Crystalloids, colloids and kids: a review of paediatric burns in intensive care

This is a retrospective review of all burns patients admitted to a paediatric intensive care unit (PICU) over a 7 year period. Resuscitation fluid therapy and clinical course are presented. Ninety-eight new burns victims were admitted with a mortality rate of 10.2%, all in burns of greater than 25% body surface area (BSA). The incidence of ARDS was 20%, with an 18% mortality rate. Of 85 patients with burns greater than 5% BSA, 33 received the hospital-recommended colloid-based resuscitation formula, 46 received a combination of crystalloids and colloids and in 6 patients the resuscitation regimen was not able to be determined. The aetiology, age distribution, sex ratio, severity of burns and length of stay in hospital did not alter significantly over the study period. The number of burns admissions to PICU increased, as did their duration of intubation and ICU stay. The hospital-recommended resuscitation formula consistently underestimated the fluid volume required for adequate resuscitation. No statistically significant difference in adverse effects was found between the resuscitation groups. This study is unable to recommend a definitive approach to the fluid resuscitation of burns shock in paediatrics and the best approach is one of meticulous fluid resuscitation titrated on clinical effect.     

表皮细胞体外培养及临床应用

用手术切除阴茎包皮，制成单细胞悬液，经体外培养和传代培养，达到扩大增殖面积目的。将培养的单层表皮细胞薄膜，移植１００例深二度烧伤创面及肉芽创面，（最大移植面积３００ｃｍ２，最小面积２８ｃｍ２）均获得满意效果。因此，用阴茎包皮作为培养皮肤的细胞来源，具有实用价值和发展前景。     

烟花爆竹烧伤91例分析

目的：探讨探花爆竹烧伤的特点及提高治愈率和预防方法,方法：对25年来91例烟花爆竹烧伤病人的临床资料进行回顾性分析及总结。结果：（1）烟花爆竹烧伤的特点：事故发生后受伤人数多,伤情严重,合并吸入性损伤及复合伤多,创面污染严重,（2）早期合理的救治,即：及时有效的液体复苏;对中,重度吸入性损伤坚持早期气管切开,辅以气道湿化,灌洗,保持气道通畅,加强创面处理,合理应用抗菌药,坚持早期胃肠道营养及重视合并伤诊治,提高了抢救成功率,结论：烟花爆竹烧伤伤情严重,早期合理救治可提高治愈率,,同时就重视预防工作。     

单态氧猝灭剂叠氮钠治疗角膜碱烧伤实验研究

为研究叠氮钠对角膜碱烧伤的治疗作用,在家兔的角膜碱烧伤模型中,用1 g/L NaN3及10 g/L NaN3+100g/L枸橼酸钠滴眼剂治疗.同时用硫代巴比妥酸(TBA)反应法检测过氧化脂质(LPO),用组织培养人角膜上皮细胞检测NaN3毒性,发现角膜烧伤后LPO逐渐减少.治疗组病情较轻,且NaN3毒性低,认为角膜碱烧伤后,用NaN3治疗有一定效果.     

烧伤血清对腹腔巨噬细胞凋亡的影响

目的 探讨体外培养的腹腔巨噬细胞（Ｍ）经烧伤血清刺激后的凋亡情况。方法制作３０％体表总面积（ＴＢＳＡ）Ⅲ 度烧伤大鼠模型,分离其伤后２４ ｈ血清。流式细胞术检测体外培养的Ｍ经烧伤血清刺激后的凋亡情况并与正常大鼠 进行对照。结果烧伤大鼠血清诱导Ｍ凋亡明显增加,这种作用随刺激时间的延长和烧伤血清浓度的增加而加强,与 对照组比较有显著差异（Ｐ＜０．０１）。结论烧伤血清可能在烧伤后Ｍ功能失调中起重要作用。     

Investigating the effects of walnut ointment on non-healing burn wounds

Effective treatments for non-healing burn wounds are an unmet need for 95% of burn sufferers. Approaches currently available to treat non-healing burn wounds are not satisfactory due to undesirable side-effects or expense. The anti-oxidation and antibacterial activities of walnuts are recommended for treating chronic diseases. Walnut ointment has been developed and successfully applied to treat non-healing burn wounds in our hospital for decades. We report herein a detailed retrospective case review examining patients’ response to the walnut ointment. The walnut ointment has shortened healing time of non-healing burn wounds and improved clinical outcomes. In order to investigate the mechanism of action, walnut ointment has been applied on wounds of porcine full-thickness burn wound models. Histological and immunohistochemical analysis indicated our walnut ointment supports wound healing through promoting keratinocyte proliferation and differentiation. Taken together, we recommend the walnut ointment offers an effective and economical treatment for patients presenting with non-healing burn wounds.     

Assessing opioid administration in pediatric burn patients with nonsurgical management

BackgroundDespite the vast literature studying the opioid crisis, sparse data describe this in the pediatric burn population. This study sought to assess patient-level characteristics and their potential effects on opioid administration in nonsurgical pediatric burn inpatients.MethodsAdmitted burn patients from 2013 to 2018 with nonsurgical management at an American Burn Association (ABA) verified pediatric burn center were retrospectively identified. Morphine milligram equivalents by weight (MME/kg) per admission were evaluated through a multiple loglinear regression with race, sex, age, total body surface area burned (TBSA), and burn depth as predictors. Simple linear regression was used to evaluate the temporal trend of median opioid utilization.ResultsA total of 806 patients (55% White, 35% Black, 5% Hispanic, 5% Other) were included. In an adjusted analysis, no differences in opioid administration were seen by sex, burn degree, or for Blacks and Hispanics when compared with Whites. Increased MME/kg was associated with older age (10–18 years; p < 0.0001) and larger burns (>5% TBSA burned; p < 0.0001). From 2013 to 2018, median MME/kg per admission declined significantly (2013:0.21, 2018:0.09; p = 0.0103).ConclusionsNonsurgical burn patients who were older and presented with larger TBSA experienced marked increases in opioid utilization. Overall, opioid administration decreased over time.     

A clinical observation of early short-term use of potent antibiotics in severely burned patients

Objective: To evaluate the effect of early and short-term use of potent antibiotics following extensive severe burn injury. Methods: Seventeen severely burned patients hospitalized in the same period (Nov.,1998 to Oct., 2000) wer esame treatment in Group 2 (n=8) was discontinued until day 15 postburn. The survival rate, blood bacterial culture, body temperature and white blood cell and platelet counts were compared between the 2 groups. Results: All the 17 patients survived and all blood bacterial cultures were negative. No significant difference of body temperature and white blood cell and platelet counts between the 2 groups was observed (P＞0.05). Conclusion: Early use of high-potency antibiotics at short treatment course after extensive severe burn is effective to prevent infection and reduce the cost.