may reduce the depth of soft-tissue involvement and the extent of amputations.

Adolescent↗
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Serial measurements increase the accuracy of laser Doppler assessment of burn wounds.

Traditional methods of judging burn depth by clinical evaluation of the wound based on appearance and sensation remain in wide use but are subject to individual variation by examiner. In addition to the clinical difficulties with burn wound management, observer dependency of wound assessment complicates clinical trials of burn wound therapy. A laser Doppler flowmeter with a multichannel probe was used to measure burn wound perfusion as a tool to predict wound outcome. Serial measurement with laser Doppler flowmetry had an 88% specificity and a positive predictive value of 81% for identifying nonhealing wounds. These results suggest that laser Doppler flowmetry is a potentially useful tool for burn wound assessment.

Adolescent↗
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Calculation of metabolic expenditure and substrate utilization from gas exchange measurements.

At least nine different equations have been published for calculating metabolic expenditure by indirect calorimetry. This study examined the differences between equations when they are used for the nutritional assessment in an intensive care unit (ICU). Oxygen consumption and carbon dioxide production were measured in 36 ICU patients and used to calculate metabolic expenditure with the nine equations. The equations produced differences in metabolic expenditure which averaged from 0.8-96 kcal/day. The largest difference produced by any two of the nine equations was 189 kcal/day. Although differences in original stoichiometric data have resulted in numerous different equations for the calculation of metabolic expenditure, these differences are not clinically important. It makes little difference which equation is used for nutritional assessment in an ICU.

Dietary Carbohydrates↗
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A nonsplinting approach to the care of the thermally injured patient.

The background and present elements of a nonsplinting approach to burn rehabilitation are presented. Traditionally most burned extremities were prophylactically splinted to prevent contracture, frequently resulting in patient dependence on the devices. Over the past 10 years a program of acute active exercise training, nonsplinting, independent activities of daily living, and ambulation was established for our burn patients to foster patient independence and responsibility. This program not only consists of the exercise protocols, but it also furthers patient and family education, only occasional intermittent use of splints for maintenance of achieved motion, and the use of antiburn scar supports. This approach has been a successful means of promoting increased patient compliance to physical therapy.

Activities of Daily Living↗