Enoxaparin and antifactor Xa levels in acute burn patients.

Altered pharmacokinetics in critically ill patients have been shown to result in inadequate enoxaparin dosing for venous thromboembolism (VTE) prophylaxis. In the burn unit, routine monitoring of antifactor Xa levels was implemented to ensure adequate VTE prophylaxis. The purpose of this study was to examine the appropriateness of enoxaparin dosing for VTE prophylaxis in this specialized patient population.

Use of dexmedetomidine for sedation in critically ill mechanically ventilated pediatric burn patients.

Dexmedetomidine has previously been used only for short-term, procedural sedation in children. The purpose of this review was to describe the dosing, safety, and efficacy of dexmedetomidine for sustained sedation in intubated pediatric burn patients. The authors reviewed acutely burned children treated between 2005 and 2008 who were intubated during their course of care and who received dexmedetomidine for sedation.

Closure of the excised burn wound: temporary skin substitutes.

Prompt excision of major burn wounds has been repeatedly shown to improve survival, speed closure, and reduce infection. Immediate coverage with autograft skin is the preferred method of definitive closure of these wounds. However, when harvesting of donor skin is unavailable, or wounds are not ready for autografting, temporary closure with a variety of products can help reduce evaporative loss, prevent infection, and ameliorate pain and metabolic stress.

Telemedicine evaluation of acute burns is accurate and cost-effective.

Background: As the number of US burn centers has declined, access to burn care is increasingly limited. Inexperience in burn wound assessment by referring physicians often results in overtriage or undertriage. In an effort to improve access to burn care in our region, we instituted a program of telemedicine evaluation of acute burns.

Fournier's gangrene: management at a regional burn center.

Fournier's gangrene (FG) describes necrotizing infections of the perineum in both sexes. Controversies in treatment of FG include the roles of orchiectomy, urinary and/or fecal diversion, and hyperbaric oxygen (HBO). Because burn centers often treat these patients, we reviewed our experience with FG during a 14-year period.

Reduction of the incidence of amputation in frostbite injury with thrombolytic therapy.

Hypothesis: Thrombolytic therapy will decrease the incidence of amputation when administered within 24 hours of exposure.

Design: Single institution retrospective review of clinical outcomes and resource use.

Setting: Burn unit of a tertiary academic referral center.

The phenomenon of "fluid creep" in acute burn resuscitation.

Several reports have documented that modern burn patients receive far more resuscitation fluid than predicted by the Parkland formula-a phenomenon termed "fluid creep." This article reviews the incidence, consequences, and possible etiologies of fluid creep in modern practice and uses this information to propose some therapeutic strategies to reduce or eliminate excessive fluid resuscitation in burn care. A literature review was performed of historical references that form the foundation of modern fluid resuscitation, as well as reports of fluid creep and its consequences.

Telemedicine for acute burn treatment: the time has come.

This brief paper sets out the arguments for the routine use of telemedicine in the evaluation of burns. Two cases are reported from the author's practice that show the need for it.

Defining the ratio of outcomes to resources for triage of burn patients in mass casualties.

Management of a mass casualty involving burn patients that overwhelms local resources will likely require a triage process in which limited resources are devoted to the patients with the highest likelihood of survival. No objective criteria exist which define how patients could be categorized in such a situation. A table that classifies patients according to their anticipated survival from burn injury, and the resources required to achieve that survival, is presented here.

Regional air transport of burn patients: a case for telemedicine?

Background: Air transport of burn patients is plagued by frequent "overtriage." We examined the use of air transport and the feasibility of using alternative methods such as telemedicine to assist in evaluation and treatment of burn patients within our region.

Methods: We reviewed all burn patients transported by air during 2000 to 2001.

Early tracheostomy does not improve outcome in burn patients.

Early tracheostomy (ET) has been claimed to reduce ventilator support or intensive care unit or hospital length of stay in intensive care unit patients. This study was performed to assess the potential benefits of ET in burn patients. From October 1996 to July 2001, we evaluated all intubated and acutely burned adults using a formula to predict the probability of prolonged ventilator dependence.

Characterization of human and mouse rod cGMP phosphodiesterase delta subunit (PDE6D) and chromosomal localization of the human gene.

The mammalian multisubunit photoreceptor cGMP phosphodiesterase PDE alpha beta gamma 2 (PDE6 family) is a peripherally membrane-associated enzyme. A novel subunit, termed PDE delta (HGMW-approved symbol, PDE6D; MW 17 kDa), is able to detach PDE partially from bovine rod outer segment membranes under physiological conditions. Cloning of human and mouse PDE delta cDNAs revealed that PDE delta is a nearly perfectly conserved polypeptide of 150 amino acids that shows partial sequence homology to photoreceptor RG4 of unknown function.

Randomized trial of immune-enhancing enteral nutrition in burn patients.

Background: "Immune-enhancing" diets (IEDs) are aimed at improving outcomes in patients suffering trauma and infection. This study was conducted to evaluate a popular IED in patients suffering burn injury.

Methods: Fifty burned patients were randomized to receive either Impact (Sandoz Nutrition, Minneapolis, Minn), an IED enhanced with omega-3 fatty acids, arginine, and RNA, or Replete (Clintec, Deerfield, Ill), our standard high-protein diet.

Return to work as a measure of outcome in adults hospitalized for acute burn treatment.

Rehabilitation of patients with burn injuries is receiving renewed interest because survival has improved, and health reform has mandated outcomes assessment. To determine factors affecting return to work, a survey was conducted among 234 employed patients treated from 1986 through 1993. The mean burn size was 13.

Recent outcomes in the treatment of burn injury in the United States: a report from the American Burn Association Patient Registry.

This article reports outcomes of 6417 patients treated during 1991-1993 in 28 burn centers. Data were gathered by use of the ABA's computerized patient registry. Mean burn size was 14.