Acute and Critical Care

Review Articles

Infection
Microbial infections in burn patients: Souvik Roy, Preeti Mukherjee, Sutrisha Kundu, Debashrita Majumder, Vivek Raychaudhuri, Lopamudra Choudhury; Acute Crit Care. 2024;39(2):214-225. Published online May 24, 2024; DOI: https://doi.org/10.4266/acc.2023.01571

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Abstract PDF: Polymicrobial infections are the leading causes of complications incurred from injuries that burn patients develop. Such patients admitted to the hospital have a high risk of developing hospital-acquired infections, with longer patient stays leading to increased chances of acquiring such drug-resistant infections. Acinetobacter baumannii, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Proteus mirabilis are the most common multidrug-resistant (MDR) Gram-negative bacteria identified in burn wound infections (BWIs). BWIs caused by viruses, like Herpes Simplex and Varicella Zoster, and fungi-like Candida spp. appear to occur occasionally. However, the preponderance of infection by opportunistic pathogens is very high in burn patients. Variations in the causative agents of BWIs are due to differences in geographic location and infection control measures. Overall, burn injuries are characterized by elevated serum cytokine levels, systemic immune response, and immunosuppression. Hence, early detection and treatment can accelerate the wound-healing process and reduce the risk of further infections at the site of injury. A multidisciplinary collaboration between burn surgeons and infectious disease specialists is also needed to properly monitor antibiotic resistance in BWI pathogens, help check the super-spread of MDR pathogens, and improve treatment outcomes as a result.

Infection
Evolution of COVID-19 management in critical care: review and perspective from a hospital in the United Kingdom: Avinash Kumar Jha, Sudhindra Gurunath Kulkarni; Acute Crit Care. 2021;36(1):1-14. Published online February 26, 2021; DOI: https://doi.org/10.4266/acc.2020.00864

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The unexpected emergence and spread of coronavirus disease 2019 (COVID-19) has been pandemic, with long-lasting effects, and unfortunately, it does not seem to have ended. Integrating advanced planning, strong teamwork, and clinical management have been both essential and rewarding during this time. Understanding the new concepts of this novel disease and accommodating them into clinical practice is an ongoing process, ultimately leading to advanced and highly specific treatment modalities. We conducted a literature review through PubMed, Europe PMC, Scopus, and Google Scholar to incorporate the most updated therapeutic principles. This article provides a concise and panoramic view of the cohort of critically ill patients admitted to the intensive care unit. We conclude that COVID-19 management includes low tidal volume ventilation, early proning, steroids, and a high suspicion for secondary bacterial/fungal infections. Lung ultrasound is emerging as a promising tool in assessing the clinical response. Managing non-clinical factors such as staff burnout, communication/consent issues, and socio-emotional well-being is equally important.

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Feasibility of Ultrasound-Guided, Peripherally Inserted Central Catheter Placement at the Bedside in a Communicable-Disease Isolation Unit
Kyoung Won Yoon, Wongook Wi, Moon Suk Choi, Eunmi Gil, Chi-Min Park, Keesang Yoo
Journal of Personalized Medicine.2023; 13(5): 863. CrossRef
Implementation of an Emergency Department–Embedded Infusion Center for the Administration of Monoclonal Antibody Therapy in Patients With Early COVID-19 Infection
Julie Graham, Christina Ballejos, Danisha Jenkins, Christina Kelley
Journal of Infusion Nursing.2022; 45(1): 41. CrossRef
Editorial: cardiovascular anaesthesiology
Anne D. Cherry, Mark Nelson, Nirvik Pal
Current Opinion in Anaesthesiology.2022; 35(1): 1. CrossRef
Dietetic-Led Nutrition Interventions in Patients with COVID-19 during Intensive Care and Ward-Based Rehabilitation: A Single-Center Observational Study
Ella Terblanche, Jessica Hills, Edie Russell, Rhiannon Lewis, Louise Rose
Nutrients.2022; 14(5): 1062. CrossRef
Mortality of COVID-19 Patients Requiring Extracorporeal Membrane Oxygenation During the Three Epidemic Waves
Christophe Beyls, Pierre Huette, Christophe Viart, Benjamin Mestan, Guillaume Haye, Mathieu Guilbart, Michael Bernasinski, Patricia Besserve, Florent Leviel, Alejandro Witte Pfister, Florence De Dominicis, Vincent Jounieaux, Pascal Berna, Hervé Dupont, Os
ASAIO Journal.2022; 68(12): 1434. CrossRef
Comparison of characteristics and ventilatory course between coronavirus disease 2019 and Middle East respiratory syndrome patients with acute respiratory distress syndrome
Imran Khalid, Romaysaa M Yamani, Maryam Imran, Muhammad Ali Akhtar, Manahil Imran, Rumaan Gul, Tabindeh Jabeen Khalid, Ghassan Y Wali
Acute and Critical Care.2021; 36(3): 223. CrossRef

Original Article

Trauma
Lund and Browder chart—modified versus original: a comparative study: Arun Murari, Kaushal Neelam Singh; Acute Crit Care. 2019;34(4):276-281. Published online November 29, 2019; DOI: https://doi.org/10.4266/acc.2019.00647

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Abstract PDF

Background
The Lund and Browder (LB) chart is currently the most accurate and widely used chart to calculate total body surface area affected by a burn injury. However, it is not easy to use charts to calculate burn percentages because of the difficulty in performing mathematical calculations with the percentages attributed to various body regions that are only partially burned. It is also cumbersome to have to perform mental calculations, especially in emergency situations.
Methods
We compared results from the LB chart with a modified Lund and Browder (MLB) chart using 10 assessors on five different burn wounds each drawn on both charts.
Results
Variability of results was significantly reduced using the MLB chart compared to the LB chart.
Conclusions
Assessments performed using the MLB chart are less variable than those using the LB chart. Using this chart will help burn care providers rapidly, accurately, and reliably estimate burn extent.

Citations

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Evolution of Burn Care
Martin R. Buta, Matthias B. Donelan
Clinics in Plastic Surgery.2024; 51(2): 191. CrossRef
Recent alcohol intake impacts microbiota in adult burn patients
Andrew J. Hoisington, Kevin Choy, Shanawaj Khair, Kiran U. Dyamenahalli, Kevin M. Najarro, Arek J. Wiktor, Daniel N. Frank, Ellen L. Burnham, Rachel H. McMahan, Elizabeth J. Kovacs
Alcohol.2024; 118: 25. CrossRef
Insight on Pediatric Burn Morbidity and Mortality at a Tertiary Indian Burn Care Center: A Case for Burn Prevention
Neeraj Kumar, Zachary J Eisner, Shivangi Saha, Vinay Kumar, Maneesh Singhal
Journal of Burn Care & Research.2024;[Epub] CrossRef
EasyTBSA as a method for calculating total body surface area burned: a validation study
Cindy D Colson, Emily C Alberto, Zachary P Milestone, Nikita Batra, Tyler Salvador, Hadi Fooladi, Kevin Cleary, Rima Izem, Randall S Burd
Emergency Medicine Journal.2023; 40(4): 279. CrossRef
Temporal trends in burn size estimation and the impact of the NSW Trauma App on estimation accuracy
Thanya Sritharan, Morgan Haines, Anne Darton, Aruna Wijewardana, Diane Elfleet, Kate Welsh, Meredeth Cassidy, Bish Soliman, Shane O’Neill, Jeon Cha, John Vandervord, Varun Harish
Burns.2023; 49(6): 1403. CrossRef
Treatment of Pediatric Upper Extremity Burns
Carrie L. Roth Bettlach, Courtney Bergheger, Lauren Jacobson, Mitchell A. Pet
The Journal for Nurse Practitioners.2023; 19(3): 104536. CrossRef
Evaluation and Optimization of the Wallace Rule of Nines for the Estimation of Total Body Surface Area in Obese and Nonobese Populations
Daniel Iván García-Ballesteros, Delia Del Carmen Rivera-Martínez, Mauricio Manuel García-Pérez, Everardo Valdés-Flores, Yanko Castro-Govea, Hernán Jesús Chacón-Moreno
The Journal of Emergency Medicine.2023; 65(4): e320. CrossRef
Clinical Profile of Children with Burns in a Tertiary Care Hospital
AV Lalitha, K Yashaswini, GS Naresh Kanna, Abha Rani Kujur, John A Michael Raj
Indian Journal of Critical Care Medicine.2023; 27(12): 934. CrossRef
A 1% TBSA Chart Reduces Math Errors While Retaining Acceptable First-Estimate Accuracy
William C Ray, Adrian Rajab, Hope Alexander, Brianna Chmil, Robert Wolfgang Rumpf, Rajan Thakkar, Madhubalan Viswanathan, Renata Fabia
Journal of Burn Care & Research.2022; 43(3): 665. CrossRef
Body mapping chart for estimation of percentage of body surface area in mesocephalic dogs
Andrea Henriksson, Kendon Kuo, Katherine Gerken, Kelsey Cline, Adrien‐Maxence Hespel, Robert Cole, Rachel Moon
Journal of Veterinary Emergency and Critical Care.2022; 32(3): 350. CrossRef
The Nursing Effect of Different Dressings on Local Small Area Burn Wound
娟李
Nursing Science.2022; 11(02): 279. CrossRef
Integrating the Patient's Voice in Toxicity Reporting and Treatment Decisions for Breast Radiotherapy
Sara R. Alcorn, Kimberly S. Corbin, Dean A. Shumway
Seminars in Radiation Oncology.2022; 32(3): 207. CrossRef
The relationships between routine admission blood tests and burn size, and length of stay in intensive care unit
Eng-Kean Yeong, Kwang-Yi Tung, Chin-Hao Chang, Shang-Jie Tsai
Journal of the Formosan Medical Association.2022; 121(12): 2512. CrossRef
Estimation of percent body surface area in cats with use of computed tomography
Andrea Henriksson, Jack Hamersky, Kendon Kuo, Katherine Gerken, Rachel Moon
Journal of Veterinary Emergency and Critical Care.2022; 32(6): 743. CrossRef
Effect of Different Itraconazole Dosing Regimens on Cure Rates, Treatment Duration, Safety, and Relapse Rates in Adult Patients With Tinea Corporis/Cruris
Ananta Khurana, Aastha Agarwal, Diksha Agrawal, Sanjeet Panesar, Manik Ghadlinge, Kabir Sardana, Khushboo Sethia, Shalini Malhotra, Ankit Chauhan, Nirmala Mehta
JAMA Dermatology.2022; 158(11): 1269. CrossRef
Hallway Gait Monitoring System Using an In-Package Integrated Dielectric Lens Paired with a mm-Wave Radar
Hajar Abedi, Jennifer Boger, Plinio Pelegrini Morita, Alexander Wong, George Shaker
Sensors.2022; 23(1): 71. CrossRef
To compare the effect of sea buckthorn and silver sulfadiazine dressing on period of wound healing in patients with second‐degree burns: A randomized triple‐blind clinical trial
Mehrdad Abdullahzadeh, Saeed Shafiee
Wound Repair and Regeneration.2021; 29(5): 732. CrossRef
State of the Art: An Update on Adult Burn Resuscitation
Jacqueline M. Causbie, Lauren A. Sattler, Anthony P. Basel, Garrett W. Britton, Leopoldo C. Cancio
European Burn Journal.2021; 2(3): 152. CrossRef
Lifetime Ambient UV Radiation Exposure and Risk of Basal Cell Carcinoma by Anatomic Site in a Nationwide U.S. Cohort, 1983–2005
Mark P. Little, Terrence Lee, Michael G. Kimlin, Cari M. Kitahara, Rui Zhang, Bruce H. Alexander, Martha S. Linet, Elizabeth K. Cahoon
Cancer Epidemiology, Biomarkers & Prevention.2021; 30(10): 1932. CrossRef

Review

Surgery
Management of Critical Burn Injuries: Recent Developments: David J. Dries, John J. Marini; Korean J Crit Care Med. 2017;32(1):9-21. Published online February 17, 2017; DOI: https://doi.org/10.4266/kjccm.2016.00969

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Abstract PDF

Background
Burn injury and its subsequent multisystem effects are commonly encountered by acute care practitioners. Resuscitation is the major component of initial burn care and must be managed to restore and preserve vital organ function. Later complications of burn injury are dominated by infection. Burn centers are often called to manage problems related to thermal injury, including lightning and electrical injuries.
Methods
A selected review is provided of key management concepts as well as of recent reports published by the American Burn Association.
Results
The burn-injured patient is easily and frequently over resuscitated, with ensuing complications that include delayed wound healing and respiratory compromise. A feedback protocol designed to limit the occurrence of excessive resuscitation has been proposed, but no new “gold standard” for resuscitation has replaced the venerated Parkland formula. While new medical therapies have been proposed for patients sustaining inhalation injury, a paradigm-shifting standard of medical therapy has not emerged. Renal failure as a specific contributor to adverse outcome in burns has been reinforced by recent data. Of special problems addressed in burn centers, electrical injuries pose multisystem physiologic challenges and do not fit typical scoring systems.
Conclusion
Recent reports emphasize the dangers of over resuscitation in the setting of burn injury. No new medical therapy for inhalation injury has been generally adopted, but new standards for description of burn-related infections have been presented. The value of the burn center in care of the problems of electrical exposure, both manmade and natural, is demonstrated in recent reports.

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Prevalence and Trend of Depression in Burn Survivors: A Single Center Cohort Study
V S Ranganath, Smitha Segu, B S Girish, Joel M Johns, C S Meghana
Journal of Burn Care & Research.2024;[Epub] CrossRef
SUBMICROSCOPIC CHANGES IN THE HEMOCAPILLARIES OF THE CEREBRAL HEMISCLE CAUSES CAUSED BY THERMAL BURN
H. V. Lukyantseva, V. A. Pastukhova, O. I. Kovalchuk
Bulletin of Problems Biology and Medicine.2021; 3(1): 268. CrossRef
Kefir Accelerates Burn Wound Healing Through Inducing Fibroblast Cell Migration In Vitro and Modulating the Expression of IL-1ß, TGF-ß1, and bFGF Genes In Vivo
Ahmad Oryan, Esmat Alemzadeh, Mohammad Hadi Eskandari
Probiotics and Antimicrobial Proteins.2019; 11(3): 874. CrossRef
Viable placental allograft as a biological dressing in the clinical management of full-thickness thermal occupational burns
Eric L. Johnson, Elisabet K. Tassis, Georgina M. Michael, Susan G. Whittinghill
Medicine.2017; 96(49): e9045. CrossRef

Randomized Controlled Trial

Central Venous Catheter-related Infection in Major Burn Patients: Comparison of Subclavian Vein and Femoral Vein: Young Ho Jang, Yong Hoon Son, Sang Kyu Kim, Joon Mo Park, Mi Young Lee, Jin Mo Kim; Korean J Crit Care Med. 2011;26(4):245-249.; DOI: https://doi.org/10.4266/kjccm.2011.26.4.245

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Abstract PDF

BACKGROUND
A central venous catheter (CVC) is usually inserted in patients with severe burns and the selection of the CVC is often difficult due to widespread burned skin. We investigated the incidences of colonization and catheter-related blood stream infection (CRBSI) according to the insertion site of the CVC in major burn patients METHODS: In 63 adult massive burn patients in the intensive care unit, 93 CVCs (47 polyurethane standard CVCs and 46 Oligon anti-mocrobial CVCs) were randomly inserted via the subclavian vein (SCV group, n = 66) or femoral vein (FEV group, n = 27). All catheter tips removed were routinely cultured. Bacterial findings from the burn wound and peripheral blood were also monitored in all patients RESULTS: There was no significant difference in the average insertion length of the CVC (14.3 +/- 6.8 days in SCV and 13.6 +/- 3.8 days in FEV) between the two groups. There were no significant differences in CVC colonization (48.5% in SCV and 63.0% in FEV) and CRBSI (7.6% in SCV and 11.1% in FEV) between the two groups. Logistic analysis found that the use of polyurethane standard CVC is significantly associated with increased risk of CVC colonization (odds ratio = 2.68) CONCLUSIONS: The placement of the CVC via the femoral vein does not increase the incidence of CVC colonization in massive burn patients. The use of Oligon anti-microbial CVC may be helpful to reduce CVC colonization in major burn patients.

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An Ounce of Prevention Saves Tons of Lives: Infection in Burns
Nishant Merchant, Karen Smith, Marc G. Jeschke
Surgical Infections.2015; 16(4): 380. CrossRef

Original Articles

Effect of 6% Hydroxyethyl Starch Solution on Coagulation Function in Patients with Major Burns: In Suk Kwak, Ji Yeong Bae, Kwang Min Kim; Korean J Crit Care Med. 2008;23(2):79-83.; DOI: https://doi.org/10.4266/kjccm.2008.23.2.79

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Abstract PDF: BACKGROUND
Patients with major burns require replacement of intravascular volume. Hydroxyethyl starch (HES) solutions are widely used to replace intravascular volume. Dilution with crystalloids or colloids and corresponding platelet dysfunction are known causes of perioperative bleeding tendencies. The aim of the current study was to evaluate the effect of crystalloid and colloid solutions on platelet function in patients with major burns.
METHODS
Forty patients scheduled for burn surgery were divided into 4 groups. The infusion was started with a Hartman solution infusion (group 1) from 7 A.M. until surgery. HES (6%, Voluven(R)) was infused in the following concentrations: 7 ml/kg (group 2), 10 ml/kg (group 3), and 15 ml/kg (group 4). The bleeding time (BT), prothrombin time (PT), prothrombin time international ratio (PT INR), activated partial thromboplastin time (aPTT), hemoglobin (Hb), platelet function analyzer-100 closing time (PFA CT), and platelet count (Plt) were measured.
RESULTS
Hartmann solution and HES had no significant effect on the BT, PT, PT INR, a PTT, Hb, and Plt. The post-operative PFA CT was significantly higher in group 4 than in group 3. In group 4, the PFA CT was significantly higher post-operatively compared to pre-operatively.
CONCLUSIONS
The use of high dose HES may increase the risk of bleeding tendencies in burn patients.

Diagnosis of Acid-base Imbalance by Stewart's Physicochemical Approach and Mortality Prediction in Severe Burn Patients with Inhalation Injury: Sunghoon Park, Cheol Hong Kim, In Gyu Hyun, Ki Suck Jung; Korean J Crit Care Med. 2006;21(1):17-27.

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Abstract PDF: BACKGROUND
Acid-base derangement are commonly encountered in critically ill patients. This study is to investigate underlying mechanisms of acid-base imbalance and also to examine whether they can predict mortality in burn patients.
METHODS
We retrospectively reviewed 73 severely burned patients who had admitted to burn intensive care unit, from January to July in 2004. All the patients had inhalation injury, identified by bronchoscopic examination. We analyzed the type and nature of the acid-base imbalances from arterial blood gas analysis, electrolytes and other biological tests between survivors and non-survivors for 30 days after admission.
RESULTS
Acidosis was the most common disorder during the early and late hospital periods. Large fractions of those showed decreased strong ion difference (SID), increased anion gap corrected by albumin (AGc) and [Cl-]corrected. Mixed disorder and alkalosis emerged after the 7(th) hospital day. As time went by, albumin, PaO2/FiO2 ratio, pH and SID were more decreased in non-survivors (n=28) than in survivors (n=45) while [Cl-] corrected, alveolar-arterial oxygen tension gradients, peripheral WBC counts and CRP were more increased in non-survivors than in survivors. In the area under the receiver operating characteristic curves for mortality prediction, APACHE II score and % of total body surface area (%TBSA) burn were high: 0.866 (95% CI; 0.785~0.946) for APACHE II score, 0.817 (95% CI; 0.717~0.918) for %TBSA burn.
CONCLUSIONS
In burned patients with inhalation injury, various types of acid-base imbalances and electrolytes abnormalities emerged after resuscitation and so, more careful attentions pursued for correcting underlying acid-base derangement.

Clinical Characteristics in Patients with Vancomycin-Resistant Enterococci Colonization or Infection during 5 years in a Private General Hospital: Jin Kyung Kim, Cheol Hong Kim, Seung Yong Han, Hyeon Woo Byun, Woo Jung Park, Heung Jeong Woo, In Gyu Hyun, Jae Jung Lee, Kyu Man Lee; Korean J Crit Care Med. 2005;20(1):54-62.

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Abstract PDF: BACKGROUND
Vancomycin-resistant enterococci (VRE) is increasing rapidly through the world and is now a major cause of nosocomial infection. The transmission dynamics and factors contributing their dissemination are complex. We conducted a study to investigate clinical characteristics in patients with VRE colonization or infection during recent 5 years. METHODS: 154 cases that had the VRE infection or colonization from January 1, 2000 to April, 2004, were reviewed. We analyzed the risk factors of VRE infection and colonization and also compared various parameters contributing their dissemination between burn and non-burn patients with VRE. RESULTS: Total 212 strains of VRE were isolated from 154 patients. Of 212 strains of VRE, Enterococcus faecium (178 strains, 83.9%) were most common and followed by E. casseliflavus (28 strains, 13.2%), E. faecalis (5 strains, 2.4%) and E. gallinaum (1 strains, 0.5%). The most common place of VRE isolation was in burn intensive care unit (ICU), 95 cases (61.7%); 27 cases (17.5%) in general wards; 17 cases (11.0%) in surgical ICU; 15 cases (9.7%) in medical ICU. Compared with patients with VRE colonization, patients with VRE infection had older age, higher APACHE II scores and high death rate significantly. Then, VRE colonization were more common in burn patients while VRE infection were more common in non-burn patients.
CONCLUSIONS
The findings from this study suggest that VRE infection are not uncommon among hospitalized patients. More strict infection control, close surveillance and judicious use of antibiotics may be warranted to prevent infection and transmission of VRE.

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