Annals of burns and fire disasters最新文献

Chronic critical illness (CCI) characterizes patients admitted to intensive care who, following an acute illness, remain dependent on care. Its incidence varies from 5 to 55% depending on the population studied. This retrospective, case-control study, conducted over a year in the Burn ICU of Tunis, included all patients aged over 16 years, burned, and hospitalized for more than 8 days. CCI was defined according to the criteria of the Research Triangle Institute (a hospital stay of more than 8 days and at least one of the following: sepsis, invasive mechanical ventilation for more than 96 hours, severe injury, traumatic brain injury or stroke, and tracheostomy). Among the 272 adult burn patients, 103 were included, with 85 developing CCI, representing an incidence of 31.2%. The eligible criteria identified were sepsis in 42.4% of cases (n=36) and invasive mechanical ventilation in 38.8% of cases (n=33). The average age was 41.5±16.9 years with a male predominance (n=53; 62.4%). The average TBSA was 29±16%. The risk factors for CCI in multivariate analysis were: TBSA >21.5%, the need for transfusion, the occurrence of anemia, thrombocytopenia, hypophosphatemia, acute renal failure, and metabolic acidosis. The median hospital stay was 12 days [8-128]. The mortality rate was 55.3%.

Denatured alcohol, bioethanol and the many forms of devices that use these flammable liquids represent a significant risk for severe burn injury. The experiences and perspectives of former victims of accidents with these accelerants and fuels have scarcely been reported. The objective of this qualitative semi-structured interview study was to describe former burn patients' experience of their accidents using flammable liquids, as well as their perspective on future prevention. Three themes were identified: "to be shocked"; "to be vigilant"; and "to use what was learnt". This meant that for all participants, the totally unexpected explosive character of the accident and the severe consequences for those burned had made them rethink earlier beliefs and adapt behaviour, as well as engage and come up with suggestions for future preventive measures. Hence, burn accidents caused by denatured alcohol or bioethanol resulted in an unanticipated and shocking experience with large injuries and long-term physical and psychological consequences, including increased vigilance and altered behaviour. The former burn victims suggested strong and combined preventive actions involving information, education for use, improved design of devices, as well as restrictions and regulations involving stakeholders, authorities and users.

The phases of burn care include initial resuscitation, definitive wound management, and rehabilitation of physical and psychological injuries. In severe burns, this response lasts for the first two to three days post-burn and burns larger than 15% of total body surface area lead to the initiation of systemic inflammatory response syndrome. Neutrophil-lymphocyte ratio (NLR) is an inflammatory biomarker that can indicate systemic inflammation. NLR is defined by the absolute number of neutrophils divided by the absolute number of lymphocytes. Many studies have been done in severe burn patients because they reflect changes in the systemic inflammatory response. This study aimed to investigate the prognostic value of NLR values in patients with severe burns and provide clinical guidance for sepsis and mortality. This was a retrospective cohort study conducted in the Service of Burns of the University Hospital Centre "Mother Teresa" in Tirana (UHCT), Albania. We compared NLR levels in burn patients with sepsis and without sepsis. Our data showed a significantly higher level of NLR in burn patients with sepsis, while the values of NLR on the 3rd day (NLR 3) have statistical significance (p<0.0001). From the logistic regression analysis, we found that only NLR 3 can predict mortality, whose cut-off (4.59) was determined with the help of ROC curve analysis and was accurately presented with the help of Kaplan-Meier curves with statistical significance. From multiple regression, we understand that mortality can be predicted based on TBSA%, age, presence of inhalatory burn, and NLR 3 together.

This is a longitudinal study of 40 firefighters, in which the effects of firefighting on saliva were investigated using firefighting simulators. Salivary concentrations of TNF-α, IL-6, IL-10, lactoferrin and lysozyme were measured using the ELISA method, and salivary volume and pH were measured before and after firefighting exposure. The concentrations of TNF-α, IL-6, lactoferrin and lysozyme showed no significant changes, in contrast there was a decrease in the concentrations of IL-10 in pH and saliva production of firefighters after acute exposure to firefighting. We conclude that firefighting alters the composition of saliva.

Acute respiratory distress syndrome (ARDS) is a common pathology in the intensive care unit associated with high mortality, especially in burn patients. A retrospective descriptive and univariate study was conducted in the intensive burn care unit over 4 years, from January 2018 to December 2021. Patients who developed ARDS during their stay according to the Berlin definition 2012 were included. One thousand one hundred and fifty patients were admitted, 360 were intubated (31%), of whom 100 presented an ARDS complication (28%). The average age was 40±13 years with a sex ratio of 1.8. The mean acute physiology and chronic health evaluation (APACHE) and severity simplified index (IGSII) were respectively 18(15-21) and ±34(29-42). The mean total body surface area burned was 46%±18, mean abbreviated burn severity index (ABSI) was 7,6±2,5. ARDS was severe among 60% (n=60) of cases and moderate in 40% (n=40) of cases, with a mean delay of occurrence from burns of 5.8±4 days. ARDS was due to infection in 56 patients, inhalation injury in 22 patients, and mixed etiology in 22 patients. The main complications observed were nosocomial infections among 71% of patients and acute kidney failure among 36% of patients. The mean duration of mechanical ventilation was 12,6±5,3 days and the mean length of stay in the intensive care unit was 13,7±5 days. Mortality was 61% (n=61). In multivariate analysis, independent mortality risk factors were identified: surface area burned greater than 39% (p=0,02), severity simplified index (IGSII) higher than 27 (p<10-3), APACHE II higher than 14,5 (p=0,01), the presence of pulmonary burns (p<10-3) and the occurrence of shock during resuscitation (p=0,04).

The gold standard burn dressing silver sulfadiazine (SSD) is widely used, but many disadvantages have been reported. An alternative is 1% feracrylum (1FA), a hemostatic agent that provides antibacterial activity, and wound improvement has been clinically proven. This study aimed to investigate the effect of 1FA in re-epithelization in burn wound management. This experimental study used 27 healthy male Wistar rats. All received inhalation anesthesia, then were prepared for deep burn injury using a metal plate. The animals were treated with either 1FA, SSD, or moist saline gauze (control group). The wound was measured with a two-ruler method on days 0, 5, 10 and 14. On day 14, quantitative and qualitative assessments of re-epithelialization were made. The percentage of wound healing was significantly better in the 1FA group compared to the control and SSD groups (p <0.001 on day 5; p<0.001 on day 10, and p <0.001 on day 14). The histopathology evaluation revealed that the epithelial thickness was significantly greater in the 1FA group compared to the control and SSD groups (p<0.001). The granulation tissue thickness was greater in the SSD group compared to the control and 1FA groups (p<0.001). The neovascularization in the 1FA group was more mature compared to the control and SSD groups (p<0.001). In this animal study, 1FA administration showed improved wound healing and re-epithelialization of the skin after deep dermal burns. These findings may lead to a new therapeutic approach for burn wound healing.

Burns are among the most serious injuries worldwide, ranking fifth in terms of non-fatal injuries in children. Scald injuries represent a significant global burden, especially in children. Scalds result from exposure to boiling liquids or steam and cause varying degrees of skin injury depending on the temperature and duration of contact. They typically occur either through immersion or spillover incidents. The study aimed to compare immersion and spillover burns in children to improve prevention strategies, treatment approaches, and overall outcomes for young burn victims. An analytical cross-sectional study was conducted at the Burn Care Center of the Pakistan Institute of Medical Sciences, Islamabad by reviewing data on scald cases admitted during 2022-2023 with a study duration of 12 months. Data from 266 scald cases were analyzed, including 148 male and 118 female patients. Of these cases, 156 were spillover burns and 110 were immersion burns. Spillover burns (24.1%) affected a slightly smaller area of the body compared to immersion burns (26.5%) which was statistically significant (p=0.004). Number of fasciotomies and mortality rate was higher in immersion burns (28.1% and 68.4% respectively) than spillover burns (2.56% and 31.5%). Overall, spillover burns were more common, but immersion burns were more severe and fatal. Scald burns in children, though preventable, remain a major concern. Immersions, despite being less common, result in higher mortality and severe outcomes. Effective prevention strategies, including improved parental supervision and widespread public awareness through social media and communication channels, are essential to reduce the incidence and severity of scald burns.

Renal failure frequently occurs as the primary organ failure in patients with severe burns, but accurately defining acute kidney injury and renal failure remains complex. This study aims to explore the relationship between these commonly measured renal biomarkers, diuresis and clinical outcomes in burn patients. The purpose of this study was to investigate the relationship between serum creatinine and urea levels, and the clinical outcomes in burn patients. By analyzing this relationship, the study aims to enhance the understanding of renal function and its impact on prognosis in patients with severe burns, thereby improving the management and treatment strategies for this vulnerable patient population. This was a retrospective cohort study that examined patients from the Department of Burns and Plastic Surgery at "Mother Teresa" University Hospital Center in Tirana, Albania. Data were collected from the burn registry and Medical Records from January 2023 to April 2024. Elevated creatinine levels upon admission are linked with a higher risk of morbidity and mortality. Similarly, increased urea levels and low diuresis are also associated with poor prognosis in burn patients. We propose that both admission creatinine and urea levels, along with diuresis measurements, can serve as "warning signs" to identify patients at higher risk for adverse outcomes.

Burn injury is trauma that has a negative impact on physical and psychosocial function and affects quality of life in post-burn patients. This study aimed to measure quality of life and analyze factors that affect quality of life, including psychological aspects in post-burn patients. This was an analytic observational study with a cross-sectional design. The study was conducted at the plastic surgery outpatient unit of Dr. Soetomo from May to August 2024 among post-burn patients who met the inclusion criteria. Quality of life was measured using the Burn Specific Health Scale Brief (BSHS-B) questionnaire, and measurement of patient depression levels uses the PHQ-9 questionnaire. Binary logistic regression was used to analyze the factors that affect quality of life. One hundred and thirteen patients were included in this study, with the majority being male. Overall, the patients' quality of life was classified as good, with an average score of 99.71 ± 30.75. Based on the PHQ-9 score, the post-burn patients were classified as mildly depressed. For female patients, the burn area, frequency of debridement, comorbid diseases and PHQ-9 score affected their quality of life (p <0.05). This study concluded that post-burn patients had a good quality of life. Interventions need to be carried out by the burn care team to improve quality of life, especially for patients with risk factors.