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Diagnosis and Treatment of Infections in the Burn Patient. 烧伤病人感染的诊断和治疗。
IF 1 Q4 CRITICAL CARE MEDICINE Pub Date : 2024-09-04 DOI: 10.3390/ebj5030028
David G Greenhalgh, John L Kiley

Infection is very common in burn patients because they lose the primary barrier from microorganism invasion, the skin. While there are attempts to prevent infections, topical antimicrobials and systemic prophylaxis tend to lead to more resistant organisms. After the initial resuscitation, the most common cause of death is from sepsis and multiple organ dysfunction syndrome. The diagnosis is difficult in the burn population because the constant exposure from the open wound leads to an inflammatory response that leads to persistent hypermetabolism. This paper reviews the current understanding and treatment of infection and sepsis in burns.

感染在烧伤患者中非常常见,因为他们失去了防止微生物入侵的主要屏障--皮肤。虽然有人试图预防感染,但局部抗菌药和全身预防性治疗往往会导致耐药菌增多。经过初步抢救后,最常见的死亡原因是败血症和多器官功能障碍综合征。烧伤患者的诊断比较困难,因为开放性伤口的持续暴露会导致炎症反应,从而导致持续的高代谢。本文回顾了目前对烧伤感染和败血症的认识和治疗。
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引用次数: 0
High-Voltage Electrical Burn Requiring Urgent Scalp Reconstruction after Developing a Brain Abscess. 高压电烧伤后出现脑脓肿,需要紧急头皮重建。
IF 1 Q4 CRITICAL CARE MEDICINE Pub Date : 2024-09-03 DOI: 10.3390/ebj5030027
Elena Blyth, Elizabeth Vujcich, Darryl Dunn

Electrical burn injuries to the scalp are at risk of extensive tissue damage and neurological complications. We present the case of a patient who came into contact with a high-voltage power line while cherry picking, resulting in a large full-thickness scalp defect. Early on in his presentation, he developed progressive global weakness which remained relatively static during his admission. An incidental finding of an extradural abscess complicated his management, requiring urgent surgical intervention with definitive tissue coverage. The scalp was reconstructed using a free myocutaneous anterolateral thigh flap. There were no postoperative complications. Following rehabilitation, the patient was discharged home with limited functional recovery. He mobilises independently with a wheelchair and requires full-time carers.

头皮电烧伤有可能造成大面积组织损伤和神经系统并发症。我们介绍了一例患者的病例,他在采摘樱桃时接触到高压电线,导致头皮大面积全厚缺损。入院初期,患者出现进行性全身乏力,入院后一直处于相对静止状态。偶然发现的硬膜外脓肿使他的治疗变得更加复杂,需要紧急手术治疗并进行明确的组织覆盖。使用游离肌皮大腿前外侧皮瓣重建了头皮。术后没有出现并发症。康复治疗后,患者出院回家,功能恢复有限。他可以坐轮椅独立行动,但需要全职护理人员照顾。
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引用次数: 0
Introduction to the Special Issue on Wars and Disasters: Advancing Care during Times of Crisis. 战争与灾难特刊导言:推进危机时期的护理工作。
IF 1 Q4 CRITICAL CARE MEDICINE Pub Date : 2024-09-02 DOI: 10.3390/ebj5030026
Leopoldo C Cancio

Civilian mass-casualty disasters and armed conflict share many features, including the fact that both maximally challenge multidisciplinary burn teams. Rigorous training is required to build teams and systems that can respond effectively. One of the critical but potentially overlooked components of readiness for crisis care is a robust clinical research program. Rather than stalling progress, disasters and conflict over the last 100 years consistently energized advances in care. This was made possible by the hard work of our predecessors to learn from the crisis in the midst of the crisis, and resulted in significant reductions in postburn mortality. Now, further work is needed not only to maintain these improvements in mortality, but also to understand the long-term functional outcomes and to improve the quality of life of burn survivors. Clinical research programs to address these issues must be established now, so that we are optimally prepared for the next conflict or disaster.

平民大规模伤亡灾难和武装冲突有许多共同之处,其中包括两者都对多学科烧伤团队提出了最大挑战。要建立能够有效应对的团队和系统,就必须进行严格的培训。危机救护准备工作的一个关键但可能被忽视的组成部分是强大的临床研究计划。在过去的 100 年中,灾难和冲突不但没有阻碍医疗事业的发展,反而不断推动医疗事业的进步。这得益于我们的前辈们在危机中学习危机的艰苦努力,并显著降低了烧伤后的死亡率。现在,我们需要进一步努力,不仅要保持死亡率方面的这些改善,还要了解烧伤幸存者的长期功能结果,并提高他们的生活质量。现在就必须制定临床研究计划来解决这些问题,以便为下一次冲突或灾难做好最佳准备。
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引用次数: 0
The Successful Treatment of Multi-Resistant Colonized Burns with Large-Area Atmospheric Cold Plasma Therapy and Dermis Substitute Matrix-A Case Report. 大面积常压冷等离子体疗法和真皮替代基质成功治疗多发性菌落性烧伤--病例报告。
IF 1 Q4 CRITICAL CARE MEDICINE Pub Date : 2024-08-26 DOI: 10.3390/ebj5030025
Moritz R Milewski, Frederik Schlottmann, Vincent März, Thorben Dieck, Peter M Vogt

The treatment of severe burn injuries, which occur particularly in the context of armed conflicts, is based on a multimodal treatment concept. In addition to complex intensive care therapy, the surgical reconstruction options of plastic surgery and typical antiseptic wound treatment are the main focuses. In recent years, atmospheric cold plasma therapy (ACPT) has also become established for topical, antiseptic wound treatment and for the optimization of re-epithelialization. This case report shows a successful treatment of extensive burn injuries using dermal skin substitute matrix and topical treatment with a large-area cold plasma device to control multi-resistant pathogen colonization. This case report illustrates the importance of ACPT in burn surgery. However, larger case series and randomized controlled trials in specialized centers are needed to assess its place in future clinical practice.

严重烧伤(尤其是在武装冲突中发生的烧伤)的治疗基于多模式治疗理念。除了复杂的重症监护治疗外,整形外科的手术重建方案和典型的伤口消毒处理也是治疗的重点。近年来,常压冷等离子体疗法(ACPT)也开始用于局部伤口防腐治疗和优化再上皮化。本病例报告显示,使用真皮皮肤替代基质和大面积冷等离子设备进行局部治疗,成功治疗了大面积烧伤,控制了多重耐药病原体的定植。该病例报告说明了 ACPT 在烧伤手术中的重要性。不过,还需要在专业中心进行更大规模的病例系列研究和随机对照试验,以评估其在未来临床实践中的地位。
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引用次数: 0
Sustainable Primary Cell Banking for Topical Compound Cytotoxicity Assays: Protocol Validation on Novel Biocides and Antifungals for Optimized Burn Wound Care. 用于局部化合物细胞毒性试验的可持续原代细胞库:新型杀菌剂和抗真菌剂的方案验证,优化烧伤伤口护理。
IF 1 Q4 CRITICAL CARE MEDICINE Pub Date : 2024-08-06 DOI: 10.3390/ebj5030024
Zhifeng Liao, Nicolas Laurent, Nathalie Hirt-Burri, Corinne Scaletta, Philippe Abdel-Sayed, Wassim Raffoul, Shengkang Luo, Damian J Krysan, Alexis Laurent, Lee Ann Applegate

Thorough biological safety testing of topical therapeutic compounds and antimicrobials is a critical prerequisite for appropriate cutaneous wound care. Increasing pathogen resistance rates to traditional antibiotics and antifungals are driving the development and registration of novel chemical entities. Although they are notably useful for animal testing reduction, the gold standard in vitro cytotoxicity assays in continuous cell lines (HaCaT keratinocytes, 3T3 fibroblasts) may be discussed from a translational relevance standpoint. The aim of this study was thus to establish and validate a sustainable primary cell banking model with a view to performing optimized in vitro cytotoxicity assay development. Primary dermal fibroblasts and adipose-derived stem cell (ASC) types were established from four infant polydactyly sources. A multi-tiered primary cell banking model was then applied to prepare highly sustainable and standardized dermal fibroblast and ASC working cell banks (WCBs), potentially allowing for millions of biological assays to be performed. The obtained cellular materials were then validated for use in cytotoxicity assays through in vitro biosafety testing of topical antiseptics (chlorhexidine, hypochlorous acid) and an antifungal compound (AR-12) of interest for optimized burn wound care. The experimental results confirmed that IC50 values were comparable between cytotoxicity assays, which were performed with cell lines and with primary cells. The results also showed that hypochlorous acid (HOCl) displayed an enhanced toxicological profile as compared to the gold standard chlorhexidine (CLX). Generally, this study demonstrated that highly sustainable primary cell sources may be established and applied for consistent topical compound biological safety assessments with enhanced translational relevance. Overall, the study underscored the safety-oriented interest of functionally benchmarking the products that are applied on burn patient wounds for the global enhancement of burn care quality.

对局部治疗化合物和抗菌剂进行彻底的生物安全性测试是进行适当的皮肤伤口护理的关键前提。病原体对传统抗生素和抗真菌药物的耐药性不断增加,推动了新型化学实体的开发和注册。尽管体外细胞毒性试验对减少动物试验非常有用,但从转化相关性的角度来看,连续细胞系(HaCaT 角质细胞、3T3 成纤维细胞)体外细胞毒性试验才是金标准。因此,本研究的目的是建立并验证一种可持续的原代细胞库模型,以便进行优化的体外细胞毒性检测开发。原代真皮成纤维细胞和脂肪源性干细胞(ASC)来自四种婴儿多指畸形来源。然后采用多层原代细胞库模式,制备高度可持续和标准化的真皮成纤维细胞和脂肪干细胞工作细胞库(WCB),可进行数百万次生物检测。然后,通过对局部杀菌剂(洗必泰、次氯酸)和一种用于优化烧伤创面护理的抗真菌化合物(AR-12)进行体外生物安全测试,验证了所获得的细胞材料是否可用于细胞毒性试验。实验结果证实,使用细胞系和原代细胞进行的细胞毒性试验的 IC50 值相当。结果还显示,与黄金标准洗必泰(CLX)相比,次氯酸(HOCl)的毒性更强。总体而言,这项研究表明,可以建立高度可持续的原代细胞来源,并将其应用于一致的局部化合物生物安全性评估,从而提高转化相关性。总之,这项研究强调了以安全为导向,对烧伤患者伤口上使用的产品进行功能性基准测试,以全面提高烧伤护理质量的重要性。
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引用次数: 0
Optimising Scar Management Intervention in the Case of a Head-and-Neck Burn for a Patient with a Learning Disability. 为有学习障碍的头颈部烧伤患者优化疤痕管理干预。
IF 1 Q4 CRITICAL CARE MEDICINE Pub Date : 2024-06-25 DOI: 10.3390/ebj5030019
Katie Spooner, Matthew Pilley, Liz Rose, Stephen Frost, Reena Agarwal

Scars following burns can often prove complex to manage, particularly when crossing joints or special areas such as the head and neck, due to contractures. This case report discusses the individualised care and rehabilitation provided to a burn patient with a learning disability. The patient suffered both full and partial thickness burns equating to a total body surface area (%TBSA) of 7% of the face, neck, and anterior chest via the self-ignition of clothing. Acute treatment was provided at a regional burn unit followed by further in-patient care and rehabilitation at our burn facility. A motion rehabilitation instrument was employed to manage potential orofacial contracture; however, due to the patient's impaired social functioning, this device was found to be unsuitable. Subsequently, a bespoke mouth-opening device replicating an ice lolly was fabricated utilising computer-aided design (CAD), enhancing the patient's understanding along with encouraging independence. Microstomia was a risk in this case; however, this was prevented via the discussed regime, and successful patient rehabilitation was achieved.

烧伤后留下的疤痕往往会很难处理,尤其是在跨越关节或特殊部位(如头部和颈部)时,会因挛缩而造成疤痕。本病例报告讨论了为一名有学习障碍的烧伤患者提供的个性化护理和康复治疗。该患者因衣服自燃而导致面部、颈部和前胸全部和部分烧伤,烧伤面积相当于总体表面积(%TBSA)的 7%。患者在地区烧伤科接受了急性治疗,随后在本院烧伤科接受了进一步的住院治疗和康复治疗。我们使用了一种运动康复器械来控制潜在的口面部挛缩,但由于患者的社会功能受损,我们发现这种器械并不适用。随后,利用计算机辅助设计(CAD)制作了一个仿冰棍的定制张口装置,增强了患者的理解能力,同时鼓励患者独立生活。在这个病例中,小口畸形是一个风险;不过,通过讨论的治疗方案,这一风险得以避免,患者的康复也取得了成功。
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引用次数: 0
Person-Centred Pain Measurement in the ICU: A Multicentre Clinimetric Comparison Study of Pain Behaviour Observation Scales in Critically Ill Adult Patients with Burns. 重症监护室中以人为中心的疼痛测量:烧伤重症成人患者疼痛行为观察量表的多中心临床计量比较研究》。
IF 1 Q4 CRITICAL CARE MEDICINE Pub Date : 2024-06-17 DOI: 10.3390/ebj5020018
Alette E E de Jong, Wim E Tuinebreijer, Helma W C Hofland, Nancy E E Van Loey

Pain in critically ill adults with burns should be assessed using structured pain behavioural observation measures. This study tested the clinimetric qualities and usability of the behaviour pain scale (BPS) and the critical-care pain observation tool (CPOT) in this population. This prospective observational cohort study included 132 nurses who rated pain behaviour in 75 patients. The majority of nurses indicated that BPS and CPOT reflect background and procedural pain-specific features (63-72 and 87-80%, respectively). All BPS and CPOT items loaded on one latent variable (≥0.70), except for compliance ventilator and vocalisation for CPOT (0.69 and 0.64, respectively). Internal consistency also met the criterion of ≥0.70 in ventilated and non-ventilated patients for both scales, except for non-ventilated patients observed by BPS (0.67). Intraclass correlation coefficients (ICCs) of total scores were sufficient (≥0.70), but decreased when patients had facial burns. In general, the scales were fast to administer and easy to understand. Cut-off scores for BPS and CPOT were 4 and 1, respectively. In conclusion, both scales seem valid, reliable, and useful for the measurement of acute pain in ICU patients with burns, including patients with facial burns. Cut-off scores associated with BPS and CPOT for the burn population allow professionals to connect total scores to person-centred treatment protocols.

成人烧伤重症患者的疼痛应采用结构化疼痛行为观察方法进行评估。本研究测试了行为疼痛量表(BPS)和危重症疼痛观察工具(CPOT)在该人群中的临床测量质量和可用性。这项前瞻性观察性队列研究包括 132 名护士,他们对 75 名患者的疼痛行为进行了评分。大多数护士表示,BPS 和 CPOT 反映了背景和手术疼痛的特异性特征(分别为 63-72% 和 87-80%)。除顺应呼吸机和发声(CPOT 分别为 0.69 和 0.64)外,所有 BPS 和 CPOT 项目都加载在一个潜在变量上(≥0.70)。除 BPS 观察到的非通气患者(0.67)外,通气和非通气患者两个量表的内部一致性也符合≥0.70 的标准。总分的类内相关系数(ICC)足够高(≥0.70),但当患者面部烧伤时,类内相关系数会降低。总的来说,这些量表操作简便,易于理解。BPS 和 CPOT 的临界值分别为 4 分和 1 分。总之,这两种量表对于测量 ICU 烧伤患者(包括面部烧伤患者)的急性疼痛似乎都是有效、可靠和有用的。与烧伤人群的 BPS 和 CPOT 相关的临界值可使专业人员将总分与以人为本的治疗方案联系起来。
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引用次数: 0
Person and Family Centredness-The Need for Clarity of Focus. 以人为本和以家庭为中心--明确重点的必要性。
IF 1 Q4 CRITICAL CARE MEDICINE Pub Date : 2024-05-27 DOI: 10.3390/ebj5020014
Brendan McCormack

Congratulations to the editorial team of the European Burn Journal for having the vision to host a Special Issue on the theme of "Person-Centred and Family-Centred Care Following Burn Injuries" [...].

祝贺《欧洲烧伤杂志》的编辑团队具有远见卓识,主办了一期以 "烧伤后以人为本和以家庭为中心的护理 "为主题的特刊 [...] 。
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引用次数: 0
Nonsteroidal Anti-Inflammatory Drugs Decrease Coagulopathy Incidence in Severe Burn Patients. 非甾体抗炎药降低严重烧伤患者的凝血病发病率
IF 1 Q4 CRITICAL CARE MEDICINE Pub Date : 2024-04-28 DOI: 10.3390/ebj5020009
Lyndon Huang, Kassandra Corona, Kendall Wermine, Elvia Villarreal, Giovanna De La Tejera, Phillip Howard Keys, Alen Palackic, Amina El Ayadi, George Golovko, Steven E Wolf, Juquan Song

The study investigated the impact of nonsteroidal anti-inflammatory drugs (NSAIDs) on burn-induced coagulopathy in severely burned patients. Patients with a greater than 20% TBSA were identified in the TriNetX research network and categorized into receiving or not receiving NSAIDs in the first week after the burn. The statistical significance of the rate of burn-induced coagulopathy, mortality and sepsis in the week following injury was analysed. We observed 837 severely burned patients taking NSAIDS during the week following the burn and 1036 patients without. After matching for age, gender and race, the risk of burn-induced coagulopathy significantly decreased (p < 0.0001) in patients taking NSAIDs (17.7%) compared to those without (32.3%). Patients taking NSAIDs were also less likely to develop sepsis (p < 0.01) and thrombocytopenia (p < 0.001) or die the week following injury (p < 0.0001). In conclusion, the early protective effects of NSAIDs at reducing the risk of coagulopathy as well as sepsis and mortality occur during the acute phase of burns.

该研究调查了非甾体抗炎药(NSAID)对严重烧伤患者烧伤引起的凝血病的影响。研究人员在 TriNetX 研究网络中确定了总烧伤面积大于 20% 的患者,并将他们分为在烧伤后第一周接受或未接受非甾体抗炎药治疗的两类。我们分析了受伤后一周内烧伤引起的凝血病、死亡率和败血症发生率的统计学意义。我们观察了烧伤后一周内服用非甾体抗炎药的 837 名严重烧伤患者和未服用非甾体抗炎药的 1036 名患者。在对年龄、性别和种族进行匹配后,与未服用非甾体抗炎药的患者(32.3%)相比,服用非甾体抗炎药的患者(17.7%)发生烧伤诱发凝血病的风险明显降低(p < 0.0001)。服用非甾体抗炎药的患者在受伤后一周内发生败血症(p < 0.01)和血小板减少症(p < 0.001)或死亡(p < 0.0001)的可能性也较小。总之,在烧伤的急性期,非甾体抗炎药对降低凝血病、败血症和死亡风险具有早期保护作用。
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引用次数: 0
Development and Testing of the Aftercare Problem List, a Burn Aftercare Screening Instrument. 烧伤后护理筛查工具 "烧伤后护理问题清单 "的开发与测试。
IF 1 Q4 CRITICAL CARE MEDICINE Pub Date : 2024-03-29 DOI: 10.3390/ebj5020008
Nancy E E Van Loey, Elise Boersma-van Dam, Anita Boekelaar, Anneke van de Steenoven, Alette E E de Jong, Helma W C Hofland

A growing interest in person-centered care from a biopsychosocial perspective has led to increased attention to structural screening. The aim of this study was to develop an easy-to-comprehend screening instrument using single items to identify a broad range of health-related problems in adult burn survivors. This study builds on earlier work regarding content generation. Focus groups and expert meetings with healthcare providers informed content refinement, resulting in the Aftercare Problem List (APL). The instrument consists of 43 items divided into nine health domains: scars, daily life functioning, scars treatment, body perceptions, stigmatization, intimacy, mental health, relationships, financial concerns, and a positive coping domain. The APL also includes a Distress Thermometer and a question inquiring about preference to discuss the results with a healthcare provider. Subsequently, the APL was completed by 102 outpatients. To test face validity, a linear regression analysis showed that problems in three health domains, i.e., scars, mental health, and body perceptions, were significantly related to higher distress. Qualitative results revealed that a minority found the items difficult which led to further adjustment of the wording and the addition of illustrations. In summation, this study subscribes to the validity of using single items to screen for burn-related problems.

从生物心理社会学的角度来看,以人为本的护理越来越受到人们的关注,因此结构性筛查也越来越受到重视。本研究旨在开发一种易于理解的筛查工具,使用单个项目来识别成年烧伤幸存者的各种健康相关问题。本研究建立在先前有关内容生成的工作基础之上。通过与医疗服务提供者进行焦点小组讨论和专家会议,对内容进行了完善,最终形成了 "烧伤后护理问题清单"(APL)。该工具由 43 个项目组成,分为九个健康领域:疤痕、日常生活功能、疤痕治疗、身体感知、耻辱感、亲密关系、心理健康、人际关系、财务问题和积极应对领域。APL 还包括一个压力温度计和一个询问是否愿意与医疗保健提供者讨论结果的问题。随后,102 名门诊患者填写了 APL。为了检验表面效度,线性回归分析表明,三个健康领域(即疤痕、心理健康和身体感知)的问题与较高的痛苦度有显著关系。定性结果表明,少数人认为这些项目比较困难,因此需要进一步调整措辞并增加插图。总之,这项研究证实了使用单一项目筛查烧伤相关问题的有效性。
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引用次数: 0
期刊
European burn journal
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