Role of resuscitation ratio in monitoring burn patients.

INTRODUCTION: Efforts with the utilization of an Input/Output ratio (I/O ratio) are done with success for analyzing and moving forward the treatment in the resuscitation phase of the burn patient. The need for conducting this research is to apply the I/O ratio in our cohort as a helpful index for classifying the resuscitation response of the burn patients. Our prespecified hypothesis is if it matters the analysis of the I/O ratio at 8 h of fluid resuscitation period. MATERIAL AND METHOD: This prospective observational study was performed in 50 patients (22 adults and 28 children) admitted in the Intensive Care of the Service of Burns in Tirana, Albania in the period January to December 2016. We calculated the I/O ratio at 8 h and the end of the 1st 24 h based on the stratification of patients according to the ratio in respective groups. In the adult population we did an analysis whereby the ratio I/O at 8 h has a relationship with the 24 h results as well as with ICU-free days. RESULTS: The 24 h fluid resuscitation was done with the majority clustered in the range 2-4 ml/kg/% TBSA with fluid-weight score (ml/kg) correlated with % TBSA. After calculation of the I/O ratio at 8 h, 29 patients were assigned in over-responders (<0.166), 16 patients in the expected group(0.166-0.334), and 5 patients were assigned in under-responders (>0.334). There is a strong correlation between the I/O ratio at 8 h and the I/O ratio at 24 h and I/O ratio predict better the longer ICU-free days. CONCLUSIONS: The I/O ratio is a very useful parameter not only at 12 h and 24 h but also at 8 h after burns. By classifying the patients into outcome groups that reflect not only the volume given but moreover the physiologic reactions to the resuscitation volume gotten, we were more attentive to patients in under-responders at 8 h. This parameter fulfills the criteria for better classifying patients and a better understanding of the physiology of burns.

Epidemiological trends of severe burns, 2009-2019: A study in the service of burns in Albania.

INTRODUCTION: Statistical and epidemiological data taken throughout decades show trends of the pathology of burns and its treatment. The aim of this study is to analyze the summarized epidemiological and clinical data of severe burn patients during the period 2009-2019 in order to acquire an accurate and recent picture of this pathology. This can create a basis for improving community health outcomes. MATERIAL AND METHOD: The study retrospectively analyzes the data of severe burn patients admitted in the Intensive Care Unit (ICU) of the Service of Burns and Plastic Surgery of the University Hospital Center in Tirana, Albania, from 2009 to 2019. SPSS 23 software is used for the conduction of the Descriptive and Inferential Statistics. Statistical significance is defined as p<0.05. RESULTS: Incidence rate of burn admissions which need ICU treatment in our data was 5.2 patients/100,000population/year. The mean age of our population was 24.9±25.5 years. The most frequent causes of burns in all patients were scalds (49.6%) followed by flame (39.5%), electrical (5.1%), chemical (5%) and with unknown cause (0.7%). Death rate from fire and burns for the period 2009-2019 was 0.3 patients per 100,000population/year. Overall mortality was 6.8%. The ABSI, Baux and R Baux scoring system remain accurate and valuable tools in the prediction of burn patient mortality. A probability of death chart for our service has been developed based on age and BSA (%) burned which needs to validate in the future. CONCLUSIONS: Etiology of burns have changed toward an increase in proportion of flame burns especially in adults and elderly population. Survival following severe burns has improved over the past 11 years even in patients with three risk factors (age ≥60, BSA (%) burned ≥40% and presence of inhalation burn). LA 50 for all patients was 80%. LOS/BSA (%) ratio is a more valuable indicator than LOS alone. Improvement in the treatment of severe burns is a combination of preventive health care, appropriate treatment protocols and improvements in equipment and infrastructure.

Epidemiology and outcome analysis of sepsis and organ dysfunction/failure after burns.

BACKGROUND: The aim of this prospective study in adult population is to give frequency data (prevalence, incidence) of burn wound sepsis and its consequences (organ dysfunction/failure); to analyze the evolution of the SOFA cumulative score during the disease and relationship between the SOFA score in the 3rd, 7th, 14th and 21th day after burn with mortality. METHOD: A prospective cohort study was performed among adult patients (age ≥20 years) admitted in the ICU, with major and moderate burns. Sepsis, organ dysfunction, organ failure and mortality were calculated as Cumulative Incidence (CI) and as Incidence rate (IR). Data from patients with sepsis were compared with those without sepsis. Evaluation of SOFA evolution was done with delta score and the influence of the SOFA score in mortality was calculated with AUC of the ROC curve. RESULTS AND CONCLUSIONS: Period prevalence of sepsis in our adult burned population was 26%. Incidence proportion as CI was 0.3 or 30 patients per 100 adults. Incidence rate (IR) was 6 patients with sepsis per 100 patient-years. Overall morbidity was 88.1% while overall mortality was 11.9%. Mortality in patients with sepsis was 34.4%. Incidence of MOD was 63% while incidence of MOF was 37%. Respective mortality as CI was 7% and 81% while mortality rate as IR was 1.4 per 100 patient-years in patients with MOD and 16.2 per 100 patient-years in patients with MOF. SOFA-3 should be considered a "reliable indicator" at separating survivors from non survivors and SOFA 7, 14, and 21 should be considered excellent in predicting mortality.

Epidemiology of infections in a burn unit, Albania.

BACKGROUND: Many types of nosocomial infections (NIs) can be present in the burned patient. The purpose of this study is to calculate the rates for NI in the Intensive Care Unit of the Service of Burns and Plastic Surgery in University Hospital Centre (UHC) in Tirana, Albania. METHOD: The study is prospective, clinical and analytical. The study is continued/longitudinal because monitors all patients with severe burns during a specified time period (1year). For data analysis was used SPSS 19.0. RESULTS: The infection prevalence rate was 12 infected patients per 100 patients. The colonisation prevalence rate was 43 colonised patients for 100 patients. The most frequent infection microorganisms were Pseudomonas aeruginosa and Staphylococcus aureus (67% and 24%). Incidence of BSI was 3 BSI for 1000 hospitalization days. Incidence of catheter-related bloodstream infection (CRBSI) was 11.7 BSI for 1000 catheter days. Colonisation of the tip of the central catheter (CTC) was 15.6 for 1000 catheter days. CONCLUSIONS: The epidemiology of burn wound infections as well as the definitions have changed due to important changes in burn wound treatment but further studies should be done documented the factors that can reduce the burn wound infection rates.

Epidemiology and mortality of burned patients treated in the University Hospital Center in Tirana, Albania: an analysis of 2337 cases during the period 1998-2008.

BACKGROUND: The basis for qualitative changes concerning everyday clinical practice are created from epidemiological studies, which not only generalize situations but at the same time provide specific details of the country's features; especially during periods of social transition. The aim of this study was to present demographic and epidemiological features of severe burns treated in the Service of Burns in UHC (University Hospital Center) in Albania and to analyze burn mortality as an important outcome measure. METHOD: The data used was obtained by the analysis of the medical records of 2337 patients hospitalized in Burns Service ICU near in Tirana, Albania during 1998-2008. Statistical analysis is done with SPSS 15 software. Descriptive analyses, inferential statistics and Chi-square test and Kendall's tau_b are calculated. Logistic regression is used for the prediction of death probability by two risk variables, BSA burned and age. RESULTS: The severe burn incidence was 7 patients per 100,000 persons/year. The overall mean estimated BSA (%) is 22.8±14.7. The main causes of the burn were found to be the scalds in 61.8% of the cases followed by flame (23%), chemicals (10.7%) and electrical injury in 4.5% of the cases. The mean hospital period is 11.6±10. The overall mortality is 10.5%. Based on probability of death, we noticed that older age and larger burn size were associated with a higher likelihood of mortality. CONCLUSIONS: The long-term studies and the comparison of our results with the ones of other burn centers has allowed us to determine the actual level of care and as well as to build up contemporary protocols in order to improve the treatment with the objection of decreasing the mortality.

Comparison of hypertonic vs isotonic fluids during resuscitation of severely burned patients.

BACKGROUND: The hypertonic lactate saline (HLS) solutions with mild concentration of sodium have been used in some burn centers to maintain plasma volume without infusing larger fluids volumes. To evaluate the fluid requirements during resuscitation with lactated Ringer's solution and to realize resuscitation with HLS, we suggest the following clinical trial. Specific objectives include fluid loads, sodium loads, and fluid accumulation. METHOD: This prospective study included 110 patients with severe burns. The first group included patients resuscitated in the beginning with lactated Ringer's solution, according to Parkland formula for adults and Shriner formula for children. In the other group, the patients were resuscitated with HLS solution. Patients are divided in 2 groups for comparison. RESULTS: There is difference between sodium loads (P = .03), fluid load in the first hour (P = .001), sodium load in the first hour (P = .001), and net fluid accumulation (P = .0025). There is a difference regarding plasma sodium and plasma osmolality in the first hour (P = .003, P = .002). There is difference regarding sodium given (P = .001) and sodium excreted (P = .001) in 2 groups. CONCLUSIONS: Hypertonic resuscitation consists in giving a higher fluid and sodium load in the first hour of therapy that is accompanied with a decrease in fluid requirements and fluid accumulation for the first 24 hours of burn shock.