Intensive insulin therapy, insulin sensitisers and insulin secretagogues for burns: A systematic review of effectiveness and safety.

This systematic review investigated the effectiveness and safety of intensive insulin therapy (IIT), insulin secretagogues and sensitisers in burn patients. PubMed, Embase, clinicaltrials.gov and Cochrane central were searched from 1990 to 2016. Title/abstract screening, full-text review, critical appraisal and data extraction were carried out by two independent reviewers. Inclusion criteria were hospitalised burn patients, IIT, insulin sensitisers or secretagogues and the outcomes mortality, length of stay, resting energy expenditure, blood glucose, catabolism, or complications. We identified 594 potential studies of which 13 were included. Five studies investigated IIT in paediatric patients, 3 investigated IIT in adults and 5 investigated sensitisers or secretagogues. Glycaemic targets differed with age group - paediatric studies compared IIT to loose glycaemic control while adult studies compared IIT to more moderate control. Meta-analyses were limited by differences in outcome reporting, however mortality was increased in children by loose glycaemic control (OR=3.78, 95%CI 1.19-12.02) but not significantly affected in adults by moderate compared to tight control. Meta-analyses could not be performed for sensitisers or secretagogues. These findings support recommendations that moderate insulin administration (130-150mg/dL) is the prudent approach in burn patients. The evidence is relatively sparse and further research is warranted.

Face care amongst patients admitted to the Adult Burn Service: a best practice implementation project.

BACKGROUND: Burn injuries to the face and neck are very common. Once vital structures such as the mouth, ears, nose and eyes are damaged by burn injury, there will be pain, swelling, deformity and the potential for contractures to develop. This can lead to a lifetime of physical and psychological issues. It is very important to deliver evidence-based recommended practice in order to achieve the best outcome as these structures heal. OBJECTIVES: The aim of this project was to ensure the compliance of face care procedures with JBI evidence-based recommended practice. METHODS: This evidence implementation project employed the Joanna Briggs Institute Practical Application of Clinical Evidence System, and Getting Research into Practice audit and feedback tools. Design and implementation of strategies to improve practice involved identification of barriers and outlining strategies to overcome barriers, resources utilized and outcomes of this process. This project retrospectively surveyed the case notes of ten patients who sustained facial burns, based on both baseline and follow-up audits. RESULTS: Compliance with best practice audit criteria in the baseline audit was moderate to high (70-100%) in four out of 10 criteria. These criteria reflect appropriate administration of analgesia prior to wound care, attendance at education sessions on facial burns, ophthalmic testing being performed, assessment for inhalation injuries and mouth care. Poor compliance rates (10-40%) were seen in the criteria representing nasal care, explanation of the procedure to the client and eye and ear care. Documentation for these criteria was almost non-existent resulting in the outcome of poor compliance. Education sessions were held across both the Adult Burn Service and Intensive Care Unit settings with particular emphasis on the importance of complete documentation. The results of the follow-up audit showed significant improvement (67-100% compliance) in documentation for the performed procedures. CONCLUSIONS: The aims of the project were partially achieved. Future plans to undertake another project and look into the compliance rate of face care procedures with the face care protocol across both Adult Burn Service and Intensive Care Units have been discussed with current stakeholders. This will involve auditing a further ten cases of actual face care procedures performed by nursing staff in both settings.