Associationbetween hyperoxia and mortality in severely burned patients.

INTRODUCTION: The use of oxygen is a key component of acute burn resuscitation, particularly when there is concern for carbon monoxide toxicity or inhalation injury. Prior studies of critically-ill patients have shown an association between early hyperoxia and increased mortality. There are no studies to date evaluating outcomes related to excessive oxygen administration in burn patients. METHODS: We conducted a retrospective analysis of 219 severely burned patients to quantify the average amount of oxygen given during initial resuscitation, the level of carbon monoxide exposure, and to determine if early exposure to supratherapeutic oxygen was associated with increased hospital mortality or ventilator-associated pneumonia (VAP). The models were adjusted for inhalation injury and total body surface area (TBSA) burned. RESULTS: Early hyperoxia in severely burn patients is common and possibly associated with increased overall mortality, although the results were inconclusive and after adjusting for burn-specific scoring systems, we found a negative correlation between hyperoxia and mortality. Confirmed carbon monoxide poisoning was relatively uncommon, but also associated with increased mortality. Patients with elevated carboxyhemoglobin did not receive more oxygen compared to others within the cohort. CONCLUSIONS: Burn patients are exposed to higher concentrations of pure oxygen compared to other critically-ill patients, presumably for empiric treatment of carbon monoxide poisoning. Our data showed a liberal use of oxygen therapy across all patients. Considering the potentially negative effects of hyperoxia, this study exposes either a gap in clinical research or need for clearer indications.

Randomized Comparison of Hypochlorous Acid With 5% Sulfamylon Solution as Topical Therapy Following Skin Grafting.

Objective: Infections are a serious complication of thermal injury. Excision and grafting have led to a decrease in incidence, but to ensure successful skin grafting, antimicrobial irrigants are frequently utilized to prevent infection. A safe, efficacious, and cost-effective irrigant capable of preventing infections would be a valuable adjunctive therapy. The objectives of this study were to determine whether the test article was noninferior to current therapy in controlling infection and reducing postoperative pain in patients with skin graft. Methods: Patients with burns requiring skin grafting were randomized to hypochlorous acid or 5% Sulfamylon solution as topical dressings postoperatively. Inclusion criteria included thermal injury 20% or more total body surface area requiring excision and autografting, and age 18 years or more. Exclusion criteria included pregnant females, chlorine sensitivity, and electrical/chemical/cold injuries. The following outcomes were assessed: patient demographics, graft viability, infection, pain score, narcotic usage, adverse events, and cost. Results: Treatment groups were demographically equivalent. There were no differences in adverse or serious adverse events between the 2 groups. Graft viability and infection rate were equivalent between the 2 groups. In addition, pain scores and narcotic usage were similar. Hypochlorous acid was significantly less expensive than 5% Sulfamylon solution. Conclusions: Hypochlorous acid demonstrated equivalent efficacy and safety compared with 5% Sulfamylon when used as the postoperative topical dressing for skin grafts. Hypochlorous acid was more cost-effective. This pilot study was limited by its small sample size. However, hypochlorous acid shows promise as a topical wound dressing and further study with larger groups is warranted.

Arch dimensional changes in children with idiopathic short stature treated with recombinant growth hormone: a five-year study.

Recombinant human growth hormone (rhGH) increases stature when administered to non-GH-deficient idiopathic short statured children. The aims of this investigation were to determine pretreatment arch dimensions of short statured children (height > or = 2 S.D. below mean for age) and to evaluate their response to rhGH administration by measuring arch-dimensional changes over 5 years of rhGH treatment. Dental casts of 28 short subjects (22 male, 6 female) and of age/gender-matched controls of normal stature were analyzed using a digital imaging system. Four measures of arch width and one of arch depth were calculated for each maxillary and mandibular cast. Subjects receiving orthodontic care were eliminated from the study at the initiation of treatment. Z-scores were calculated to allow for pooling of data. Prior to rhGH treatment, all arch dimensions of the short statured subjects were smaller than the controls, with the exception of mandibular arch depth. Arch dimensions of the rhGH subjects did increase with the continued administration of rhGH. The control group also showed a significant trend for the arch dimensions to increase over time. The influence of rhGH treatment on arch dimensional changes over time remains equivocal based on the results of this investigation.

Topical growth factors and wound contraction in the rat: Part II. Platelet-derived growth factor and wound contraction in normal and steroid-impaired rats.

The wound contraction model described in Part I was used to study topically applied, recombinant platelet-derived growth factor (rPDGF-BB) and wound contraction in normal and steroid-impaired rats. Circular wounds 4 cm in size were made on the dorsum of the rats with halothane anesthesia. Five groups of 20 normal rats each were treated with the vehicle alone and four concentrations of rPDGF-BB (0.5, 1.0, 3.0, and 10.0 micrograms/ml). Four groups of 20 steroid-impaired rats each were treated with the vehicle alone and three concentrations of rPDGF-BB (0.5, 1.0, and 3.0 micrograms/ml). The wounds were dressed with 2 x 2 gauze, Adaptic, 4 x 4 gauze, and Tubigrip. The investigators were blinded to the treatments until the completion of the experiment, and the treatments were applied in random order. Dressings were changed every 2 to 3 days for 14 days and the wound areas were determined, expressed as a fraction of the original, and plotted versus time. The areas under the curves and the means of the fraction open each day were compared between groups using Student's t-test. The treatment with 3.0-micrograms/ml rPDGF-BB accelerated the rate of wound contraction in the steroid-impaired animals (p less than 0.05).

Topical growth factors and wound contraction in the rat: Part I. Literature review and definition of the rat model.

The isolation and production of growth factors and the observation that a platelet extract will promote wound healing in chronic wounds has led to an interest in the study of growth factors and wound healing. We wished to study the effect of platelet-derived growth factor on wound contraction. However, because studies of growth factors and wound contraction are quite recent, we could find only two models described in the literature and neither seemed ideal. Both used small wounds, which are difficult to measure, anesthetics with slow induction and recovery and which are difficult to titrate, and no dressings, which permits the animals to lick the wounds and possibly introduce other growth factors. We therefore reviewed wound contraction models used for other studies. In particular, we reviewed the animal used, anesthetic, wound size and shape, dressing methods, scab treatment, and measurement and comparison techniques. We then combined features of many of them into a model that solves the problems listed and permits the study of topically applied growth factors and wound contraction. The composite model to be described uses a large, circular wound on the rat, halothane anesthesia, and flexible, Tubigrip dressings.