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@#Burns often happen unexpectedly and have the potential to cause death, lifelong disfigurement and dysfunction.[1] According to the depth of the burn wound and extent of affected burned body surface area, burns are classified as mild or severe. Mild burns usually refer to burns that encompass less than 10% of the total body surface area (TBSA), mainly superficial burns. Severe burns are defined as TBSA >10% in elderly patients, TBSA>20% in adults, and TBSA>30% in children.[2] Burn injuries, particularly severe burns, are accompanied by an immune and inflammatory response, metabolic changes and distributive shock that can be challenging to manage and can lead to multiple organ failure.[3] Therefore, burn care providers face many challenges, including acute and critical care management, long-term care, and rehabilitation. Here, we report a 94-year-old patient with severe burns who recovered well and was discharged from the hospital in a wheelchair.
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Resumen: Objetivo: se presenta una breve descripción de la experiencia de un centro de tercer nivel de atención de pacientes quemados graves en la unidad de cuidados intensivos (UCI) en la Ciudad de México. Material y métodos: análisis retrospectivo de 101 pacientes adultos que ingresaron a la UCI entre los años 2019-2022. Se describen características demográficas, principales diagnósticos, causas de complicaciones y tasa de mortalidad. Se subdividen en grupo de sobrevivientes y no sobrevivientes, y en grupo de adultos mayores de 65 años y menores de 65 años. Resultados: se describen 101 pacientes mayores de 18 años, 20 mujeres (19.1%), 81 hombres (80.1%). Promedio de edad de 40.1 ± 12.4 años. Promedio días de estancia de 13.3 ± 12.4 días/paciente. El principal diagnóstico de ingreso fue por quemaduras por fuego en 66 pacientes (65.3%). Mortalidad global de 19.8%, y en mayores de 65 años de 28.5%. La principal causa de muerte fue el choque séptico. Las principales causas de infección fueron Acinetobacter baumannii, Pseudomonas aeruginosa y diferentes especies de Candida. Conclusiones: las lesiones secundarias por quemaduras graves ocasionan una alta morbimortalidad, principalmente en adultos mayores, siendo la principal causa de muerte el choque séptico por bacterias multirresistentes.
Abstract: Objective: a brief description of the experience of a tertiary care center for severely burned patients in the intensive care unit in Mexico City is presented. Material and methods: retrospective analysis of 101 adult patients admitted to the intensive care unit between the years 2019-2022. Demographic characteristics, main diagnoses, causes of complications and mortality rate are described. They are subdivided into the group of survivors and non-survivors, and adults over 65 years of age and under 65 years of age. Results: 101 patients older than 18 years are described, 20 women (19.1%), 81 men (80.1%). Average age of 40.1 ± 12.4 years. Average days of stay of 13.3 ± 12.4 days/patient. The main admission diagnosis was fire burns in 66 patients (65.3%). Overall mortality of 19.8%, and in those over 65 years of age 28.5%. The main cause of death was septic shock. The main causes of infection were Acinetobacter baumannii, Pseudomonas aeruginosa and different species of Candida. Conclusions: secondary injuries due to severe burns cause high morbidity and mortality, mainly in older adults, with septic shock due to multiresistant bacteria being the main cause of death.
Resumo: Objetivo: apresenta-se uma breve descrição da experiência de um centro de atenção terciária para pacientes queimados em estado grave na unidade de terapia intensiva da Cidade do México. Material e métodos: análise retrospectiva de 101 pacientes adultos, internados na Unidade de Terapia Intensiva entre os anos de 2019-2022. São descritas características demográficas, principais diagnósticos, causas de complicações e taxa de mortalidade. Eles são subdivididos em grupos de sobreviventes e não sobreviventes e adultos com mais de 65 anos e menos de 65 anos. Resultados: são descritos 101 pacientes maiores de 18 anos, 20 mulheres (19.1%), 81 homens (80.1%). Idade média de 40.1 ± 12.4 anos. Média de dias de internação de 13.3 ± 12.4 dias/paciente. O principal diagnóstico de admissão foi queimaduras por fogo em 66 pacientes (65.3%). Mortalidade geral de 19.8%, e em pessoas com mais de 65 anos de 28.5%. A principal causa de morte foi choque séptico. As principais causas de infecção foram Acinetobacter baumannii, Pseudomonas aeuroginosa e diferentes espécies de Candida. Conclusões: lesões secundárias a queimaduras graves causam alta morbimortalidade, principalmente em idosos, sendo o choque séptico por bactérias multirresistentes a principal causa de morte.
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Objective To explore the preventive effect of low molecular weight heparin calcium in severe burn patients with venous thrombosis. Methods 64 patients of lower extremity burns complicated by systemic inflammatory response in Taizhou Enze medical center (Group) Enze hospital from March 2016 to 2017 March as the research object, were received once daily subcutaneous injection of 2850 U (0.3 mL) low molecular weight heparin calcium treatment, continuous injection of 10 d. The control group was given the routine nursing on the basis treatment, the observation group was given nursing intervention, the incidence rate of deep venous thrombosis and nursing satisfaction rate were compared between two groups. Methods FIB and blood D-dimer in the seventh day after treatment were improved (P<0.05) , PT and APTT in the seventh day after treatment were increased (P<0.05) , the level of FIB in the seventeenth day after treatment was significantly lower than the first day and the seventh day. The incidence of deep vein thrombosis in the observation group was significantly lower than the control group, nursing satisfaction rate in the observation group was higher than the control group, the difference was statistically significant (P<0.05). Conclusion Subcutaneous injection of low molecular weight heparin calcium in patients who are in high blood coagulation state after moderately severe burns SIRS can effectively prevent deep venous thrombosis, auxiliary nursing intervention is helpful to promote the rehabilitation of patients and improve nursing satisfaction.
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Objective To explore the preventive effect of low molecular weight heparin calcium in severe burn patients with venous thrombosis. Methods 64 patients of lower extremity burns complicated by systemic inflammatory response in Taizhou Enze medical center (Group) Enze hospital from March 2016 to 2017 March as the research object, were received once daily subcutaneous injection of 2850 U (0.3 mL) low molecular weight heparin calcium treatment, continuous injection of 10 d. The control group was given the routine nursing on the basis treatment, the observation group was given nursing intervention, the incidence rate of deep venous thrombosis and nursing satisfaction rate were compared between two groups. Methods FIB and blood D-dimer in the seventh day after treatment were improved (P<0.05) , PT and APTT in the seventh day after treatment were increased (P<0.05) , the level of FIB in the seventeenth day after treatment was significantly lower than the first day and the seventh day. The incidence of deep vein thrombosis in the observation group was significantly lower than the control group, nursing satisfaction rate in the observation group was higher than the control group, the difference was statistically significant (P<0.05). Conclusion Subcutaneous injection of low molecular weight heparin calcium in patients who are in high blood coagulation state after moderately severe burns SIRS can effectively prevent deep venous thrombosis, auxiliary nursing intervention is helpful to promote the rehabilitation of patients and improve nursing satisfaction.
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Objective To compare changes in indexes and analyze their values in prognosis of severe burn patients with sepsis.Methods A retrospective analysis was conducted. The patients with severe burn sepsis admitted to the Third Affiliated Hospital of Soochow University from August 2014 to December 2016 were enrolled. The blood culture was positive in the clinical diagnosis of sepsis. According to the prognosis, the patients were divided into death group and survival group. Their general information, vital signs, blood routine examination, serum sodium (Na+), serum glucose (Glu), C-reactive protein (CRP) and arterial partial pressure of carbon dioxide (PaCO2) at the time of admission and diagnosis of sepsis as well as the level of serum procalcitonin (PCT) at admission, diagnosis of sepsis and 1-8 days of post diagnosis were also compared. Receiver operating characteristic curve (ROC) was used to analyze the prognostic value of each index, and multivariate Cox regression analysis was used to analyze the influence of each index on the survival time, and the survival curve of Kaplan-Meier was analyzed for dead patients.Results There were 25 cases of severe burn patients with sepsis, which were admitted to hospital within 12 hours after injury; the time of diagnosis of burn sepsis was (14±6) days; 8 cases of survival; 17 cases died, the mortality rate was 68.0%, the time from diagnosis of sepsis to death was (28±14) days. The age of the death group was significantly higher than that of the survival group (years: 41±12 vs. 29±9,t = 2.598,P = 0.016), but there was no significant difference in the gender, total burn area,Ⅲ degree area, and the time of diagnosis of sepsis between the two groups. The platelet count (PLT) at the diagnosis of sepsis in death group was significantly lower than that of the survival group (×109/L: 69±43 vs. 180±108,t = -2.773, P = 0.023), and the PCT at 1-8 days of post-diagnosis in the death group was significantly higher than that of survival group [μg/L: 4.4 (2.2, 9.0) vs. 1.6 (0.7, 2.3),Z = -2.521,P = 0.012], but there was no significant difference in body temperature, heart rate, white blood cell count (WBC), percentage of neutrophils (Neu), Na+, Glu, CRP, PCT, PaCO2 at the time of admission and diagnosis of sepsis and PLT at the time of admission between the two groups. ROC curve analysis showed that the area under ROC curve (AUC) of age, PLT at the time of diagnosis and PCT at 1-8 days of post-diagnosis of sepsis was 0.808, 0.779, 0.825, respectively, for predicting the prognosis of patients with severe burn sepsis (allP < 0.05). At the cut-off age of 32, the sensitivity was 73.3% and the specificity was 75.0%. As the cut-off of PLT was 138×109/L at the time of diagnosis, the sensitivity was 92.3% and the specificity was 75.0%. As the cut-off of PCT was 2.39μg/L at 1-8 days of post-diagnosis of sepsis, the sensitivity was 73.3% and the specificity was 87.5%. Multivariate Cox regression analysis showed that age and PLT at the time of diagnosis were the favorable factors for the survival time of patients with severe burn sepsis (β value were -1.834, -0.029, respectively, bothP < 0.05). Kaplan-Meier survival analysis for patients in the death group showed that the median survival time of patients ≥32 years old was longer than that of patients < 32 years old (days: 32 vs. 9); 18-day cumulative survival rate was significantly higher than that of patients < 32 years old [83.3% (10/12) vs. 25.0% (1/4),χ2 = 9.705,P = 0.003].Conclusion Age, PLT at diagnosis of sepsis and PCT at 1-8 days after diagnosis of sepsis could be used as prognostic indexes for severe burn patients with sepsis.
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Objective To investigate the effect of comprehensive nursing intervention and evaluate its role in the entire clinical course of in the treatment of children with severe burns. Methods A total of 60 children with 1-5 years old with clinical diagnosis of severe burns were randomly divided into experimental group and control group by random digits table method, 30 cases in each group. The control group received routine burn care. The experimental group received comprehensive nursing interventions on the basis of routine burn care and the intervention time covered the entire course of treatment. During hospitalization, the recovery and family social system were evaluated by anxiety scales and social support scales combined with the cure rate and hospitalization of children. Results Before intervention, the score of Anxiety Rating Scale was high in both groups of families, while Social Support Scale was lower, the difference was not statistically significant between the two groups (P>0.05). After intervention, the score of Anxiety Rating Scale and was Social Support Scale were (52.31±7.81), (31.52± 5.48)points in the experimental group, and (62.51 ± 6.52), (23.62 ± 5.62) points in the control group, and there were significant differences (t=5.491 3, 5.512 5, P<0.01). The length of stay was (18.34±3.58) d in the experimental group, and (21.82 ± 4.23) d in the control group, and there was significant difference(t=3.439 6, P<0.05). The cure rate was 93.33%(28/30) in the experimental group, and 56.67%(17/30) in the control group, and there was significant difference(χ2=10.755 6, P<0.05). Conclusions The comprehensive nursing intervention can provide comprehensive refinement of the overall care in children and their families, promote physical and psychological rehabilitation of children with severe burns, and repair their family and social support systems. The comprehensive nursing intervention has far-reaching implications for the rehabilitation of children with severe burns.
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Objective To compare the effects of different moist environment for treating severely burned patients.Methods From November 2009 to December 2014 in the Burn Unit of Hainan General Hospital, 170 hospitalized patients with severe burns were randomly equally divided into observation group and control group.The patients of control group were treated with the traditional wet therapy treatment, while of the observation group were given the closed moist therapy treatment.The wound healing, pain relief and adverse reactions were observed.Results All patients completed the treatment,and the cure rates at the 7th and 14th day of treatment in the treatment group were 80.0% (68/85) and 97.6% (83/85), significantly higher than those of the control group (52.9% (45/85), 89.4% (76/85), x2 =8.344,4.111, P < 0.05).The number of dressing changes((7.44±2.39) times), cumulative dressing time ((45.98 ± 13.29) min) and wound healing time ((14.98±4.33)d) in the observation group were significantly less than those in the control group((11.76 ±3.14) times, (87.03 ± 14.99) min), (18.87 ± 5.13) d)), the differences were statistically significant (t =6.349,6.540,3.111, P<0.05).After treatment, the pain scores were showed clear downward trend, with had significant difference compared before treatment (P<0.05), while the pain scores at the 7th day((3.10± 1.34) scores) and 14th day((1.76±0.67) scores) of treatment in the treatment group were significantly lower than the control group((4.09±0.89) scores, (3.11±0.56) scores, P<0.05).The incidence of adverse events during treatment in both groups were 5.9%, obviously improved after symptomatic treatment.Conclusion The moist environment conducive to the treatment of severely burned patients, and safety.Conclusion to traditional wet therapy, closed moist therapy has better cure rate of severe burns, can promote wound healing, relieve pain and shorten the dressing cycle time.
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Objective To investigate the application effect of Orem theory in the clinical care of patients with severe burns and its impact on the quality of life of patients. Methods All 60 patients with severe burns in accordance with the way randomly divided into control group(n=30) with the observation group(n=30), respectively, with the use of conventional care nursing model of Orem. Changes, satisfaction with care, quality of life after treatment were com-pared before and after the psychological status of nursing intervention. Results (1)Two nursing intervention psycho-logical status were significantly better than the pre-nursing intervention and nursing intervention group before and after the degree of psychological conditions improve significantly greater than in the control group, and the SAS and SDS scores were statistically significant differences (P<0.05); (2)the control group patient's care satisfaction 70.00%, was significantly lower than 93.33%of the observation group (P<0.05);(3)based on simple burns health Scale (BSHS-A),ob-served in patients after nursing intervention BSHS-A total score and dimension scores of obser vation group were sig-nificantly lower than the control group (P<0.05). Conclusion Compared with usual care model, the theory of Orem for the clinical care of patients with severe burns,the effect is significant,the quality of life of patients is significantly improved,should be widely used in clinical care.
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Objective To explore the current research status and existing problems in severe burn nursing by reviewing relevant literature of severe burn nursing published in 6 kinds of nursing core journals. Methods Search 6 kinds of nursing core journals using the following key words: severe burn critical burn serious burn large area burn intensive burn and nursing. Applying bibliometrics to conduct descriptive analysis of the external and internal characteristics of these papers. Results Two hundred and nine papers were included;the main literature research type of thess articles was clinical experience summary, the content of these literature was extensive. Conclusions Severe burn nursing research focus on clinical symptomatic nursing; clinical nurse scientific research ability needs to be strengthened, and subject aspects should be paid more attention to children, the elderly, and clinical nurse physical and psychological conditions.
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Objective To investigate the effect of glutamine on energy intake and prognosis of severe burn patients in differ-ent pathway.Methods Using retrospective study method,we brought the patients into our study from October 2010 to April 2014 in accordance with the inclusion criteria.Patients who were given the Gln before 5 days after injury through gastric bowel were brought into the EN group,others who were given the Gln after 5 days after the injury through vein were brought into PN groups. A total of 66 patients were included in this study,with 31 cases of EN group and 35 cases of PN group.Total energy intake,external and internal energy intake,nutrients heating,energy intake/energy consumption ratio,blood glucose control,insulin use and viscera damage(the blood urea nitrogen,creatinine,alanine aminotransferase,aspartate aminotransferase,total bilirubin,creatine kinase,lac-tate dehydrogenase),ICU days,hospital stays and mortality were observed in 1,2,3,4 weeks after injury.Results Within a month after the injury,the energy intake of patients in EN group were more than PN group,especially the energy from intestinal canal.Be-sides,the ICU days of patients in EN group were shorter than patients in PN group (all P 0.05).Conclusion Supplement of Gln may be more conducive to improve the intestinal function in patients with burns may be more conducive to improve the intestinal function in patients with burns,im-prove the degree of tolerance of enteral nutrition,increase energy intake and conducive to improving the prognosis of patients.
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Objective To research the influence of ulinastatin on body inflammatory factor levels in patients with severe burns, and provide the basis treatment of patients with severe burns. Methods A total of 94 patients from Jan 2010 to June 2013 were studied in this test. The control group was treated with basic therapy including fluid infusion, antishock, cutting scab surgery and early nutrition support while the treatment group was received ulinastatin on the basic of control. Routine blood, body inflammatory factors level change and APACHE II score were compared between the two groups, Results The number of WBC and neutrophil in treatment group was higher than control 1group (P <0.05), while the PLT was lower than control group (P<0.05). The APACHE II score was in the same level between the two groups before treatment, while the score of treatment group was obvious lower than control control group after 72hr (P<0.05). The TNF-α and IL-6 in treatment group was lower than control wihle the IL-2 and IL-10 was higher than control(P<0.05). Conclusion Ulinastatin played an important role in improving the patient's body state of inflammation, the patient's symptom and preventing complications.
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Introducción: acorde con las investigaciones actuales con respecto al paciente con quemaduras, resulta de gran interés poder evaluar las alteraciones del estrés oxidativo en estos para buscar su vínculo con la fisiopatología de esta entidad nosológica y su posibilidad de establecer pronósticos de vida. Objetivo: evaluar el comportamiento de marcadores prooxidantes y antioxidantes de pacientes quemados mayores, e identificar la posible relación entre los valores de estos marcadores con el grupo en que se ubican los pacientes, dentro de la clasificación cubana de pronósticos de vida. Métodos: en una muestra de 15 pacientes, con quemaduras, distribuidos en: 6 graves, 6 muy graves y 3 críticos extremos, según la clasificación cubana de pronósticos de vida, se determinaron las concentraciones plasmáticas de malonildialdehído, superóxido dismutasa, catalasa y peroxidación lipídica, en las primeras 24 h, al sexto día y a los 21 días de recibida la lesión. Los datos se procesaron con el programa STATISTICA 6.1 Resultados: los valores de los marcadores variaron de forma patológica, con un nivel significativo entre cada momento estudiado. El estrés oxidativo en estos pacientes se instauró en las primeras horas de recibido el trauma y su comportamiento no dependió de la gravedad de los pacientes según la clasificación cubana de pronósticos de vida Conclusiones: el desbalance oxidativo que se produce en el paciente quemado abarca desde la fase de shock hipovolémico hasta la adaptación según la clasificación fisiopatológica de Kirsbaum. La variación de los marcadores de estrés oxidativo, no se comporta de forma homogénea dentro de los grupos de estudio de la clasificación cubana de pronósticos de vida
Introduction: according to current researches regarding the burnt patient, it is interesting to assess the oxidative stress alterations in them to seek its link with the physiopathologic features of this nosologic entity and its possibility to establish life prognosis. Objective: to assess the behavior of pro-oxidative and oxidative markers of patients with severe burns and to identify the possible relationship among the values of these markers with the group where the patients are located within a Cuban classification of life prognosis. Methods: sample included 15 burnt patients, distributed in: six severe, six very severe and three critically severe, according the Cuban classification of life prognosis, determining the plasma concentrations of malonyldialdehyde, superoxide, dismutase, catalase and lipid peroxidation during the first twenty four hours, at sixth day and at twenty one days after lesion. Data were processed using the STATISTICA 6.1 program. Results: marker's values changed the pathological way, with a significant level between each study moment. The oxidative stress in these patients appeared during the first hours after trauma and its behavior not depended on severity of patients according to the Cuban classification of the life prognosis. Conclusions: the oxidative lack of balanced present in the burnt patient covers from the phase of hypovolemic shock up to the adaptation according the Kirsbaum physiopathologic classification. The variation of the oxidative stress markers not behaves in a homogenous way in the study groups of the Cuban classification of life prognosis
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Humans , Male , Female , Catalase , Free Radicals , Glutathione , Oxidative Stress , Superoxide DismutaseABSTRACT
0.05).These findings indicate that severe burns can destroy the coupled phosphorylation in the mitochondria and impair their capability to produce ATP.Immediate fluid infusion after burns can protect the mitochondrial function effectively.
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The dynamic changes of the transcriptional activities of the nuclei of the rat liver and skeletal muscle cells were observed in the 6th, 12th, 24th, 48th, and 72nd hours after the animals were inflicted with 30% TBSA third degree burns.It was found that the incorporation of [3H]-UTP into the liver cell nuclei in vitro increased significantly in the 6th and 12th postburn hours. The peak of elevation occurred in the 6th hour postburn (from 7408 ?690 cpm/50?g DNA of normal to 10175 ? 1227 cpm/50?g DNA, P
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In order to study the mechanism of the barrier functional impairment-of gastric mucosa after burus, phosphorus or napalm 30% TBSA Ⅲ? burns was inflicted to rats and the osmolarity of hydrogen and chlorine ions of their gastric lavage fluid was determined. It was found the concentrations of the 2 ions in the lavage fluid decreased immediately after burn injury, reached the lowest point in the 5th hour postburn, and did not return to its preburn level even in the 72nd hour postburn.It is considered by the authors that the lowering of hydrogen and chlorine ions in the gastric lavage fluid after burns results from the reversed diffusion of the ions into the gastric mucosa since the stress reaction of the organism towards severe burns can impair the barrier function of the gastric musosa and the increase of hydrogen ions in gastric mucosa can aggravate the function impairment. In addition, phosphorus is a cytoplasm toxic. It can be rapidly absorbed through the cutaneous tissue of the burned area and carried to the gastric mucosa to intensify the mucosal lesion.