Journal of Burn Care & Research最新文献

Objective: Severe burns result in both temporary local pathophysiological changes and long-term, profound, and extensive pathophysiological abnormalities. In this review, we studied the significance of multi-omics techniques in understanding the complex processes after burns.

Methods: We searched databases for relevant literature, focusing on burn research that combines genomics, transcriptomics, proteomics, metabolomics, and microbiomics.

Results: This review encapsulates recent advancements in the utilization of omics approaches to elucidate pathophysiological alterations and biomarkers associated with inflammation, wound healing, and metabolic pathways after burn injuries, encompassing the genome, transcriptome, proteome, metabolome, and microbiome.

Conclusions: An enhanced comprehension of the pathophysiological alterations and biomarkers associated with burn injuries can promote the creation of more efficacious and focused therapeutic approaches.

Acute ocular burns can lead to severe complications such as vision loss or eyelid contractures. While management strategies vary, no standardized algorithm exists. This study examines the etiology, management, and outcomes of ocular burns at a single burn center, with a focus on the differences between thermal and chemical burns. A retrospective cohort study was conducted on patients admitted with ocular burns to a burn center from 2012 to 2023. Data on demographics, injury characteristics, treatments, and outcomes were analyzed to identify differences in clinical presentation and management by burn type. Among 50 patients (84% male, mean age 39.4 ± 20.4 years) with 81 eyes affected, 78% of burns were thermal, 20% chemical, and 2% electrical. Visual acuity was worse in chemical burns (103.3 ± 111.3 vs 67.0 ± 58.6), though not statistically significant. Chemical burns consistently received immediate irrigation (100% vs 20.5%, P < .001) and more frequent anti-inflammatory treatment (70% vs 23.1%, P = .009). Hospital stays were longer for thermal burns (24.1 ± 15.0 days vs 3.7 ± 4.3 days, P = .037). Complications included 2 cases of significant vision loss and 1 case of entropion requiring multiple 2 surgeries. In summary, ocular burns differ significantly in management and outcomes depending on burn etiology. However, these differences in early management may reflect variations in clinical presentation and triage priorities, rather than differences in treatment importance. Standardized protocols that emphasize early ocular care for all burn types may help reduce variability in practice, particularly in thermal burns where systemic injuries often take priority.

This study aimed to develop and validate an early predictive model using clinical and laboratory indicators to identify high-risk critically burned patients for Enteral Feeding Intolerance (ENFI) within 24 hours post-burn. A retrospective analysis was conducted on data from 290 adult patients meeting inclusion criteria, selected from 803 admitted to a Burn ICU between March 2014 and December 2023. Univariate and multivariate logistic regression identified key predictors significantly associated with ENFI: total body surface area (TBSA) burned, shock status upon admission, inhalation injury, and total bilirubin (TB). Additional clinically relevant variables-prealbumin (PA), Hemoglobin (Hb), age, and lactate (LAC)-were incorporated into the model. The model's performance was robust, demonstrating strong discrimination with area under the curve (AUC) values of 0.821 in the training cohort and 0.785 in the validation cohort. This indicates excellent predictive ability and clinical utility. The developed model effectively evaluates ENFI risk early after severe burns, offering high accuracy and practical applicability in clinical settings. It enables the early identification of high-risk patients, allowing for optimized enteral nutrition strategies to improve care.

Enzymatic debridement with anacaulase-bcdb was approved by the US Food and Drug Administration in 2023. The purpose of this study is to compare outcomes from our first cohort of patients treated with this novel enzymatic agent. We compared patients treated with anacaulase-bcdb at our burn center from November 2023 to August 2024 to a 1:1 matched control group. Demographic, clinical, and photographic data were collected to ensure appropriate matching. Outcomes included: hospital length of stay, number of surgeries, time to first surgery, autograft size, total opioid and benzodiazepines received for wound care over the first 5 days, pain/sedation scores during wound care, time to wound closure, and readmission data. Descriptive statistics were used to assess anacaulase-bcdb treatment practices, while non-parametric tests were used for all comparisons. 13 patients treated with anacaulase-bcdb were identified. Median (interquartile range) cohort age, total body surface area, and mechanism of injury were 46 years (33.5, 59.5), 4.5% (2, 10.2), and flame (46.2%). No baseline differences were identified between groups. Anacaulase-bcdb was used before day 3 with regional anesthesia in all but 2 cases and successful eschar removal in 12 patients (92%). Patients treated with anacaulase-bcdb had a shorter time to first surgery from admission (4 days [3, 5] vs 6 [5, 7], P = .017) and higher average maximum wound care pain scores during the first 5 days (7 [6, 8] vs 5 [3, 7], P = .047). There was no difference in length of stay, area grafted, number of surgeries, total opioids/benzodiazepines received, or sedation scores.

Burns are associated with significant morbidity and mortality. Palliative care (PC) has been shown to improve patients' comfort, clinical decision-making, and overall satisfaction in the burn unit. The purpose of this paper is to describe the frequency of PC utilization after burn injury and to understand the patient characteristics that affect whether they are seen by PC. We conducted a retrospective study by querying the Healthcare Cost and Utilization Project National Inpatient Sample, identifying patients admitted with a primary burn diagnosis from 2016 to 2021. Patient characteristic differences were assessed between patients who did and did not receive PC using chi-square analyses and multi-variable regression, weighted to represent the national population. Revised Baux (rBaux) scores were calculated. Of 146 455 patients admitted with a primary burn diagnosis, 3535 (2.4%) received PC consultation. Of 5205 patients who died prior to discharge (3.6% of total), 2370 (45.5% of deaths) had a PC encounter. Older patients, patients with larger burns, and patients with higher rBaux scores were most likely to receive PC. White patients were more likely to receive PC than Black and Hispanic patients. Patients in teaching hospitals were more likely to receive PC than those in rural, nonteaching hospitals. Patients in northern regions received PC more often than those in other regions. More than half of patients with burn injuries who died prior to discharge did not receive PC. Older patients and those with higher rBaux scores received PC most often. Further research is necessary to identify burn patients most likely to benefit from and receive PC.

Background: Burn injuries are characterized by intense nociceptive pain, often requiring effective analgesia and sedation during medical interventions and hospital stays.

Methods: We conducted a scoping review to outline the existing literature on dexmedetomidine use in burn patients. Relevant sources were identified through broad searches of five databases (PubMed, Embase, CINAHL, Scopus, and the Cochrane Library), and included materials were reviewed to summarize common themes and reported practices.

Results: Dexmedetomidine, an α2-adrenergic agonist, serves as a promising sedative in this context. Its mechanism of action involves the inhibition of norepinephrine release, thereby modulating pain pathways and inducing a state of sedation without significant respiratory depression. Our review identified that dexmedetomidine is effective not only for ongoing sedation during hospitalization but also for acute short-term sedation during wound dressing changes, which can be particularly challenging for burn patients.

Conclusion: While some studies have noted potential adverse effects, such as respiratory depression and hemodynamic instability, the majority of the literature supports its safety and efficacy in critically ill burn patients. However, there is limited data on its effects on fluid resuscitation, with initial findings indicating a possible need for increased fluid to address hemodynamic changes. Furthermore, research on its impact on wound healing is scarce, emphasizing the need for further studies to better understand its overall role in burn treatment.

Pharmacotherapy interventions following thermal or inhalation injury remain an underrepresented area of focus in the literature, with studies dispersed across a broad array of journals. This review builds upon several years of previous efforts to highlight and summarize the most recent, quality pharmacotherapy-focused studies in the context of thermal and inhalation injuries. Twenty-five geographically dispersed, board-certified pharmacists participated in the review. A Medical Subject Heading-based, filtered search resulted in 2234 manuscripts over the previous 2-year period. After manual review, 78 (3.5%) manuscripts were determined to have a potential impact on current pharmacotherapy practice. Summaries of the 10 articles scored to have the highest impact are included in this review. There exists a continued need for high-impact research addressing pharmacotherapeutic strategies in the management of patients with thermal and inhalation injuries.

Introduction: There is growing awareness of the indirect trauma exposure experienced by healthcare providers and the resulting development of secondary traumatic stress (STS). However, STS in burn care clinicians has not been examined thoroughly. The current study aimed to examine feasibility of study procedures in this population, estimate the prevalence of STS, and examine the relationship between STS and additional factors.

Material and methods: Cross-sectional data were collected from 103 burn clinicians from 15 different occupations working in a large civilian burn center in the United States. Participants completed measures of STS, burnout, demographics, and occupation-related information.

Results: Study procedures were feasible. Over 40% (42.16%) of participants met criteria for moderate to severe STS. Secondary traumatic stress was significantly correlated with younger age and burnout subscales. Binomial logistic regression analyses showed that the overall model containing burnout subscales was statistically significant and able to distinguish between respondents who endorsed symptoms consistent with post-traumatic stress disorder due to STS and those that did not endorse them. Results regarding STS and time spent with patients with burn injuries varied. Nonsignificant results were found regarding STS and the remaining demographic and occupational variables.

Conclusions: Results support the feasibility of studying STS in this population, and the prevalence of STS among burn care clinicians warrants attention. Important information was added to the extant literature on related risk and protective factors. Increased knowledge about STS in this population will help to inform prevention efforts and interventions at both the individual and organizational level to prioritize staff well-being and improve patient care.

Healthcare professionals who care for burn survivors are frequently exposed to patient pain, trauma, and distress, placing them at high risk for burnout, compassion fatigue, and secondary traumatic stress. These occupational stressors threaten both the health and career longevity of providers and the quality of patient care. Perceived support-an individual's belief that organizational and social supports are present and reliable-may mitigate these risks and promote professional well-being. This secondary analysis examined the relationship between perceived support and professional quality of life outcomes in burn therapists. Data (n = 140) were drawn from a 2023 survey utilizing the Professional Quality of Life Scale; additional items assessed perceptions of workplace and peer support. Findings from Spearman rank-sum analyses demonstrated significant positive associations between compassion satisfaction and perceived support. Specifically, feeling connected to others and having trusted colleagues to discuss struggles were strongly protective, while feeling "bogged down by the system" was linked to higher stress and lower satisfaction. Both feelings of connection and support correlated with lower levels of workplace burnout. Results highlight the critical role of interpersonal and organizational supports in sustaining resilience and compassion among burn therapists. Interventions that foster team connectedness, reduce systemic barriers, and enhance perceptions of organizational concern may reduce occupational stress, strengthen professional fulfillment, and decrease turnover. Promoting perceived support is an actionable strategy to protect the well-being of burn rehabilitation providers and, ultimately, improve patient outcomes.