Propranolol attenuates hemorrhage and accelerates wound healing in severely burned adults.

INTRODUCTION: Propranolol, a nonselective ß-blocker, exerts an indirect effect on the vasculature by leaving α-adrenergic receptors unopposed, resulting in peripheral vasoconstriction. We have previously shown that propranolol diminishes peripheral blood following burn injury by increasing vascular resistance. The purpose of this study was to investigate whether wound healing and perioperative hemodynamics are affected by propranolol administration in severely burned adults. METHODS: Sixty-nine adult patients with burns covering ≥ 30% of the total body surface area (TBSA) were enrolled in this IRB-approved study. Patients received standard burn care with (n = 35) or without (control, n = 34) propranolol. Propranolol was administered within 48 hours of burns and given throughout hospital discharge to decrease heart rate by approximately 20% from admission levels. Wound healing was determined by comparing the time between grafting procedures. Blood loss was determined by comparing pre- and postoperative hematocrit while factoring in operative graft area. Data were collected between first admission and first discharge. RESULTS: Demographics, burn size, and mortality were comparable in the control and propranolol groups. Patients in the propranolol group received an average propranolol dose of 3.3 ± 3.0 mg/kg/day. Daily average heart rate over the first 30 days was significantly lower in the propranolol group (P < 0.05). The average number of days between skin grafting procedures was also lower in propranolol patients (10 ± 5 days) than in control patients (17 ± 12 days; P = 0.02), indicative of a faster donor site healing time in the propranolol group. Packed red blood cell infusion was similar between groups (control 5.3 ± 5.4 units vs. propranolol 4.4 ± 3.1 units, P = 0.89). Propranolol was associated with a 5 to 7% improvement in perioperative hematocrit during grafting procedures of 4,000 to 16,000 cm(2) compared to control (P = 0.002). CONCLUSIONS: Administration of propranolol during the acute hospitalization period diminishes blood loss during skin grafting procedures and markedly improves wound healing in severely burned adults. As burn patients require serial surgical interventions for motor and cosmetic repair, restricting blood loss during operative intervention is optimal.

Rising to the challenge: transforming an adult ICU into an adult and pediatric ICU.

Published literature on natural disasters describes lessons learned in preparing for disasters, evacuating patients, and caring for patients in the immediate aftermath. Some disasters, however, require longer-term solutions to best meet the health needs of the community during the recovery from the disaster. This article presents an account of one academic medical center's experience in transforming an existing adult burn intensive care unit into an adult and pediatric burn intensive care unit to meet the needs of a community following a hurricane. The process of training 2 groups of specialty nurses and the success of expanding an adult unit are described.

Efforts to catalogue non-governmental organizations with a role in global burn relief.

INTRODUCTION: Non-governmental organizations (NGOs) have been instrumental in the treatment of traumatic injuries, including burns, particularly in low- and middle-income counties. The purpose of this project was to catalogue burn injury related NGO activities, describe coordinated efforts, and provide insight to burn health care professionals seeking volunteer opportunities. METHODS: Eligible burn NGOs were identified through internet searches, literature reviews, and social media. The organizations' websites were reviewed for eligibility and contact was attempted to confirm details. Global health organizations, including the World Health Organization, were consulted for their viewpoints. RESULTS: We identified 27 unique NGOs working in the area of burn care in African countries, all with differing missions, capacities, recruitment methods, and ability to respond to disaster. We also describe 14 global NGOs, some of which accept volunteers. Some NGOs were local, while others were headquartered in western countries. CONCLUSIONS: To our knowledge, this is the first effort towards the establishment of a Burn-NGO catalogue. Challenges included: frequent shifts in geographical regions supported, lack of collaboration among organizations, availability of public information, and austere environments. We invite collaborators to assist in the creation of a comprehensive, interactive and complete catalogue.

Development of the Pan African burn services directory.

BACKGROUND: International burn societies in many parts of the world have created electronic registries of burn centers in their region. No such directory exists for the continent of Africa. OBJECTIVE: To create the first electronic directory of burn care providers in Africa. METHODOLOGY: Emails were sent out to attendees of the Pan African Burn Congress and members of the Pan African Burn Society (PABS) asking if they would like to participate in the directory. Basic information about each burn site were obtained from respondents and compiled into the directory. An online interactive map was created and made available to the public. RESULTS: 40 burn sites were identified across 14 different countries. The majority of burn sites are located in only 5 countries. The most common language spoken is English, followed by French, Amharic, and Afrikaans. CONCLUSION: This is the first known online directory of burn sites in Africa. Significant challenges exist identifying burn care providers in large portions of the continent.