The Euro-Mediterranean Council for Burns and Fire Disasters

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Volume XXXV	Number 2	June 2022

Summaries

91	SODIUM BALANCE ANALYSIS IN THE BURN RESUSCITATION PERIOD (Belba M.K., Belba G.P. - Albania) The different formulae for resuscitation therapy after thermal damage recommend 0.5-0.6 mmol sodium for each % TBSAburned,suggesting fluid requirementsfrom 2-4 ml/kg/% burn because ofsodium lossin burned and unburned tissues. There is a gap especially in the recommendations regarding dysnatremia in the burn population. Many studies have focused on calculating amount of resuscitation fluids, avoiding the situation of "fluid creep", and not on calculating sodium remaining in the body after resuscitation. The goal of this observationalstudy wasto provide data forsodium disturbancesin the shock period after burns. Our study underscores the challenge of understanding whether there is a relationship between amount of crystalloid fluids given during resuscitation and meeting sodium needs. We set out to examine sodium balance (sodium deficit, received, excreted, and retained) after burns. The area under the ROC curve was performed by analyzing fluid and sodium load. Moreover, we conducted linearregression to analyze ifthere was a correlation between sodium retained and sodium excreted. Sodium deficit persisted until the second 24h despite resuscitation. Resuscitation was performed using Parkland formula, but urine output (UO) values were higher than expected. The threshold for fluid administration (ml/kg/%) or fluid load in the first 24h and sodium load (mmol/kg/%) for positive state (sodium received >0.5-0.6 mmol/kg/%) was 3.7 ml/kg/%.With linearregression, it was evident thatsodiumexcreted wasresponsible forsodiumretained, indicating amoderate correlation in the first 24h and a strong correlation in the second 24h. Resuscitation with LR did not correct hypoosmolality hyponatremia, which persisted even after the first 24h, especially in patients with burns >60%. If more than 3.7 ml/kg/% of LR is given, a sodium load higher than the normal level will be introduced, leading to increased urinary output, elevated sodium excretion, and non-correction of plasma sodium at the end ofresuscitation.What isimportantfor colleaguesin clinical practice isthat the focus of burn resuscitation should be expanded with data regarding sodium balance and the impact of dysnatremias in morbidity and mortality.
103	COAGULATION DISORDERS AND MORTALITY IN BURN INJURY: A SYSTEMATIC REVIEW (Nikolaidou E., Kakagia D., Kaldoudi E., Stouras J., Sovatzidis A., Tsaroucha A. - Greece) Even though coagulopathy is a familiar entity in trauma, its relationship to burn injury remains unclear. Literature appears inconsistent as to the conclusions of the use of coagulation assays, either routine methods or newer viscoelastic coagulation assays (VCAs), thromboelastography (TEG) and rotational thromboelastometry (ROTEM), for prediction of patients' coagulation status and mortality. The use of diagnostic assays as mortality markers will be of great importance, since they would recognize at early stages patients with great medical demands and objectify burn injury severity. The aim of thisstudy wasto review the literature and evaluate burn patients' characteristics and coagulation markersin the early post burn period. The secondary outcome was to investigate the role of different coagulation assays in mortality prognosis. Literature search was performed using PubMed, ScienceDirect, Wiley Online Library, Google Scholar, Proquest Dissertation and Theses Global, Scopus and Cochrane Library databases. All types of articles referring to adults with any type of burn injury admitted in the first 24h assessing coagulation and mortality were included. PRISMAguidelines ensured the evidence-based process. Eleven studies met the eligibility criteria. This review demonstrated the indubitable relationship of coagulopathy with burn injury and itssignificant impact on mortality. The rapid and dynamic process of coagulation makesstandard coagulation assays unable to detectshort-lived haemostatic changes. More susceptible markerssuch as VCAs need to be applied to the routine assessment of burn patients in order to obtain an overview on coagulopathy and standardize the gained knowledge.
116	SYNDROME DE LYELL ET SYNDROME DE STEVENS-JOHNSON : ÉTUDE RÉTROSPECTIVE OF 30 CASES (Hamich S., Sqalli Houssaini A., Meziane M., Ismaili N., Benzekri. - Maroc) Le syndrome de Stevens-Johnson et le syndrome de Lyell sont des toxidermies bulleuses graves qui peuvent engager le pronostic vital. Ce travail a pour objectif de décrire les données épidémiologiques, étiologiques, cliniques, thérapeutiques et évolutives des malades hospitalisés dans notre service de dermatologie. Il s'agit d'une étude descriptive rétrospective sur une période de 10 ans. Tous les dossiers des patients admis dans le service de dermatologie pour ces toxidermies ont été inclus. Un total de 30 patients a été enregistré, avec une prédominance masculine. Nous avons recensé 18 cas de syndrome de Lyell, 8 cas de syndrome de Stevens- Johnson et 4 cas de syndrome de chevauchement. La surface cutanée décollée moyenne était de 48%. Une atteinte viscérale (pulmonaire, rénale, hématologique ou hépatique) était fréquemment observée. La notion de prise médicamenteuse a été retrouvée chez tous nos patients, avec un délai moyen de survenue après la prise de 7,5 jours. Les médicaments anticonvulsivants étaient les principaux déclencheurs. Tous nos patients ont bénéficié d'un traitement symptomatique, une corticothérapie a été administrée chez un seul patient en raison d'un syndrome d'activation macrophagique. Le taux de mortalité était de 17%. La surface cutanée atteinte, la survenue d'une insuffisance rénale ou d'une détresse respiratoire étaient les principaux facteurs pronosti.
125	ANALYZING MORTALITY AND THEEFFECT OFEARLYEXCISION AS A PRELIMINARY TREATMENT OF ACUTE BURN PATIENTS IN A LIMITED RESOURCE SETTING USING LA50 AS AN OUTCOME MEASUREMENT (Syarif A.N., Afira F., Wardhana A., Ramadhan A. - Indonesia) Advances in burn care have led to an overall improvement in mortality in high-income countries, but in low-middle income countries mortality remainsrelatively high. In a limited resource setting where temporary wound closure options were unavailable, it was determined whether early excision as a preliminary treatment could improve prognosis. A retrospective cohort study was conducted in Cipto Mangunkusumo Hospital Burn Unit to evaluate the outcomes of acute burn patients admitted from January 2013 to December 2018 using mortality and lethal area 50 (LA50), and to compare the outcomes between groups who underwent early excision withoutskin graft (EEWG), early excision with skin graft (EESG), delayed excision withoutskin graft (DEWG), or delayed excision with skin graft (DESG). Out of 390 patients available for screening, 256 were eligible for furtherstudy.The overall mortality was 17.9% with an increase linear with age and total body surface area (TBSA). The overall LA50 was 49%. Preliminary data showed the highest percentage of deathsin the no treatment group, with no deaths seen in treatment groups EESG and DESG. The odds ratio for mortality in the EEWG group was 2.11 (p-value 0.201, CI95% = 0.65-6.80) compared to the DEWG group. LA50 is more objective compared to crude mortality and enablesfuture internal and external comparison.The highest mortality wasin the no treatment group with mortality in the EEWG group higher than in the DEWG, but notstatistically different. Early excision without skin grafting as a preliminary procedure may still be considered in a limited resource setting.
132	APPLICATION OF THE ENZYMATIC DEBRIDEMENT OF BURN WOUNDS IN PATIENTS DURING THE COVID-19 EPIDEMIC (Korzeniowski T., Madry R., Torres K., Kozicka M., Struzyna - Poland) The unfolding pandemic necessitated optimalization of treatment methods and assurance of the highest precautionary standards to prevent transmission of COVID-19 to burn patients. One of them included an expanded access treatment with the minimally invasive method - enzymatic burn wound debridement using Nexobrid® concentrate. The study assessed the effectiveness and usefulness of the expanded treatment project using enzymatic burn wound debridement with Nexobrid® concentrate in patients (n=11) during the pandemic (2020) when compared with the results of the same method in a corresponding period of 2019. The concentrate was applied to the wound on the third day following injury at the latest. All patients were treated with the same accepted standards, including initial debridement of the wound, application of Nexobrid® concentrate, and removal of devitalized tissue and dressing. Clinical visual assessment of the wound sites confirmed successful debridement of dead tissue following the application of the concentrate. No allergic or adverse reaction, nor significant deterioration of CBC parameters were observed in any patient. Although surgical excision of necrosis is recognized as the method of choice, enzymatic wound debridement using Nexobrid® concentrate may contribute to a reduction in epidemiological risk when treating burn patients for several reasons; the procedure can be performed at the patient's bedside, it limits the number of required surgeries, helps to improve medical equipment and supplies management, and saves human resources.
137	COST BENEFIT ANALYSIS OF FIRE SAFETY SYSTEMS IN THE READY-MADE GARMENT INDUSTRY: A CASE STUDY (Asaduzzaman MD. - Bangladesh) Fire safety has become a major issue of public concern in the ready-made garments (RMG) sector, encouraging the Government of Bangladesh and the garment industry to step forward to rebuild consumer confidence. This thesis gathered information on the cost-effectiveness of the protection systems from several garment factories in Bangladesh. A four-step methodology was used in an attempt to adopt a systemic approach to constructing a fire safety management system (FSMS) for an offshore platform which, although the approach is general nowadays, has been applied to the case of the RMG industry. Significant changes have been made in fire safety management in the ready-made garment factories over the past few years. However, fire safety still tends to be analyzed in isolation through all fire loss that affects the garment industry. Fire loss may be seen as a set of 'systematic' failures, not as a result of only one reason. This study proposes an FSMS for the ready-made garment industry. It is hoped that this approach will lead not only to more effective management of fire safety, but also to the more effective management of safety, health and the environment for any organization. This study discussed the problems encountered by the management, and proposed a way to quantitatively evaluate fire risk and identify the cost-effectiveness of undertaking fire safety measures for the RMG sector of Bangladesh.
152	REVUE DE LA LITTÉRATURE SUR LES BRÛLURES AU PHOSPHORE (Lacroix G., Martinot-Duquennoy V., Ngo B., Knipper P., Pasquesoone L. - France) Entre septembre et novembre 2020, l'Arménie et l'Azerbaïdjan se sont affrontés dans le HautKarabagh. Plusieurs missions chirurgicales ont été organisées par l'Assistance Publique - Hôpitaux de Paris pour aider à la prise en charge des blessés de guerre arméniens. Ces missions avaient notamment pour objectif l'évaluation de soldats victimes de brûlures suspectes d'être causées par du phosphore. Confrontés lors de ces missions à cette étiologie peu fréquente de brûlures, nous nous sommes intéressés à leur physiopathologie, leur prise en charge et leurs complications. Des actualisations itératives sont nécessaires pour guider de la meilleure façon la prise en charge des brûlures au phosphore. Dans ce but, nous avons réalisé une revue de la littérature en recherchant dans Pubmed les mots-clés «phosphorus», «burns» en Mesh Terms sans limite de date de parution des articles. Il ressort de cette revue que les brûlures au phosphore sont profondes, extensives et peuvent être responsables d'une toxicité systémique avec notamment une hypocalcémie pouvant être responsable de troubles du rythme cardiaque et de mort subite. En aigu, les brûlures doivent être lavées abondamment au sérum physiologique ou à l'eau stérile puis bénéficier d'une décontamination mécanique de l'ensemble des particules de phosphore blanc. Il ne faut pas effectuer de pansement gras en raison du caractère liposoluble du phosphore blanc. Par la suite, un ou plusieurs parages sont nécessaires avant de commencer la couverture des pertes de substance induites. Cette couverture fait appel à l'ensemble des techniques de chirurgie plastique. Les brûlures au phosphore sont rares mais graves. Elles sont surtout rencontrées sur des théâtres de guerre et doivent ainsi être connues de tous les soignants qui interviennent dans ces circonstances.
160	RÉSUMÉS DES INTERVENTIONS LORS DE LA TABLE RONDE DU 40ÈME CONGRÈS DE LA SFB, AYANT POUR THÈME: BRÛLURE ET OBÉSITÉ - PREMIÈRE PARTIE (Rédacteurs: Hautier A., Le Floch R. - Orateurs: Jeschke M., Eljaafari A., Lachamp J., Rousseau A.F., Duhamel P., Perrot P.,Chaouat M., Conti E., Le Touze A., Defours A.F., Jeanne M., Wiramus S., Losser M.R., Boussard N. - France) Nous rapportons ici une partie de la session «brûlure et obésité» du 40ème congrès de la SFB, qui s'est tenu à Toulon du 5 au 7 octobre 2021. Les sessions à orientations «réanimatoire» et chirurgicale sont concernées, dans l'attente de la finalisation du rapport concernant la session à orientation «rééducative».

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