Ultrasound-based evaluation of loss of lean mass in patients with burns: A prospective longitudinal study.

OBJECTIVES: To evaluate the loss of lean mass in patients with burns using ultrasonography of the quadriceps muscle of the thigh. METHODS: A prospective longitudinal study was conducted using ultrasound of the quadriceps muscle of the thigh to assess the change in thickness in millimeters on days 1, 3 and 7 after study enrollment in 45 patients with burns who were admitted to a burn center (BTC) of a university hospital between April 2020 and September 2021. Patients burns on the thighs, which made it difficult to undertake examinations, were excluded. Depending on where they were admitted, patients were divided into ward and intensive care unit (ICU) patients. ICU patients were considered to have more severe injuries. The general data collected included age, sex, weight, height, area of body surface burn, burn degree and etiology, and airway injury. The data collected for all patients during hospitalization at the BTC were as follows: existence of chronic illness, requirement for mechanical ventilation, Simplified Acute Physiology Score 3 (SAPS 3) and Sequential Organ Failure Assessment (SOFA) on the first day of hospitalization in an intensive care bed in the burn treatment unit (BTU), health-related infection, feeding route, length of hospital stay, and time spent in the BTU. RESULTS: Loss of muscle thickness was observed in all patients between days 1 and 7. The median thickness for all patients on day 1 was 24.50 mm (ITQ 21.22-30.85) and on day 7 it was 18.80 (ITQ 16.07-23.62), with P = 0.0001. The variation in thigh quadricep muscle thickness between day 1 and day 3, a median of - 2.80 mm (ITQ - 3.52-2.02) was obtained for patients on the ward and - 2.50 mm (ITQ - 3.92 to - 1.47) for ICU patients. Between day 3 and day 7, the variation was - 2.55 mm (ITQ - 4.55 to - 1.25) for ward patients and - 2.10 mm (ITQ - 3.12 to - 1.15) for ICU patients. The median thickness variation assessed between day 1 and day 7 was - 4.95 mm (ITQ - 8.25 to - 3.70) for patients on the ward and - 4.40 mm (ITQ - 7, 35 to - 2.90) for ICU patients. A correlation was observed between the variation in muscle thickness in the interval between day 1 to day 3 and age (P = 0.035). CONCLUSIONS: Muscle loss occurred early and rapidly within the first seven days of hospitalization, reflecting the impact of burn injury on nutritional risk. An association was observed between muscle thickness loss and age, but no association was observed with the extent of burn, length of hospital stay, occurrence of health-related infections or mortality. These findings suggest the importance of monitoring muscle loss in these patients in planning nutritional therapy, early mobilization, and prevention of complications.

Risk factors for acute respiratory distress syndrome in severe burns: prospective cohort study.

INTRODUCTION: Age and inhalation injury are important risk factors for acute respiratory distress syndrome (ARDS) in the burned patient; however, the impact of interventions such as mechanical ventilation, fluid balance (FB), and packed red blood cell transfusion remains unclear. The purpose of this study was to determine the incidence of moderate and severe ARDS and its risk factors among burn-related demographic variables and clinical interventions in mechanically ventilated burn patients. Risk factors for death within 28 days were also evaluated. METHOD: A prospective longitudinal study was carried out over a period of 30 months between July 2015 and December 2017. Patients older than 18 years, with a burn injury and under mechanical ventilation were included. The outcomes of interest were diagnosis of ARDS up to seven days after admission and death within 28 days. The proportional Cox regression risk model was used to obtain the hazard ratio for each independent variable. RESULTS: The cases of 61 patients were analyzed. Thirty-seven (60.66%) of the patients developed ARDS. The groups of patients with or without ARDS did not present differences regarding age, sex, burned body surface, or prognostic scores. Factors independently related to the occurrence of ARDS were age (hazard ratio [HR] = 1.04; 95% confidence interval [CI] 1.02-1.06; P < 0.001), inhalation injury (HR = 2.50; 95% CI 1.25-5.02; P = 0.01), and static compliance (HR = 0.97; 95% CI 0.94-0.99; P = 0.03). Tidal volume, driving pressure, acute renal injury, and FB between days 1 and 7 were similar in both groups. Accumulated FBs of 48, 72, 96, and 168 hours were also similar. Mortality at 28 days was 40.98% (25 patients). ARDS (HR = 3.63, 95% CI 1.36 to 9.68; P = 0.01) and burned body surface area (HR = 1.03, 95% CI 1.02 to 1.05; P < 0.001) were associated with death in 28 days. CONCLUSION: ARDS was a frequent complication and a risk factor for death in patients under mechanical ventilation, with large burned areas. Age and inhalation injury were independent factors for ARDS. Current tidal volume, driving pressure, red blood cell transfusion, acute renal injury, and FB were not predictors of ARDS.

The Effect of Support Surfaces on the Incidence of Pressure Injuries in Critically Ill Patients: A Randomized Clinical Trial.

PURPOSE: To analyze whether a viscoelastic mattress support surface can reduce the incidence of stage 2 pressure injuries compared to a standard hospital mattress with pyramidal overlay in critically ill patients. METHOD: A randomized clinical trial with intention-to-treat analysis was carried out recruiting patients with Braden scale ≤14 on intensive care unit admission from April 2016 to April 2017. Patients were allocated into two groups: intervention group (viscoelastic mattress) and control group (standard mattress with pyramidal overlay). The level of significance adopted was 5%. RESULTS: A total of 62 patients were included in the study. There was a predominance of males (53%) and the mean age was 67.9 (SD 18.8) years. There were no differences in clinical or severity characteristics between the patients in the control group and the intervention group. Pressure injuries occurred in 35 patients, with a median time of 7 days (ITQ 4-10) from admission. The frequency of pressure injuries was higher in the control group (80.6%) compared to the intervention group (32.2%; p < 0.001). CONCLUSIONS: Viscoelastic support surfaces reduced the incidence of pressure injuries in moderate or higher risk critically ill patients when compared to pyramidal support surfaces.

Caring for critically ill patients outside intensive care units due to full units: a cohort study.

OBJECTIVES: This study sought to analyze the clinical and epidemiologic characteristics of critically ill patients who were denied intensive care unit admission due to the unavailability of beds and to estimate the direct costs of treatment. METHODS: A prospective cohort study was performed with critically ill patients treated in a university hospital. All consecutive patients denied intensive care unit beds due to a full unit from February 2012 to February 2013 were included. The data collected included clinical data, calculation of costs, prognostic scores, and outcomes. The patients were followed for data collection until intensive care unit admission or cancellation of the request for the intensive care unit bed. Vital status at hospital discharge was noted, and patients were classified as survivors or non-survivors considering this endpoint. RESULTS: Four hundred and fifty-four patients were analyzed. Patients were predominantly male (54.6%), and the median age was 62 (interquartile range (ITQ): 47 - 73) years. The median APACHE II score was 22.5 (ITQ: 16 - 29). Invasive mechanical ventilation was used in 298 patients (65.6%), and vasoactive drugs were used in 44.9% of patients. The median time of follow-up was 3 days (ITQ: 2 - 6); after this time, 204 patients were admitted to the intensive care unit and 250 had the intensive care unit bed request canceled. The median total cost per patient was US$ 5,945.98. CONCLUSIONS: Patients presented a high severity in terms of disease scores, had multiple organ dysfunction and needed multiple invasive therapeutic interventions. The study patients received intensive care with specialized consultation during their stay in the hospital wards and presented high costs of treatment.

Caring for critically ill patients outside intensive care units due to full units: a cohort study

OBJECTIVES: This study sought to analyze the clinical and epidemiologic characteristics of critically ill patients who were denied intensive care unit admission due to the unavailability of beds and to estimate the direct costs of treatment. METHODS: A prospective cohort study was performed with critically ill patients treated in a university hospital. All consecutive patients denied intensive care unit beds due to a full unit from February 2012 to February 2013 were included. The data collected included clinical data, calculation of costs, prognostic scores, and outcomes. The patients were followed for data collection until intensive care unit admission or cancellation of the request for the intensive care unit bed. Vital status at hospital discharge was noted, and patients were classified as survivors or non-survivors considering this endpoint. RESULTS: Four hundred and fifty-four patients were analyzed. Patients were predominantly male (54.6%), and the median age was 62 (interquartile range (ITQ): 47 - 73) years. The median APACHE II score was 22.5 (ITQ: 16 - 29). Invasive mechanical ventilation was used in 298 patients (65.6%), and vasoactive drugs were used in 44.9% of patients. The median time of follow-up was 3 days (ITQ: 2 - 6); after this time, 204 patients were admitted to the intensive care unit and 250 had the intensive care unit bed request canceled. The median total cost per patient was US$ 5,945.98. CONCLUSIONS: Patients presented a high severity in terms of disease scores, had multiple organ dysfunction and needed multiple invasive therapeutic interventions. The study patients received intensive care with specialized consultation during their stay in the hospital wards and presented high costs of treatment.

Treatment costs of burn victims in a university hospital.

OBJECTIVES: To analyze the direct costs of treating critically ill patients in the intensive care unit of a center specializing in treating burns. METHODS: This is a prospective cohort study of 180 patients from May 2011 to May 2013. Clinical and demographic data were collected in addition to data for the calculation of severity scores. The costs related to daily clinical and surgical treatment were evaluated until hospital outcome. The costs were grouped into five blocks: Clinical support, Drugs and blood products, Medical procedures, Specific burn procedures and Hospital fees. The level of significance was set at 5%. RESULTS: There was a predominance of males, 131 (72.8%). The mean age of the patients was 42.0±15.3years and the mean burned body surface area was 27.9±17%. The median length of stay in intensive care beds was 15.0 (interquartile range IQR: 7.0-24.8) days and the median hospital stay was 23.0 (IQR: 14.0-34.0) days. The mean daily cost was US$ 1330.48 (standard error of the mean SE=38.36) and the mean total cost of hospitalization was US$ 39,594.90 (SE: 2813.11). The drugs and blood products block accounted for the largest fraction of the total costs (US$ 18,086.09; SE 1444.55). There was a difference in the daily costs of survivors and non survivors (US$ 1012.89; SE: 29.38 and US$ 1866.11, SE: 36.43, respectively, P<0.001). CONCLUSION: The direct costs of the treatment of burn patients at the study center were high. The drugs and blood products block presented the highest mean total and daily costs. Non surviving patients presented higher costs.

Epidemiology and outcome analysis of burn patients admitted to an Intensive Care Unit in a University Hospital.

OBJECTIVES: To describe the epidemiologic aspects of burn victims who were hospitalized in the Intensive Care Unit (ICU) at the Burn Center in the University Hospital of the State University of Londrina (UEL). METHODS: A longitudinal retrospective study was conducted, involving patients admitted to the Intensive Care Unit of the Burn Center from January 2010 to December 2012. Demographic and diagnostic data including the diagnosis of the extent and causes of the burns, complications resulting from the burns and the need for specific surgical interventions were collected, together with data for the calculation of the Acute Physiology and Chronic Health Evaluation (APACHE II), Sequential Organ Failure Assessment (SOFA), Therapeutic Intervention Scoring System (TISS-28) and Abbreviated Burn Severity Index (ABSI). Data were collected at admission and daily until discharge from the burn Intensive Care Unit. Risk factors for death and the prognostic performance of scores to predict mortality were analyzed. The level of significance was set at 5%. RESULTS: Two hundred ninety-three patients were analyzed in the study; 68.30% were men, with a median age of 38 years (interquartile range: 28-52). The mean total body surface area burned was 26.60±18.05%. Home incidents were the most frequent cause, occurring in 53.90% of the cases. Fire was the most common cause, found in 77.10% of patients. Liquid alcohol was the most common agent and was associated with 51.50% of the cases. The ABSI presented a median of 7, and the area under the ROC curve was 0.890. In multivariate analysis, age (p<0.001), female gender (p=0.02), total body surface area burned (p<0.001), mechanical ventilation (p<0.001) and acute renal failure (p<0.001) were all associated with mortality. ICU mortality was 32.80%, and hospital mortality was 34.10%. CONCLUSION: Burns most often occurred in young adult men in our study. The most common cause was a direct flame. Liquid alcohol was the most frequent accelerating agent. Patients were considered to be severely burned. Most of the samples had a high mean total body surface area burned. The ABSI score showed the best performance in discriminating non-survivors. Hospital mortality rate was high.