Intubation in burns patients: a 5-year review of the Manchester regional burns centre experience.

Despite criteria to guide intubation from the American Burn Association (ABA), concerns remain regarding over-intubation of burns patients. The purpose of this study was to review appropriateness of intubation at a UK regional burns centre over a 5-year period. A 5-year retrospective review of adult patients admitted to the Manchester Burns Centre who underwent intubation at or prior to admission was performed. Intubations for non-burn indications or burns >40%TBSA were excluded. Patient demographic and burn characteristics data were extracted from medical records. Indications for intubation were compared to ABA and Denver criteria. 47 patients were identified, of which 40 met inclusion criteria for analysis. 72.5% and 95% of these patients met ABA or Denver criteria respectively. 30.8% of patients were extubated within 48 h. 50% patients extubated within 48 h had ≤1 indication for intubation or negative laryngoscopy. Complications related to intubation and ventilation were noted in 37.5% of patients, with ventilation associated pneumonia (VAP) being the most common occurring in 27.5%. 95% of patients fulfilled recognised criteria for intubation. However, 30% were extubated within 48 h, suggesting potentially avoidable intubation. This study suggests current intubation criteria may over-estimate risk of airway compromise and supports results from non-UK studies that a proportion of patients may be suitable for close observation rather than early intubation.

The pain of surgery: pain experienced by surgeons while operating.

INTRODUCTION: The operating theatre can be a dreaded experience not only for the patient but also occasionally for the surgeon. We sought to investigate the prevalence of pain experienced by surgeons while operating. METHODS: One hundred and thirty anonymous questionnaires were sent to surgical consultants in the Britain. RESULTS: The response rate was 60% and 63 experienced pain while operating. The back and neck were the most common areas of pain (36 & 30 consultants respectively), followed by the hand (24 consultants). Nearly 80% described pains on a regular basis. Table height was the most common cause of pain (35%), followed by the use of microscopes (27%) and standing (22%). Nearly 43% of the consultants will take a break from surgery because of their symptoms, and 4 took sick leave in direct relation to pain experienced as a result of operating. However only 27% took measures to reduce their symptoms and 65% never sought any help or advice and only one consultant informed the occupational health department. CONCLUSION: Many surgeons will experience pain while operating due to positioning or the instruments they use, however there are no guidelines from occupational health departments or training courses to help minimise these symptoms.

Spatial differences of cellular origins and in vivo hypoxia modify contractile properties of pulmonary artery smooth muscle cells: lessons for arterial tissue engineering.

Tissue engineering of functional arteries is challenging. Within the pulmonary artery wall, smooth muscle cells (PASMCs) have site-specific developmental and functional phenotypes, reflecting differing contractile roles. The force generated by PASMCs isolated from the inner 25% and outer 50% of the media of intrapulmonary elastic arteries from five normal and eight chronically hypoxic (hypertensive) 14 day-old piglets was quantified in a three-dimensional (3D) collagen construct, using a culture force monitor. Outer medial PASMCs from normal piglets exerted more force (528 +/- 50 dynes) than those of hypoxic piglets (177 +/- 42 dynes; p < 0.01). Force generation by inner medial PASMCs from normal and hypoxic piglets was similar (349 +/- 35 and 239 +/- 60 dynes). In response to agonist (thromboxane) stimulation, all PASMCs from normal and hypoxic piglets contracted, but the increase in force generated by outer and inner hypoxic PASMCs (ranges 13-72 and 14-56 dynes) was less than by normal PASMCs (ranges 27-154 and 34-159 dynes, respectively; p < 0.05 for both). All hypoxic PASMCs were unresponsive to antagonist (sodium nitroprusside) stimulation, all normal PASMCs relaxed (range - 87 to - 494 dynes). Myosin heavy chain expression by both hypoxic PASMC phenotypes was less than normal (p < 0.05 for both), as was the activity of focal adhesion kinase, regulating contraction, in hypoxic inner PASMCs (p < 0.01). Chronic hypoxia resulted in the development of abnormal PASMC phenotypes, which in collagen constructs exhibited a reduction in contractile force and reactivity to agonists. Characterization of the mechanical response of spatially distinct cells and modification of their behaviour by hypoxia is critical for successful tissue engineering of major blood vessels.

Self-inflicted burns, outcome and cost.

INTRODUCTION: Self-inflicted burns represent a small number of total admissions to a burns unit, yet they constitute a major workload. METHODS: A retrospective analysis of self-inflicted burns admitted between 1998 and 2002. RESULTS: One thousand six hundred and fifty six patients were admitted with acute burn injuries, of these 56 were self-inflicted. 24 patients had a previous history of self-harming and 22 were unemployed. History of a psychiatric illness was found in 46 patients. Flames caused 46 out of 56 injuries. Mean total body surface area (TBSA) was 27%. Approximately 39% needed admission to intensive care unit (ICU). The mortality rate was 25%. On discharge, 29% of the patients re-self harmed. CONCLUSION: Self-inflicted burns have a poorer outcome. Improving the psychiatric and social support can reduce the incidence of self-harming behaviour, its repetitiveness and subsequently the cost of burn care.