The use of propranolol in adult burn patients: Safety and outcome influence.

OBJECTIVES: This study investigated safety and effect of propranolol on adult patients with severe burn. METHODS: A prospective study was conducted on 124 severely adult burn patients who were randomly divided into propranolol and non-propranolol group. Propranolol was given by nasogastric tube to achieve the target of lowering 15-20% of initial heart rate. RESULTS: Average dose of propranolol was 1.9 ± 0.5 mg/kg/day ranging from 0.9 to 3.3 mg/kg/day and was not affected by burn extent and inhalation injury. Mean heart rate reduced by 21.2% during the 28 day period. Recorded adverse events included hypotension (11.9%), bradycardia (1.6%), hypoglycemia (17.7%) and total number of held events was 8 occurring in 7 (11.3%) patients. Serum levels of glucose, total protein, albumin, cholesterol and triglyceride at different times were not significantly different between the two groups. Significantly lower resting energy expenditure on the 7th and 14th day were seen in propranolol group (p < 0.05). After 3 weeks, liver size in the propranolol group did not change significantly from admission, while in the non-propranolol group, liver size increased significantly (p < 0.05). The complete healing time of partial-thickness burns and donor sites were significantly shorter in propranolol group (p < 0.01). Duration of ventilation, length of stay in intensive care unit and in hospital, number of operations, rate of multiple organ failure, and death were not different between the two groups (p > 0.05). CONCLUSION: For severely burned adults, propranolol was safe and effective on reducing energy expenditure, limited hepatomegaly, and accelerated partial burn wound and donor site closure, but does not affect length of stay in ICU, hospitalization, complication ormortality rate.

Species Distribution and Antifungal Susceptibility Pattern of Candida Recovered from Intensive Care Unit Patients, Vietnam National Hospital of Burn (2017-2019).

INTRODUCTION: Candida species is the most common cause of invasive fungal infection. With the wide variation in species distribution and antifungal susceptibility of causative agents, local epidemiological profiles are needed to provide effective guidelines for the treatment of invasive candidiasis. OBJECTIVE: To find out the species distribution and antifungal susceptibilities of Candida strains isolated from patients in an intensive care unit (ICU) of Vietnam. METHODS: All patients in ICU of Vietnam National Hospital of Burn with Candida isolation reported from January 2017 to December 2019 were retrospectively studied. Species identification and antifungal susceptibility testing were performed using VITEK 2 Compact. The identification was reconfirmed by sequencing of the internal transcribed spacer regions when needed. RESULTS: A total of 186 yeasts belonging to ten species were collected. The most common agent was C. tropicalis (45.7%), followed by C. albicans (42.4%), and C. parapsilosis (7.53%). The isolated yeasts showed less susceptibility to fluconazole (resistant rate R 10.7%) than to micafungin, caspofungin, flucytosine and amphotericin B (R 0%, 0.6%, 2.3% and 3.4%, respectively, p < 0.05). C. albicans isolates were more susceptible to fluconazole (R 5.2%) than C. tropicalis (R 15.7%). Resistance to voriconazole was seen only among C. albicans (3.9%) and C. tropicalis isolates (9.9%). CONCLUSION: Non-albicans species (especially C. tropicalis) is the predominant species, and there is a significant proportion of isolates with reduced susceptibility to azole but not to echinocandin.

A Rare Case of Fungal Burn Wound Infection Caused by Fusarium solani in Vietnam.

A patient with extensive burn injuries was admitted to the National Hospital of Burns in Hanoi, Vietnam, and diagnosed with fungal wound infection by histological examination of skin biopsy samples. Fusarium solani was isolated and identified by analysis of its morphological features and the sequence of the internal transcribed spacer region. The isolation showed in vitro resistant to fluconazole, voriconazole, itraconazole, amphotericin B, and caspofungin. Invasive fusariosis is difficult to treat due to its angioinvasive property and its lacking amenability to treatment with antifungal drugs. This infection is rare and has not been reported so far in Vietnam.

Influence of pre-existing medical condition and predicting value of modified Elixhauser comorbidity index on outcome of burn patients.

OBJECTIVES: To evaluate the impact of comorbidity and predicting value of the modified Elixhauser comorbidity index score on the outcome of burn patients. METHODS: A retrospective study was conducted on 5480 patients admitted during 24 h after burn to the National Burn Hospital from 1/1/2016 to 31/12/2018. Demographic data and pre-existing medical conditions were collected. Modified Elixhauser comorbidity index (ECI) score developed by Walravel et al. was calculated for each patient. The score was the weighted sum of comorbid conditions. Outcomes measured included hospitalization, complication and mortality. RESULTS: Among 5480 patients, 345(6.3%) had at least one pre-existing medical condition. Most common comorbidities were neurological disorder, diabetes, hypertension and psychoses. Pre-existing medical conditions were more common in elderly (25% vs. 4.8%; p < .001) and female (7.5% vs. 5.8%; p < .05). Moreover, significantly larger burn extent, higher rate of inhalation injury (p < .01) and complication (12.8% vs. 6.1%; p < .001), longer time of hospitalization (21.4 vs. 17.1 days; p < .001) were recorded in comorbidity group. It is noted that higher ECI score was remarkably higher in patients who developed complication (.6 vs. .3 respectively, p < .05) and death (.5 vs. .3; p < .05). Multivariate analysis indicated that apart from presence of inhalation injury, increased burn extent, full thickness burn area, ECI score was an independently predicted factor for prolonging the time of staying, for the development of complication and death. Each score of ECI results in increased probability unit of complication to .13 and probability unit of death to .11. CONCLUSION: Pre-existing medical conditions lead to more severe and worse outcomes among burn patients. Modified Elixhauser comorbidity index score should be used as a prognosis factor for outcomes of burn patients.

Impact of "opening the lung" ventilatory strategy on burn patients with acute respiratory distress syndrome.

OBJECTIVE: The objective of this study was to investigate the feasibility and influence of opening the lung strategy ventilation on burned patients complicated with ARDS. METHODS: A prospective study was carried out in 66 moderate to severe burned patients also presented with ARDS who were randomly divided into the control group (ventilated as ARDS net) and the study group (ventilated with open lung strategy). All patients were ventilated with volume control mode until weaning. RESULTS: Opening the lung procedure was safe in all patients with optimal PEEP of 14.8 ± 1.8 cmH2O. After 24 h of lung recruitment and PEEP titration, oxygenation significantly improved (PaO2/FiO2 ratio increased from 119.8 ± 7.4 to 263.4 ± 11.6; p < 0.01). Along the time, the absolute values of static compliances in the study group were significantly higher (33.9 ± 0.9 vs. 26.3 ± 0.6 at 1st day; 48.4 ± 1.5 vs. 35.7 ± 0.8 at 3rd day; 48.2 ± 1.5 vs. 42.6 ± 1 at 5th day and 53.2 ± 1.8 vs. 45.3 ± 2.3 at 7th day). In addition, within the first 5 days of ventilation, PaO2/FiO2 ratio significantly increased in both groups (p < 0.05) but a faster rate was recorded in the study group (176.2 ± 11.9 vs. 152.1 ± 7.5 at 1st day; 284.2 ± 16.7 vs. 210.8 ± 15.3 at 3rd day and 302.2 ± 21 vs. 233.7 ± 22.4 at 5th day, p < 0.05). Number of ventilator-free days during the first 28-days after burn injury was significantly higher in the study group (12.9 ± 5.7 vs. 9.5 ± 5.9 days; p < 0.05). Ventilation time, lengths of stay in the ICU and hospital length of stay were not significantly different across both groups (p > 0.05). In addition, duration time from ADRS onset to death and from admission to death were also remarkably longer in the study group (p < 0.05). Mortality rate was significant lower in the study group (24.2% vs. 63.6%; p < 0.01) within 7 days since onset of ARDS, but not significantly different after two weeks as well as at the 28th day after burns injury. Overall mortality rate was also not significant difference between two groups. CONCLUSION: It is necessary to conduct further trials to find out the effectiveness of this ventilation strategy on burns injury induced ARDS.

Early enteral feeding for burned patients--an effective method which should be encouraged in developing countries.

A randomized control trial was conducted to investigate impact of early enteral feeding on immune, metabolic aspects and outcomes of 82 severe burned patients admitting to National Institute of Burns, Hanoi, Vietnam from November 2003 to November 2004. Fourty-one patients were in early enteral group and 41 patients were in total parenteral nutrition group. Blood samples were collected at admission and 7th day postburn to determine plasma level of IgG, IgM, insulin, corrtisol and blood absolute number of TCD4, TCD8. Intestinal chyme was drawn through a weighted feeding tube to determine intestinal secreted IgA. Results showed that, at the 7th day after burn, both humoral and cellular immunology recovered faster in enteral nutrition group as compared to total parenteral group (p<0.05). In the early enteral nutrition group, after 1 week, plasma concentration of cortisol decreased from 599.70 to 437nmol/l and that of insulin increased from 12.07 to 30.34micromol/ml. Vice versa, in the control group the change was in the reverse direction (p<0.01). Overall complication decreased in the enteral nutrition group in comparison with parenteral group. Finally, mortality was significantly lower in early enteral nutrition group as compared to the parenteral group (14.65% and 36.58%, respectively). In conclusion, early enteral nutrition after burn has positive effects on immune and metabolic function, and reduces complication as well as death rate.

First aid and initial management for childhood burns in Vietnam--an appeal for public and continuing medical education.

A prospective study to investigate first aid and initial management for 247 paediatric burn patients from 1 June, 2004 to 31 June, 2006 at the Burn Intensive Care Unit, National Institute of Burns (NIB), Hanoi. Data were collected from documents from referring hospitals and direct interview of patients, relative and transport team as guided by the International Society for Burn Injury (ISBI) and the World Health Organization (WHO). Results showed that cooling the burn surface by cold water was applied in 27.17%. Among 132 patients transferred from other hospitals, fluid resuscitation was given in 102 patients (77.28%) before transferring and over a half of these patients were not given intravenous fluid during the time of transfer, especially for children under 1 year of age (p<0.05). Dressings were applied in 36.36% of transferred patients. Burn surface area was accurately diagnosed in only 21.90% of total cases. In conclusion, first aid and initial management in Vietnam are still far from ideal. Further public education and continuing medical education should be applied in Vietnam.