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Volume XI |
Number 2 |
June 1998 |
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SUMMARIES
| 67 |
THE ELDERLY PATIENT IN A BURNS CENTRE
(Gallo l., Iannotti B., Magliacani G. - ITALY)
In the last few years the Turin Burns Centre (Italy) has seen a considerable increase in the number of elderly patients admitted. This study considers whether the management of elderly patients in an isolated ward is different from that of younger patients and, if so, in what way. The data collected indicate that the experience of elderly patients admitted to a Burns Centre is different from that of other patients, as it is often less traumatic, and their assistance requires a different approach from that provided by other protocols.
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| 70 |
EVALUATION DES TAUX SERIQUES DU ZINC, DU CUIVRE ET DU MAGNESIUM CHEZ LES BRULES A LA PHASE INITIALE
(Messadi A., Mahjoub E., Asairi M., Nouira R., Hedhili A., Mahbouli S., Braham F. - TUNISIE)
Les Auteurs ont entrepris ce travail dans le but d'évaluer les taux sériques de trois oligo-éléments (zinc, cuivre et magnésiu in) chez les brûlés au cours de la phase initiale après la lésion, sur la base de leur importance biologique. Les patients atteints de brûlure graves ont présenté une diminution des trois oligo-éléments dosés, peu importante pour le cuivre mais significative pour le zinc (-27,Y,,) et le magnésium (- 11 %). Cette carence aiguë de zinc et magnésium, au cours de la phase d'inflammation majeure et de stress, impose une thérapeutique substitutive précoce pour ces deux oligo-éléments.
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| 74 |
TREATMENT OF SERIOUS INFECTIOUS COMPLICATIONS IN BURNED PATIENTS WITH-IMIPENEM/CILASTATIN
(Lesseva M., Hadjiski O. - BULGARIA)
Systemic antibiotics are inevitable in the treatment of infectious complications in Burns and one of their unfavourable sequels is the selection of multiresistant nosocomial strains. This means that numerous antimicrobial agents cannot be used and a search has to be made for new alternatives. The aim of the present study is to present our clinical experience with the use of Imipencm/Cilastatin in the treatment of severe infections in patients with extensive deep Burns. Twenty patients were included, fifteen during the last year. The results presented of in vitro susceptibility tests to Imipenem characterize it as the most effective of all available antimicrobial agents against bacterial pathogens in Burns. Some P. aeruginosa strains were relatively more resistant to Irnipenern. The results of the treatment were evaluated as very good (80.0%) and good (20.0%), while in 75.0% of the cases the symptoms of infection initially resolved before the 36th hour. Candida superinfection appeared in 35.0% of the patients after several different antibiotic courses. The good clinical and bacteriological results of our study indicate that Imipencm/Cilastatin is a correct choice in empirical treatment and in proved serious cases, including mixed infections, with multiresistant bacterial pathogens. However, its use must be strictly controlled in order to restrict growth of resistant strains.
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| 80 |
SERUM NEOPTERIN AND PLASMA ENDOTOXINS AS PREDICTORS OF ENDOTOXAEMIA IN BURNED PATIENTS
(Mabrouk A.R., Shetta A. M. - EGYPT)
Serum neopterin, plasma endotoxins, ALT, AST, BUN, creatinine and TLC were determined in 35 burned patients on the fourth day after burn injury. The TBSA ranged from 10-75 % (mean, 34 ± 21 %). The results were compared with those of nineteen normal healthy controls and correlated with TSBA, sepsis, mortality, and hepatic and renal function tests. The results demonstrated higher serum neopterin and endotoxins, AST, ALT, BUN and creatinine in the patient groups than in controls (p < 0.001). Serum neopterin and plasma endotoxins were significantly increased and were related to the extent of the burn surface area (p < 0.001). They were significantly higher in the septic and deceased group than in the non-septic and survivors groups. These results suggest that thermal injury can lead to an elevation of serum neopterin. Endotoxin release in the circulation may be responsible for continuous induction of neopterin. In addition, plasma endotoxin and serum neopterin act as predictive factors for the occurrence of early sepsis with subsequent multiple organ failure and death.
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| 86 |
CLINICAL AND STATISTICAL DATA ON THE OCCURRENCE OF PULMONARY COMPLICATIONS IN SEVERE BURN PATIENTS TREATED IN AN INTENSIVE CARE UNIT
(Belba M., Pema L., Dauti L, Mingomata L., Isarai S., . Belba G.- ALBANIA)
Burns continue to be a seriously dangerous illness with a strong potentiality of a fatal outcome, despite the intensive propaganda aimed at their prevention and the great steps taken in the field of scientific treatment. One of the possible complications of the course of the illness is pulmonary disease. The problem is focused on in this paper, which provides a full epidemiological view of the complication seen in its different aspects. A detailed analysis of the results of our work in the intensive care unit over a threeyear period of time and the discussion of cases in accordance with the data in the Tables highlight the age-groups most afflicted, the time of appearance of the complication, and the interrelations between cause of burn, extent of burn, and death rate.
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| 91 |
MANAGEMENT OF SMOKE INHALATION - A STUDY OF 244 SEVERELY BURNED PATIENTS WITH SMOKE INHALATION ADMITTED TO THE BURN INTENSIVE CARE UNIT AT THE BURN AND PLASTIC SURGERY CENTER, TRIPOLI, LIBYA IN THE PERIOD 1.1.93-31.12.96
(Zaidi M., Franka M.R., Abusetta A., Shehata G., Shain A. - LIBYA)
Our study covers 224 patients with smoke inhalation admitted to our Burn Intensive Care Unit in the period 1.1.9331.12.96. The criteria for admission to our ICU are extensive burns, inhalation injury, and Burns with other systemic problems. We diagnose smoke inhalation on the basis of history, facial Burn, sooty sputum, hoarseness of the voice, laboratory investigations, ABG, carboxyhaemoglobin level in the blood, and bronchoscopy. In the four-year period 1. 1.93-31.12.96, 224 patients with smoke inhalation were admitted to our Burn ICU, divided into two groups. The 86 patients in the first group were treated with appropriate resuscitation, improvement of oxygenation by oxygen mask, nasal oxygen catheter, nasal endotracheal tube, calcium channel blocker, and cardiopulmonary support, together with PPV and PEEP in the presence of hypoxia and pulmonary insufficiency. Of these patients admitted with smoke inhalation 51 died (59%). The 138 patients in the second group admitted with smoke inhalation were managed with the same treatment and with improvement of oxygenation by PPV with PEEP soon after admission, without waiting for hypoxia or pulmonary insufficiency. Out of these patients admitted with smoke halation 57 died (41 %).
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| 95 |
A RAT MODEL OF SMOKE INHALATION INJURY
(Xiei.F., Yang Z.C., Wang D., FuQ.F, Weiji -CHINA)
Using a self-designed apparatus consisting of a smoke generator and a traurnatogenic chamber, we successfully established a rat model of smoke inhalation injury and observed smoke components and the situation of animal pulmonary injuries. This model could be applied in experimental research on the pathogenesis and treatment of inhalation injury.
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| 100 |
VARIATIONS IN NUTRITIONAL PARAMETERS AFTER THERMAL INJURY IN MAN
(Bollero D., Giannotti L., Stella M., Broglio F, Calcagni M., Ghigo E., Magliacani G. - ITALY)
In spite of optimized artificial nutrition, the development of malnutrition is often rapid in critically ill patients. This particularly applies to burn patients, in whom dramatic metabolic and hormonal alterations occur. The aim of this study was to define the variations of nutritional parameters, including IGF I levels, in burn patients. To this goal, in 22 burn patients (mean age ± SEM, 46.5 ± 3.4 yr; BMI, 24.9 ± 0.9 M2; % burn surface area 26.0 ± 3.0%; ROI score, 0.22 ± 0. 1) we evaluated prealburnin (pre A), al burnin (A) and transferrin (TRA) as well as IGF I levels on days 1, 3, 7, 14 and 28. On day I post burn, pre A (18.5 ± 2.1 mg/dl), A (3.5 ± 0.2 g1l) and TRA (158.0 ± 13.0 mg/dl) were lower than the normal range, while IGF I levels were still in the low normal range (120.2 ± 11.2 pg/1). Pre A, A and TRA underwent a further decrease, with the lowest point on day 7, for pre A and TRA (7.1 ± 0.6 rng/dI and 103.0 ± 6.5 mg/dI, respectively), and later, on day 14, for A (2.7 ± 0.2 g/dl). A rebound increase was observed from day 7 for pre A and TRA until day 28 (20.3 ± 1.6 mg/dl and 165.5 ± 13.0 mg/dI, respectively), when these parameters were in the normal range. On day 28, A levels persisted lower than the normal range (3.0 ± 0.2 g/dl). IGF I levels showed a progressive decrease until day 14 (86.9 ± 10.9 pg/1), when they were as low as in hypopituitaric patients with severe growth hormone deficiency. IGF I levels then increased and on day 28 (p < .05) they were again in the low normal range (127.4 ± 19.0 pg/1). A levels, but not pre A and TRA levels, showed a negative correlation to burn extent and ROI score (r = .07; p < .05) on days 3 and 7 only, while IGF I levels were not associated either with other nutritional parameters or with burn extent and ROI score. These findings indicate that in burn patients pre A, A and TRA levels, but not IGF I levels, are reduced within a few hours post burn. Pre A and TRA show a faster recovery and are normal one month after thermal injury, when A levels still are reduced. IGF I levels show a delayed decrease, which is as marked as in hypopituitaric patients with severe GH deficiency, on day 14 post burn. One month after the burn lGF I levels are normalized. These findings confirm the usefulness of IGF I as a marker of nutritional status, together with al burnin, prealburnin and transferrin as a marker of nutritional status, although only al burnin levels are associated with the severity of the injury and could have prognostic value.
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| 105 |
HIGH-VOLUME SLOW CONTINUOUS VENOVENOUS HAEMOFILTRATION IN SEPTIC NONOLIGURIC BURNED PATIENTS
(Weksler N., Chorny L, Gurman G.M, Shapira A.-R. - ISRAEL)
In spite of optimized artificial nutrition, the development of malnutrition is often rapid in critically ill patients. This particularly applies to burn patients, in whom dramatic metabolic and hormonal alterations occur. The aim of this study was to define the variations of nutritional parameters, including IGF I levels, in burn patients. To this goal, in 22 burn patients (mean age ± SEM, 46.5 ± 3.4 yr; BMI, 24.9 ± 0.9 M2; % burn surface area 26.0 ± 3.0%; ROI score, 0.22 ± 0. 1) we evaluated prealburnin (pre A), al burnin (A) and transferrin (TRA) as well as IGF I levels on days 1, 3, 7, 14 and 28. On day I post burn, pre A (18.5 ± 2.1 mg/dl), A (3.5 ± 0.2 g1l) and TRA (158.0 ± 13.0 mg/dl) were lower than the normal range, while IGF I levels were still in the low normal range (120.2 ± 11.2 pg/1). Pre A, A and TRA underwent a further decrease, with the lowest point on day 7, for pre A and TRA (7.1 ± 0.6 rng/dI and 103.0 ± 6.5 mg/dI, respectively), and later, on day 14, for A (2.7 ± 0.2 g/dl). A rebound increase was observed from day 7 for pre A and TRA until day 28 (20.3 ± 1.6 mg/dl and 165.5 ± 13.0 mg/dI, respectively), when these parameters were in the normal range. On day 28, A levels persisted lower than the normal range (3.0 ± 0.2 g/dl). IGF I levels showed a progressive decrease until day 14 (86.9 ± 10.9 pg/1), when they were as low as in hypopituitaric patients with severe growth hormone deficiency. IGF I levels then increased and on day 28 (p < .05) they were again in the low normal range (127.4 ± 19.0 pg/1). A levels, but not pre A and TRA levels, showed a negative correlation to burn extent and ROI score (r = .07; p < .05) on days 3 and 7 only, while IGF I levels were not associated either with other nutritional parameters or with burn extent and ROI score. These findings indicate that in burn patients pre A, A and TRA levels, but not IGF I levels, are reduced within a few hours post burn. Pre A and TRA show a faster recovery and are normal one month after thermal injury, when A levels still are reduced. IGF I levels show a delayed decrease, which is as marked as in hypopituitaric patients with severe GH deficiency, on day 14 post burn. One month after the burn lGF I levels are normalized. These findings confirm the usefulness of IGF I as a marker of nutritional status, together with al burnin, prealburnin and transferrin as a marker of nutritional status, although only al burnin levels are associated with the severity of the injury and could have prognostic value.
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| 109 |
EXPERIENCE OF THE PLASTIC SURGERY AND BURNS DEPARTMENT OF THE GRIGORE ALEXANDRESCU CHILDREN'S CENTRAL HOSPITAL (BUCHAREST) IN THE TREATMENT OF BURNED CHILDREN
(Enescu D., Enescu M., Stoicescu M., Voicu R. - ROMANIA)
Before 1988 the care of burned children in Romania was in the hands of generic burn specialists, and it was only in that year that a specialized Burns and plastic surgery unit was established in the Children's Central Hospital in Bucharest. This remains the only one in the country for the specialized treatment of burned children, many of whom continue to be treated in unspecialized units. The results of care of burned children have now significantly improved. The purpose of this retrospective study is to report on the main epidemiological and clinical aspects in the care of burned children in Romania and to suggest some therapeutic principles based on practical experience. Early surgical management of the burned wound is recommended as the most important therapy for improving survival after extensive burns.
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