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Biomedical subjects

Robert L Sheridan

Publications and source records attributed to Robert L Sheridan.

At least 19 recordsLinked to original sources
PubMed2006

Practical guidelines for nutritional management of burn injury and recovery.

Nutrition practice in burn injury requires a multifaceted approach aimed at providing metabolic support during a heightened inflammatory state, while accommodating surgical and medical needs of the patient. Nutritional assessment and determination of nutrient requirements is challenging, particularly given the metabolic disarray that frequently accompanies inflammation. Nutritional therapy requires careful decision making, regarding the safe use of enteral or parenteral nutrition and the aggressiveness of nutrient delivery given the severity of the patient's illness and response to treatment. With the discovery that specific nutrients can actually alter the course of disease, the role of nutrition support in critical illness has shifted from one of preventing malnutrition to one of disease modulation. Today the use of glutamine, arginine, essential fatty acids, and other nutritional factors for their effects on immunity and cell regulation is becoming more common, although the evidence is often lagging. An exciting dichotomy exits, forcing nutrition support specialists to make responsible choices while remaining open to new potential helpful therapeutic options.

Burns↗
PubMed2006

Negative chemical ionization gas chromatography/mass spectrometry to quantify urinary 3-methylhistidine: application to burn injury.

A rapid method for measuring 3-methylhistidine (3MH) in rat and human urine with higher sensitivity and precision than any previously reported method is described using internal standard [1-(13)C]3MH (M+1) and negative chemical ionization (NCI) gas chromatography/mass spectrometry (GC/MS). Internal standard [1-(13)C]3MH (M+1) was added to rat and human urine samples, hydrolyzed, and absorbed onto cation exchange columns. The column eluent was dried and derivatized for GC/MS analysis. Quantification of 3MH levels was accomplished by monitoring the m/z 204 fragment. The m/z 204 fragment was chosen due to the fragment's abundance and stability as determined by analysis of [methyl-(2)H(3), (18)O(2)]3MH (M+7) and [methyl-(13)C]3MH (M+1) fragmentation patterns under NCI conditions. This method shows excellent linearity (0.9989) over the range studied (0-0.5 mol), high recovery (95.9%), and low coefficient of variation (4.7%). The described method is sensitive enough to detect 6.8 pmol amount of urinary 3MH with a precision of 9.1%. The in vivo utility of this method to quantify urinary 3MH was tested in a burn injury rat model and on urine specimens from pediatric burn patients. Data obtained from the urine of burn-injured rats and pediatric burn patients match previously reported trends and validate the in vivo utility of this method.

Adolescent↗
PubMed2006

Severe desquamating disorder after liver transplant: toxic epidermal necrolysis or graft versus host disease?

OBJECTIVE: The objective of this article is to present and discuss the clinical characteristics of TEN (Toxic Epidermal Necrolysis) and GVHD (Graft Versus Host Disease) following orthotopic liver transplantation. METHODS: Recent experience with a patient who suffered a fatal desquamation syndrome within weeks of liver transplantation provides the basis for a discussion of differential diagnosis of these two conditions. RESULTS: TEN and GVHD demonstrate similar clinical presentations as well as etiology (CD8+ lymphocyte attack on epithelial surfaces). This case demonstrates the difficulty in distinguishing between these two conditions in this particular patient. CONCLUSIONS: Advances in the understanding and treatment of one of these disease states may provide therapeutic insights into the other.

Journal Article↗
PubMed2006

The effects of music therapy on pediatric patients' pain and anxiety during donor site dressing change.

The purpose of this study was to assess the effects of music therapy on pain and anxiety in pediatric burn patients during a donor site dressing change. Fourteen subjects were randomly selected to participate in this study. The experiment was conducted in the Reconstructive Unit of Shriners Burns Hospital-Boston. The experimental group's intervention consisted of live music and was compared to a control group whose intervention was verbal interaction. Psychological, behavioral, and physiological data were assessed through the Wong Baker FACES Pain Rating Scale, the Fear Thermometer, the Nursing Assessment of Pain Index, heart rate, and respiration rate. Data were analyzed using the ANCOVA, Mann-Whitney U, and regression analysis. The results were mixed and inconclusive. The members of the experimental group reported anecdotal information about the effects of music on pain and anxiety. An exploration of the limitations of the study and suggestions for further study are discussed.

Analysis of Variance↗
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↗
PubMed2006

Uncuffed endotracheal tubes should not be used in seriously burned children.

OBJECTIVE: To document a complication associated with placement of uncuffed endotracheal tubes in seriously burned children. DESIGN: Retrospective review. SETTING: Verified pediatric burn center. PATIENTS/SUBJECTS: Acutely burned children requiring urgent replacement of uncuffed endotracheal tubes with cuffed endotracheal tubes over a 5-yr period. INTERVENTIONS: In all children, the reason behind the need for urgent tube change was uncontrollable air leak, despite properly sized uncuffed endotracheal tubes, as respiratory failure progressed and compliance worsened. RESULTS: : These two girls and three boys had an average age of 2.2 +/- 1.0 yrs, burn size of 41% +/- 6.1% of the body surface, and subsequently required mechanical ventilation for an average of 23.6 +/- 6.3 days. Urgent tube change was required an average of 64.2 +/- 43.8 hrs after arrival in the burn unit (87.6 +/- 49.4 hrs after injury). Although successful in all children, massive facial edema rendered tube change potentially dangerous. The intervention would not have been necessary if cuffed endotracheal tubes had been placed initially. All children went on to survive their injury, without further tube change or tracheostomy. CONCLUSION: If children are critically burned and expected to require more than transient mechanical ventilatory support, low-pressure cuffed endotracheal tubes should be placed, regardless of the child's age.

Burns↗
PubMed2006

Young burned children: the course of acute stress and physiological and behavioral responses.

OBJECTIVE: Symptoms of posttraumatic stress disorder (PTSD) are a focus of much research with older children, but little research has been conducted with young children, who account for about 40% of all pediatric burn injuries. This is a longitudinal study of 72 acutely burned children (12-48 months old) that assessed the course of acute posttraumatic symptoms and physiological reactivity. METHOD: Parents were interviewed shortly after their child was admitted to the hospital and 1 month after discharge. PTSD symptoms were measured with the Diagnostic Interview for Children and Adolescents (DICA) module. Nurses recorded the child's physiological data throughout the hospital stay. The child's physical and behavioral responses were assessed in a laboratory at about 1 month after discharge. RESULTS: Reduced social smiling in the children was related to PTSD symptoms, as measured by the DICA, and heart rate at 24 hours and 7 days. Reduced vocalization was related to the child's rating of pain at 24 hours. Smiling and vocalizations were also related to some DICA cluster scores but not avoidance. CONCLUSIONS: Preschool children admitted to a burn unit demonstrated PTSD symptoms and physiological reactivity. There was a relation to the frequency of smiles and vocalizations.

Age Factors↗
PubMed2005

Sepsis in pediatric burn patients.

OBJECTIVE: To review the specific infections common in pediatric burns, including their categorization, diagnosis, and treatment. DESIGN: Review of the literature and expert opinion. RESULTS: Children with serious burns are prone to a host of septic complications. This proclivity to infection is secondary to the immunosuppressive effect of burn injury, the loss of the skin and mucosal physical barriers, and the requirement for invasive support devices. CONCLUSION: Sepsis is common in the pediatric burn patient and can markedly increase morbidity and mortality. Anticipation, prompt diagnosis of infection, and effective therapy can result in successful outcomes for many of these children.

Burns↗
PubMed2005

Pediatric trauma susceptibility to sepsis.

OBJECTIVE: The purpose of this review is to review how pediatric trauma may predispose children to sepsis. DESIGN: The information discussed in this report is derived from a recent literature review of pediatric trauma and related topics and discussion at an international consensus conference on pediatric sepsis. MEASUREMENTS AND MAIN RESULTS: There is a paucity of evidence on sepsis-related complications in pediatric trauma patients. Severe traumatic brain injury is a leading predisposing factor for sepsis complications. Excluding burn trauma, traumatically injured children without severe head injury rarely succumb to overwhelming sepsis. CONCLUSIONS: Patients with multiple traumatic injuries are frequently admitted to the intensive care unit, and because head injury is the most common ailment, unconscious patients with a combination of injuries that include head injury will regularly require mechanical ventilation and central venous access and are at risk for life-threatening nosocomial infections. Outside of pulmonary contusions, organ-specific causes of infection are infrequent.

Adolescent↗
PubMed2005

Pediatric surgical site and soft tissue infections.

OBJECTIVE: The purpose of this review is to provide background and a concise set of definitions for pediatric surgical site and wound infections. DESIGN: The information discussed in this report is derived from a literature review and discussion at an international consensus conference on pediatric sepsis. MEASUREMENTS AND MAIN RESULTS: There is a paucity of literature on pediatric surgical site and wound infection definitions. Excluding burn wounds, surgical site and wound infections rarely lead to overwhelming sepsis. Nevertheless, surgical site or wound infections including pressure ulcers can lead to significant morbidity in the pediatric critical care setting. CONCLUSIONS: Although surgical site and wound infections rarely lead to intensive care unit admissions, definitions are still valuable for stratifying potential candidates for sepsis trials.

Burns↗
PubMed2004

Fibroblasts improve performance of cultured composite skin substitutes on athymic mice.

BACKGROUND: This study investigated the impact of adding human fibroblasts to a cultured composite skin substitute model of cultured human keratinocytes and acellular human dermis. METHODS: Skin substitutes were prepared by seeding human keratinocytes on the papillary side of acellular dermis with or without seeding fibroblasts on the reticular side. Performance of the grafts was compared both in vitro by histology and in vivo on surgically created full-thickness wounds on athymic mice. Graft size and contraction were measured and immunohistochemical stains were done to reveal vascularization. RESULTS: Skin substitutes with fibroblasts formed thicker epidermis than skin substitutes without fibroblasts. When transplanted onto athymic mice, skin substitutes with fibroblasts maintained their original size with only 2% contraction. In contrast, skin substitutes without fibroblasts showed 29% contraction. Vascular basement membrane specific mouse CD31staining and endothelial cell specific mouse collagen type IV staining revealed vascularization as early as 1 week posttransplant in grafts with fibroblasts, and was significantly higher than grafts without fibroblasts at 2 weeks. CONCLUSIONS: Addition of fibroblasts to keratinocyte based composite skin substitutes improves epidermis formation, enhances vascularization and reduces contraction.

Animals↗
PubMed2004

Collagen denaturation can be quantified in burned human skin using polarization-sensitive optical coherence tomography.

Quantifiable prognostic indicators are of considerable practical value following thermal injury. Collagen is a major component of the skin, and is known to undergo denaturation at the elevated temperatures associated with burns. The purpose of this study was to determine whether a recently developed, non-invasive imaging technique could detect and quantify collagen denaturation in burned human skin. Polarization-sensitive optical coherence tomography (PS-OCT) imaging was used to quantify collagen birefringence in normal human skin, and in skin excised from burn patients. Images were acquired and displayed in 1s, and demonstrated qualitative differences between normal and partial-thickness burned human skin. Birefringence loss due to thermal denaturation of collagen was quantified, with mean phase retardation rates for samples of 26 normal and 26 burned skin sites determined to be 0.401 +/- 0.020 and 0.249 +/- 0.017 degrees /microm, respectively (mean +/- S.E.M.), with this difference in sample means shown to be statistically significant (P < 0.000001). Analysis of the accuracy of the technique indicated that PS-OCT measurements may be made with resolution sufficient to distinguish between burns of varying severity. In conclusion, PS-OCT is capable of imaging and quantifying collagen denaturation in burned human skin, providing a new parameter against which post-injury outcome may be compared.

Adolescent↗
PubMed2004

Short-term enteral glutamine does not enhance protein accretion in burned children: a stable isotope study.

OBJECTIVE: Glutamine is a nonessential amino acid that, in recent years, has been found to play important roles in several metabolic and immunologic processes. It has been theorized that, in a stressed state, it may become "conditionally essential" because the patient's ability to manufacture glutamine may not be adequate to meet their needs under this condition. We chose to evaluate the ability of 48 hours of enteral glutamine to enhance immediate nitrogen accretion in stressed pediatric burn patients. METHODS: Nine children with serious burns who were tolerating tube feedings were enrolled in a human studies committee-approved protocol in which they received 48 hours of enteral feedings with glutamine replacing 20% of essential and nonessential amino acids and 48 hours of isonitrogenous, isocaloric standard enteral feedings. This interval was chosen to help ensure that the study periods were comparable from a metabolic perspective. At the end of each period, protein kinetics were determined by a primed constant infusion of L-[1-(13)C] leucine tracer. The order of the studies was randomized. Seven children completed both phases of the study. Results were compared by paired t test and are presented as mean +/- standard error of the mean. RESULTS: During the glutamine feeding period, the leucine flux and leucine oxidation rate were significantly lower than those in the conventional feeding period. This reflects a reduction in total leucine intake from 80 +/- 11 to 62 +/- 10 micromol/kg per hour. However, there was no significant difference in the net balance of leucine accretion into proteins between these 2 dietary periods, which indicated that enriched glutamine feeding for 48 hours did not result in an immediate whole body protein gain in this group of pediatric patients. In addition, plasma glutamine concentration showed a moderate increase after 48 hours of supplementation but did not reach significance. CONCLUSION: Rapid protein accretion does not occur with short-term enteral glutamine supplementation. Several days of glutamine supplementation may be required to restore plasma glutamine levels and stimulate protein synthesis.

Adolescent↗