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1.
Burns ; 43(2): 374-378, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-27658997

RESUMO

INTRODUCTION: One of the primary intraoperative challenges during burn surgery is to adequately excise the burn while avoiding massive hemorrhage. This has become increasingly important, as we see more burn patients that are older and with more medical comorbidities. While adequate excision down to healthy tissues for deep burns is essential for skin graft to take, it also leads to active bleeding that can be a challenge to control. Good hemostasis is imperative as a hematoma is the most common cause of graft loss. Several new products have become available to help control intraoperative hemorrhage. A new hemostatic dressing, NuStat®, is available and approved by FDA in United States. METHODS: A single institution prospective randomized control trial was completed at Regional Burn Center of the University of South Alabama comparing NuStat® with the institutional historic standard of care. Twenty such patients were included in our study. A cost analysis was also completed as part of the study retrospectively. RESULTS: For dressings used to treat the burn site, blood loss on the side treated with NuStat® was on average less (27g/100cm2) than the side treated with our historic standard of care (31g/100cm2), though it was not statistically significant (p=0.81). Similarly, on the donor site, blood loss on the side treated with NuStat® was on average less (14g/100cm2) than the side treated with our historic standard of care (15g/100cm2), but it was also not statistically significant (p=0.92). Average total blood loss from both excision and donor sites was also less with NuStat® (10g/100cm2) compared to the historic standard of care (12g/100cm2), but it was also not significant (p=0.77). There was no difference in the number of cycles required to achieve hemostasis for either the burn (1.15 NuStat® vs. 1.1 for historic standard of care, p=0.70) or the donor site (1 vs. 1, p=1.0). When comparing the cost of NuStat® versus the historic standard of care, the actual costs incurred for the wounds was less for the portion treated with NuStat® ($148.43) when compared to the historic standard of care ($186.45) (p<0.001). CONCLUSIONS: Based on these findings, NuStat® hemostatic action should be comparable to the historic standard of care, and these newer hemostatic agents evaluated further in burn surgery and bleeding during other procedures such as trauma surgery.


Assuntos
Traumatismos do Braço/cirurgia , Bandagens , Perda Sanguínea Cirúrgica/prevenção & controle , Queimaduras/cirurgia , Hemostáticos/uso terapêutico , Traumatismos da Perna/cirurgia , Transplante de Pele/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Unidades de Queimados , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Padrão de Cuidado , Sítio Doador de Transplante , Adulto Jovem
2.
J Burn Care Res ; 38(2): e574-e579, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-27755248

RESUMO

There are few published reports on the unique nature of burn patients using a paired spontaneous awakening and spontaneous breathing protocol. A combined protocol was implemented in our burn intensive care unit (ICU) on January 1, 2012. This study evaluates the impact of this protocol on patient outcomes in a burn ICU. We performed a retrospective review of our burn registry over 4 years, including all patients placed on mechanical ventilation. In the latter 2 years, patients meeting criteria underwent daily spontaneous awakening trial; if successful, spontaneous breathing trial was performed. Patient data included age, burn size, percent full-thickness burn, tracheostomy, and inhalation injury. Outcome measures included ventilator days, ICU and hospital lengths of stay, pneumonia, and disposition. Data were analyzed using Graphpad Prism and IBM SPSS software, with statistical significance defined as P < .05. There were 171 admissions in the preprotocol period and 136 after protocol implementation. Protocol patients had greater percent full-thickness burns, but did not differ in other characteristics. The protocol group had significantly shorter ICU length of stay, fewer ventilator days, and lower pneumonia incidence. Hospital length of stay, disposition, and mortality were not significantly different. Among patients with inhalation injuries, the protocol group exhibited fewer ventilator and ICU days. Protocol implementation in a burn ICU was accompanied by decreased ventilator days and a reduced incidence of pneumonia. A combined spontaneous awakening and breathing protocol is safe and may improve clinical practice in the burn ICU.


Assuntos
Queimaduras/terapia , Cuidados Críticos/métodos , Pneumonia Associada à Ventilação Mecânica/epidemiologia , Sistema de Registros , Respiração Artificial/efeitos adversos , Desmame do Respirador/métodos , Adulto , Extubação/métodos , Unidades de Queimados , Queimaduras/diagnóstico , Queimaduras/mortalidade , Terapia Combinada , Feminino , Seguimentos , Humanos , Escala de Gravidade do Ferimento , Unidades de Terapia Intensiva , Tempo de Internação , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Pneumonia Associada à Ventilação Mecânica/prevenção & controle , Respiração Artificial/métodos , Ressuscitação/métodos , Estudos Retrospectivos , Medição de Risco , Taxa de Sobrevida , Texas , Resultado do Tratamento
3.
Injury ; 46(4): 625-8, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25527458

RESUMO

INTRODUCTION: Since the introduction of all-terrain vehicles (ATV) to the United States in 1971, injuries and mortalities related to their use have increased significantly. Furthermore, these vehicles have become larger and more powerful. As there are no helmet requirements or limitations on engine-size in the State of Alabama, we hypothesised that larger engine size would correlate with an increased incidence of traumatic brain injury (TBI) in patients following an ATV crash. METHODS: Patient and ATV data were prospectively collected on all ATV crashes presenting to a level one trauma centre from September 2010 to May 2013. Collected data included: demographics, age of driver, ATV engine size, presence of helmet, injuries, and outcomes. The data were grouped according to the ATV engine size in cubic centimetres (cc). For the purposes of this study, TBI was defined as any type of intracranial haemorrhage on the initial computed tomography scan. RESULTS: There were 61 patients identified during the study period. Two patients (3%) were wearing a helmet at the time of injury. Patients on an ATV with an engine size of 350 cc or greater had higher Injury Severity Scores (13.9 vs. 7.5, p ≤ 0.05) and an increased incidence of TBI (26% vs. 0%, p ≤ 0.05) when compared to patients on ATV's with an engine size less than 350 cc. CONCLUSIONS: Patients on an ATV with an engine size of 350 cc or greater were more likely to have a TBI. The use of a helmet was rarely present in this cohort. Legislative efforts to implement rider protection laws for ATVs are warranted.


Assuntos
Acidentes de Trânsito/prevenção & controle , Lesões Encefálicas/epidemiologia , Dispositivos de Proteção da Cabeça/estatística & dados numéricos , Veículos Off-Road/legislação & jurisprudência , Acidentes de Trânsito/estatística & dados numéricos , Adolescente , Adulto , Lesões Encefálicas/prevenção & controle , Criança , Feminino , Humanos , Incidência , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Saúde Pública , Estados Unidos/epidemiologia
4.
J Surg Res ; 191(2): 286-9, 2014 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-25039013

RESUMO

BACKGROUND: Transfusion-related acute lung injury (TRALI) is the most frequent and severe complication in patients receiving multiple blood transfusions. Current pathogenic concepts hold that proinflammatory mediators present in transfused blood products are responsible for the initiation of TRALI, but the identity of the critical effector molecules is yet to be determined. We hypothesize that mtDNA damage-associated molecular patterns (DAMPs) are present in blood transfusion products, which may be important in the initiation of TRALI. METHODS: DNA was extracted from consecutive samples of packed red blood cells, fresh frozen plasma (FFP), and platelets procured from the local blood bank. Quantitative real-time polymerase chain reaction was used to quantify ≈200 bp sequences from the COX1, ND1, ND6, and D-loop regions of the mitochondrial genome. RESULTS: A range of mtDNA DAMPs were detected in all blood components measured, with FFP displaying the largest variation. CONCLUSIONS: We conclude that mtDNA DAMPs are present in packed red blood cells, FFP, and platelets. These observations provide proof of the concept that mtDNA DAMPs may be mediators of TRALI. Further studies are needed to test this hypothesis and to determine the origin of mtDNA DAMPs in transfused blood.


Assuntos
Lesão Pulmonar Aguda/etiologia , Dano ao DNA , DNA Mitocondrial/metabolismo , Reação Transfusional , Humanos
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