| 1. |
- Sjöberg, Folke, 1956-, et al.
(författare)
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Utility of an intervention scoring system in documenting effects of changes in burn treatment
- 2000
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Ingår i: Burns. - : Elsevier. - 0305-4179 .- 1879-1409. ; 26:6, s. 553-559
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Tidskriftsartikel (refereegranskat)abstract
- The consequences of the introduction of a program of consistent use of topical antimicrobials and early aggressive excision of deep burn wounds by utilizing a comprehensive, computerized patient registry/therapeutic intervention scoring system, were investigated. Prospectively, the clinical course, mortality, outcome and hospital costs were compared for the year preceding (89 patients) and the 4 years following (226 patients) the introduction of the new treatment program. It was found that mortality decreased from 10.1 to 4.6% after change in therapy (P < 0.001), despite an increase in mean burn extent. The length of hospital stay per % burn surface area declined from 1.2 to 1.0 days (P < 0.001). The number and complexity of therapeutic interventions and the associated costs, also declined. Patients in the new treatment program had a better level of physical and psychosocial function at follow up. In conclusion, the introduction of a program of consistent use of topical antimicrobials and early, aggressive surgical excision was associated with an improved outcome at lesser cost. The combined registry-intervention scoring system permits ready analysis of results using data entered on a daily, near-real time basis.
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| 2. |
- Zdolsek, Hans Joachim, 1960-, et al.
(författare)
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Albumin supplementation during the first week after a burn does not mobilise tissue oedema in humans
- 2001
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Ingår i: Intensive Care Medicine. - : Springer Science and Business Media LLC. - 0342-4642 .- 1432-1238. ; 27:5, s. 844-852
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To measure water balance and changes in distribution, and the effect of giving supplementary albumin, early after a burn injury.Design: Consecutive patients (matched groups) and healthy controls.Setting: National burn unit in a Swedish university hospital.Patients and subjects: Eighteen patients with 18%-90% total burned surface area and 16 healthy male control subjects.Interventions: The patients were given an intravenous infusion of ethanol over 1 h, 0.35-0.60 g/kg body weight, and a bolus of 3.3 to 6.5 g of iohexol. The control subjects were given the same amounts of either ethanol or iohexol. Patients were subdivided into two groups according to whether or not they received supplementary albumin starting 12 h post-burn.Measurements and results: Blood samples were drawn at 20-30 min intervals over 4 h after the start of the infusion. Serum ethanol was measured by headspace gas chromatography, and iohexol with high-pressure liquid chromatography (HPLC). Distribution volume was calculated from the concentration-time profiles. Total body water (TBW) was measured by the ethanol tracer and bioelectric impedance (BIA) techniques, and estimated extracellular water (ECWest) by iohexol tracer. They were all significantly increased after a burn. Excess water was accumulated mainly in the extracellular compartment. It declined towards normal values (those of volunteers) at the end of the week. Albumin supplementation did not influence the amount or distribution of the excess fluid.Conclusion: Body water increases after a burn. Excess water is mainly deposited in the extracellular space. Tissue oedema fluid is not mobilised by albumin supplementation.
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| 3. |
- Zdolsek, Hans Joachim, 1960-, et al.
(författare)
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The effect of hypermetabolism induced by burn trauma on the ethanol-oxidizing capacity of the liver
- 1999
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Ingår i: Critical Care Medicine. - 0090-3493 .- 1530-0293. ; 27:12, s. 2622-2625
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To study the rate of elimination of ethanol after a major burn trauma.Design: Prospective, controlled study.Setting: National burns unit in a Swedish university hospital.Patients and Subjects: Eight consecutive patients suffering from 18%-72% total burned surface area and nine healthy male control subjects.Interventions: The patients received ethanol, 0.35-0.60 g/kg body weight intravenously, during 1 hr. This was repeated daily during the first week postburn. The control subjects received the same amount of ethanol once.Measurements and Main Results: Blood samples were drawn at 20- to 30-min intervals during 5 hrs after the start of the infusion. Serum ethanol was determined by headspace gas chromatography. The rate of elimination of ethanol was calculated from the concentration time profile. In the control subjects, the median elimination rate was 0.074 g/kg/hr (range, 0.059-0.083 g/kg/hr). In the patients, it was already 0.138 g/kg/hr (range, 0.111-0.201 g/kg/hr) on the first day; this increased even further over the following 6 days, reaching 0.183 g/kg/hr (range, 0.150-0.218 g/kg/hr) on the seventh day.Conclusions: Ethanol elimination is augmented postburn. A more effective reoxidation of reduced nicotinamide adenine dinucleotide seems the most likely explanation for the increased rate of ethanol elimination in these hypermetabolic trauma patients. This finding suggests that the oxidative capacity of the liver may be assessed by studying the rate of ethanol elimination in burn victims.
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| 4. |
- Zdolsek, Joachim, 1960-, et al.
(författare)
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Resuscitation of the severely burned patient
- 2002
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Ingår i: International Journal of Intensive Care. - London, UK : Greycoat Publishing Ltd.. - 1350-2794. ; 8, s. 225-231
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Tidskriftsartikel (refereegranskat)
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| 5. |
- Zdolsek, Joachim, 1960-, et al.
(författare)
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Volume replacement/Joachim Boldt.
- 2004
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Ingår i: Volume replacement. - Germany : UNI-MED Verlag AG. - 9783895997211 ; , s. -116
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Bokkapitel (övrigt vetenskapligt/konstnärligt)abstract
- "This book is not another attempt to create a ""cook book"" on volume replacement of fluid substitution. This book, in contrast, summarizes the up-to-date-knowledge of this topic presented by experts from a wide range of disciplines. Everybody caring for the critically ill will profit from the different chapters at different levels - nurses, students, residents, consultants, and even experts on volume therapy
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| 6. |
- Zdolsek, Joachim, 1960-
(författare)
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Water physiology in burn victims
- 2000
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Patients who sustain a burn injury of more than 20 - 30 % TBSA will, if untreated, develop burn shock within a couple of hours. Flcid is lost fi·om the vascular compartment due to suction from the interstitium of the wound and due to a generalised increase in vascular permeability. To prevent bum shock intravenous fluids are given during the first two days after a bum in order to ensure adequate organ perfusion. Although organ perfusion will be improved when blood volume is restored, the fluid provided will add to the continuing leak into the tissues. With fluid treatment the patient survives the acute stage, but the resulting oedema interferes with the healing of the burn wound and partially damaged skin may be further compromised.To describe, follow and understand the development of the general oedema in burn injured patients we used four different techniques. Ethanol dilution was used for measurement of total body water (TBW), iohexol dilution in order to estimate extracellular volume (ECV), bioimpedance analysis (BIA) to register TBW as well as electrical membrane properties and the impression method (IM) for the measurement of visco-elastic properties in non-burned tissues. In order to further examine the non-invasive techniques (BIA and IM) these were used in patients subjected to haemodialysis.The excess fluid was found to be accumulated in the extracellular space. Interesting alterations in the visco-clastic properties of the skin and cellular electrical membrane properties could also be detected. These alterations were not related to the actual tluid volume in the tissues. Instead, they were related to changes in the fluid equilibrium of the tissues. Still, one week postbum an excess of tissue fluid, altered cellular electrical membrane properties and changed visco-elastic properties of the skin remained.Albumin supplementation did not influence the amount or distribution of the excess tissue fluid, measured with dilution techniques.
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