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- Glas, Gerie J., et al.
(författare)
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Ventilation practices in burn patients-an international prospective observational cohort study
- 2021
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Ingår i: BURNS & TRAUMA. - : Oxford University Press. - 2321-3868 .- 2321-3876. ; 9
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Tidskriftsartikel (refereegranskat)abstract
- Background: It is unknown whether lung-protective ventilation is applied in burn patients and whether they benefit from it. This study aimed to determine ventilation practices in burn intensive care units (ICUs) and investigate the association between lung-protective ventilation and the number of ventilator-free days and alive at day 28 (VFD-28). Methods: This is an international prospective observational cohort study including adult burn patients requiring mechanical ventilation. Low tidal volume (V-T) was defined as V-T <= 8 mL/kg predicted body weight (PBW). Levels of positive end-expiratory pressure (PEEP) and maximum airway pressures were collected. The association between V-T and VFD-28 was analyzed using a competing risk model. Ventilation settings were presented for all patients, focusing on the first day of ventilation. We also compared ventilation settings between patients with and without inhalation trauma. Results: A total of 160 patients from 28 ICUs in 16 countries were included. Low V-T was used in 74% of patients, median V-T size was 7.3 [interquartile range (IQR) 6.2-8.3] mL/kg PBW and did not differ between patients with and without inhalation trauma (p= 0.58). Median VFD-28 was 17 (IQR 0-26), without a difference between ventilation with low or high V-T (p= 0.98). All patients were ventilated with PEEP levels >= 5 cmH(2)O; 80% of patients had maximum airway pressures <30 cmH(2)O. Conclusion: In this international cohort study we found that lung-protective ventilation is used in the majority of burn patients, irrespective of the presence of inhalation trauma. Use of low V-T was not associated with a reduction in VFD-28.
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| 2. |
- Shahin, Hady, et al.
(författare)
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Vascularization is the next challenge for skin tissue engineering as a solution for burn management
- 2020
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Ingår i: Burns & trauma. - : Oxford University Press. - 2321-3868 .- 2321-3876. ; 8
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Forskningsöversikt (refereegranskat)abstract
- Skin regeneration represents a promising line of management for patients with skin loss, including burn victims. The current approach of spraying single cells over the defective areas results in variable success rates in different centers. The modern approach is to synthesize a multilayer skin construct that is based on autologous stem cells. One of the main complications with different types of transplants is sloughing due to the absence of proper vascularization. Ensuring proper vascularization will be crucial for the integration of skin constructs with the surrounding tissues. Combination of the right cells with scaffolds of proper physico-chemical properties, vascularization can be markedly enhanced. The material effect, pore size and adsorption of certain proteins, as well as the application of appropriate growth factors, such as vascular endothelial growth factors, can have an additive effect. A selection of the most effective protocols is discussed in this review.
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| 3. |
- Pompermaier, Laura, 1975-, et al.
(författare)
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Are there any differences in the provided burn care between men and women? A retrospective study
- 2018
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Ingår i: Burns & Trauma. - : BioMed Central. - 2321-3876. ; 6
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundDisparity between medical treatment for men and women has been recorded worldwide. However, it is difficult to find out if the disparities in both the use of resources and outcome depend entirely on sex-related discrimination. Our aim was to investigate if there are differences in burn treatments between the sexes.MethodsAll patients admitted with burns to Linköping University Hospital during the 16-year period 2000–2015 were included. Interventions were prospectively recorded using the validated Burn SCoring system (BSC). Data were analysed using a multivariable panel regression model adjusted for age, percentage total body surface area (%TBSA), and in-hospital mortality.ResultsA total of 1363 patients were included, who generated a total of 22,301 daily recordings while they were inpatients. Males were 70% (930/1363). Sex was not an independent factor for daily scores after adjustment for age, %TBSA, and mortality in hospital (model R2=0.60, p < 0.001).ConclusionWe found no evidence of inequity between the sexes in treatments given in our burn centre when we had adjusted for size of burn, age, and mortality. BSC seems to be an appropriate model in which to evaluate sex-related differences in the delivery of treatments.
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| 4. |
- Ydenius, Viktor, et al.
(författare)
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Impact of hospital type on risk-adjusted, traffic-related 30-day mortality : a population-based registry study
- 2021
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Ingår i: Burns & Trauma. - : Oxford University Press. - 2321-3876. ; 9
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Tidskriftsartikel (refereegranskat)abstract
- Background: Traffic incidents are still a major contributor to hospital admissions and trauma-relatedmortality. The aim of this nationwide study was to examine risk-adjusted traffic injury mortality todetermine whether hospital type was an independent survival factor.Methods: Data on all patients admitted to Swedish hospitals with traffic-related injuries, basedon International Classification of Diseases codes, between 2001 and 2011 were extracted fromthe Swedish inpatient and cause of death registries. Using the binary outcome measure of deathor survival, data were analysed using logistic regression, adjusting for age, sex, comorbidity,severity of injury and hospital type. The severity of injury was established using the InternationalClassification of Diseases Injury Severity Score (ICISS).Results: The final study population consisted of 152,693 hospital admissions. Young individuals(0–25 years of age) were overrepresented, accounting for 41% of traffic-related injuries. Menwere overrepresented in all age categories. Fatalities at university hospitals had the lowest mean(SD) ICISS 0.68 (0.19). Regional and county hospitals had mean ICISS 0.75 (0.15) and 0.77 (0.15),respectively, for fatal traffic incidents. The crude overall mortality in the study population was 1193,with a mean ICISS 0.72 (0.17). Fatalities at university hospitals had the lowest mean ICISS 0.68(0.19). Regional and county hospitals had mean ICISS 0.75 (0.15) and 0.77 (0.15), respectively, forfatal traffic incidents. When regional and county hospitals were merged into one group and itsrisk-adjusted mortality compared with university hospitals, no significant difference was found. Acomparison between hospital groups with the most severely injured patients (ICISS ≤0.85) also didnot show a significant difference (odds ratio, 1.13; 95% confidence interval, 0.97–1.32).Conclusions: This study shows that, in Sweden, the type of hospital does not influence risk adjustedtraffic related mortality, where the most severely injured patients are transported to the universityhospitals and centralization of treatment is common.
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