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- Abdelrahman, Islam, 1982-, et al.
(författare)
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Development of delirium : Association with old age, severe burns, and intensive care
- 2020
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Ingår i: Burns. - : Elsevier. - 0305-4179 .- 1879-1409. ; 46:4, s. 797-803
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Tidskriftsartikel (refereegranskat)abstract
- Background Delirium is defined as a disturbance of attention and awareness that develops over a short period of time, is a change from the baseline, and typically fluctuates over time. Burn care involves a high prevalence of known risk factors for delirium such as sedation, inflammation, and prolonged stay in hospital. Our aim was to explore the extent of delirium and the impact of factors associated with it for adult patients who have been admitted to hospital with burns. Methods In this retrospective study, all adult patients who had been admitted with burns during a four-year period were studied, including both those who were treated with intensive care and intermediate care only (no intensive care). Daily records of the assessment of delirium using the Nursing Delirium Screening Scale (Nu-DESC) were analysed together with age, sex, the percentage of total body surface area burned, operations, and numbers of wound care procedures under anaesthesia, concentrations of plasma C-reactive protein, and other clinical variables. Logistic regression was used to analyse factors that were associated with delirium and its effect on mortality, and linear regression was used to analyse its effect on the duration of hospital stay. Results Fifty-one patients (19%) of the total 262 showed signs of delirium (Nu-DESC score of 2 or more) at least once during their stay in hospital. Signs of delirium were recorded in 42/89 patients (47%) who received intensive care, and in 9/173 (5%) who had intermediate care. Independent factors for delirium in the multivariable regression were: age over 74 years; number of operations and wound care procedures under anaesthesia; and the provision of intensive care (area under the curve 0.940, 95% CI 0.899–0.981). Duration of hospital stay, adjusted for age and burn size, was 13.2 (95% CI 7.4–18.9, p < 0.001) days longer in the group who had delirium. We found no independent effects of delirium on mortality. Conclusion We found a strong association between delirium and older age, provision ofr intensive care, and number of interventions under anaesthesia. A further 5% of patients who did not receive intensive care also showed signs of delirium, which is a finding that deserves to be thoroughly investigated in the future.
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| 2. |
- Abdelrahman, Islam, 1982-, et al.
(författare)
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Lidocaine infusion has a 25% opioid-sparing effect on background pain after burns : A prospective, randomised, double-blind, controlled trial
- 2020
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Ingår i: Burns. - : Elsevier. - 0305-4179 .- 1879-1409. ; 46:2, s. 465-471
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundThe pain of a burn mainly results from the inflammatory cascade that is induced by the injured tissue, and is classified as background, breakthrough, procedural and postoperative pain. High doses of opioids are usually needed to treat background pain, so its management includes a combination of types of analgesia to reduce the side effects. Lidocaine given intravenously has been shown in two small, uncontrolled studies to have an appreciable effect on pain after burns.ObjectivesIn this prospective double-blind controlled trial we aimed to examine and quantify the opioid-sparing effect of a continuous infusion of lidocaine for the treatment of background pain during the early period after a burn.MethodsAdult patients injured with burns of >10 total body surface area burned (TBSA%) and treated with a morphine based patient-controlled analgesia device (PCA) were randomised to have either lidocaine infusion starting with a bolus dose (1 mg lidocaine/kg) followed by continuous infusion (180 mg lidocaine/hour) or a placebo infusion, for seven consecutive days. Total daily consumption of opioids (mg) and amount of pain (visual analogue score, VAS) were recorded.ResultsWe included 19 patients, 10 of whom were given a lidocaine infusion. There were no differences between groups in VAS, TBSA%, time of enrolment to the study since the initial burn, or duration of hospital stay. The opioid consumption in the lidocaine group declined by roughly 25% during the period of the study.ConclusionAn intravenous infusion of lidocaine was safe and had an opioid-sparing effect when treating background pain in burns.
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| 3. |
- Abdelrahman, Islam, 1982-, et al.
(författare)
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Needle Fasciotomy or Collagenase Injection in the Treatment of Dupuytren’s Contracture : A Retrospective Study
- 2020
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Ingår i: Plastic and Reconstructive Surgery - Global Open. - : Lippincott Williams & Wilkins. - 2169-7574. ; 8:1
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Forskningsöversikt (refereegranskat)abstract
- Background: Dupuytren’s contracture is common among older people in Sweden. Previous studies comparing the treatment with an injection of collagenase with percutaneous needle fasciotomy found no differences. Methods: We retrospectively compared the degree of improvement in the deficit in extension of the joints in 2 groups of patients who had been treated with collagenase (71 fingers) or needle fasciotomy (109 fingers) before and 1 year after treatment. We compared the improvement of the extension deficit among the metacarpophalangeal (MCP) and proximal interphalangeal joints before and after the intervention; additionally, the level of improvement was classified into 3 levels (mild = 0° to 29°; moderate = 30° to 60°; considerable = 61° and more). Results: The degree of improvement of extension in the MCP joints was 11° greater in the collagenase group (P = 0.001). The number of patients who had an improvement of >60° (considerable) in extension was greater in the collagenase group (P = 0.02). Conclusion: Collagenase was more effective than needle fasciotomy in treating extension deficits of the MCP joints in Dupuytren’s contracture in this retrospective analysis. Further prospective studies are required to confirm the finding.
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| 4. |
- Vieweg, Rosa, et al.
(författare)
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Renin signals renal hypoperfusion during Parkland fluid resuscitation of severe burns - a prospective longitudinal cohort study
- 2020
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Ingår i: International Journal of Burns and Trauma. - Madison, WI, United States : E-Century Publishing Corporation. - 2160-2026. ; 10:6, s. 331-337
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: Previous investigations have shown that fluid resuscitation of burns using the Parkland formula results in controlled hypovolaemia and that kidney injury is a common complication. Enhancing monitoring of tissue perfusion might reduce complications. Plasma renin has recently been suggested to be a promising marker for tissue hypoperfusion in intensive care patients. The aim of this study was to explore plasma renin levels during the first 48 hours after major burns in patients resuscitated using the Parkland formula.MATERIALS AND METHODS: Patients 18 years or older of age with 10% or more total body surface area (TBSA) burned, admitted to Linköping Burn Intensive Care Unit, and resuscitated using the Parkland formula were included. Samples for plasma renin were drawn at admission and eight-hourly thereafter for 48 hours.RESULTS: Fifteen patients were included. Median TBSA burned was 36% and age 53 years. The fluid volumes provided were in accordance with the Parkland formula. Mean arterial pressure, urinary output, and lactate remained within reference ranges during the first 48 hours. At eight hours after burn median plasma renin was elevated to more than 25 times the upper reference value, decreasing to about four times the upper reference at 48 hours. Renin concentration was associated with lactate levels and TBSA burned.CONCLUSION: During Parkland fluid resuscitation of severe burns, plasma renin levels were extremely elevated. The fact that the traditionally used endpoints for Parkland fluid resuscitation remained within the reference range raises concerns about whether the increased renin concentrations may signal a relative renal hypoperfusion.
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| 5. |
- Wyckman, Alexander, et al.
(författare)
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Reconstruction of sternal defects after sternotomy with postoperative osteomyelitis, using a unilateral pectoralis major advancement muscle flap
- 2020
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Ingår i: Scientific Reports. - : Nature Publishing Group. - 2045-2322. ; 10:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The pectoralis major flap, which is usually harvested bilaterally, is considered a workhorse flap in the reconstruction of sternal defects. After a median sternotomy for open heart surgery, 1%-3% of patients develop deep infection and dehiscence of the sternal wound, some of which will eventually require reconstructive surgery. Our aim was to describe the clinical feasibility and associated complications of the unilateral pectoralis major advancement flap in the reconstruction of sternal defects.METHODS: A retrospective analysis of all adult patients who were operated on using a unilateral pectoralis major flap for reconstruction of the chest wall at the Linköping University Hospital during 2008-18 was made using data retrieved from medical records.RESULTS: Forty-three patients had reconstructions with unilateral pectoralis major flaps. Three flaps failed completely, and another 10 patients developed complications that required further operation. The factors that were independently associated with loss of the flaps and complications were: older age, male sex, the number of different antibiotics used, and a long duration of treatment with negative wound pressure. Fewer wound revisions before the reconstruction resulted in more complications. The factors that were independently associated with prolonged time to complete healing were emergency reoperation after the initial operation and complications after reconstruction.CONCLUSION: The unilateral pectoralis major advancement flap has proved to be a useful technique in the reconstruction of most sternal defects after sternal wound infection in older patients. There is, however, need for a follow-up study on a larger number of procedures to evaluate the long-term outcome compared with other methods of sternal reconstruction.
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