Evaluating pressure redistribution surfaces for the occiput.

OBJECTIVE: Patients hospitalised in the Burn Intensive Care Unit are at increased risk of pressure ulcers (PU; also known as pressure injuries). While effective methods exist to offload pressure from other areas, offloading the head is difficult, especially with facial or head burns. An increase in occipital PUs prompted a review of practices for offloading the head in the Burn Intensive Care Unit. METHOD: A multidisciplinary team (MDT) of physicians, occupational therapists and nurses evaluated several devices used to prevent occipital PUs using a pressure mapping device. Pressure was measured using the SensorEdge Measure X device. The pressure mapping device provides a real-time graphic representation of pressure to the body area studied, in this case the occiput. In addition, the SensorEdge allows for numeric data to be exported to Excel format. RESULTS: Our data showed that the occipital pressure was observed in our health volunteer using a fluidised gel positioner using pressure mapping. As a result of this we stopped using other pillows and went to exclusive use of the fluidised gel positioner. Reimplementation and consistent use of a fluidised gel positioner resulted in decreasing occipital PUs from nine to zero. CONCLUSION: The use of a fluidised gel positioner should be considered in other critical care environments to reduce the prevalence of hospital acquired occipital PUs.

Goniometric Measurement of Burn Scar Contracture: A Paradigm Shift Challenging the Standard.

Standard goniometry is the most commonly used method of assessing the range of motion (ROM) in patients with burn scar contracture. However, standard goniometry was founded on arthrokinematic principles and doesn't consider the cutaneous biomechanical influence between adjacent joint positions and skin pliability to accommodate motion. Therefore, the use of standard goniometry to measure burn scar contracture is called into question. This prospective, multicenter, comparative study investigated the difference between standard goniometry, based on arthrokinematics and a revised goniometry protocol, based on principles of cutaneokinematics and functional positions to measure ROM outcome in burn survivors. Data were collected for 174 joints from 66 subjects at seven burn centers totaling 1044 measurements for comparison. ROM findings using the revised protocol demonstrated significantly more limitation in motion 38.8 ± 15.2% than the standard protocol 32.1 ± 13.4% (p < .0001). Individual analyses of the motions likewise showed significantly more limitation with revised goniometry compared with standard goniometry for 9/11 joint motions. Pearson's correlation showed a significant positive correlation between the percentage of cutaneous functional units scarred and ROM outcome for the revised protocol (R2 = .05, p = .0008) and the Δ between the revised and standard protocols (R2 = .04, p = .0025) but no correlation was found with the standard goniometric protocol (R2 = .015, p = .065). The results of this study support the hypothesis that standard goniometry underestimates the ROM impairment for individuals whose motion is limited by burn scars. Having measurement methods that consider the unique characteristics of skin impairment and the impact on functional positions is an important priority for both clinical reporting and future research in burn rehabilitation.

Cody.

Advances in burn management over the past 2 decades have resulted in improved survival and reduced morbidity. The treatment of a single patient following a 90% total body surface area injury illustrates the intensity of labour and coordinated hospital care required for such catastrophically injured patients. Data were extracted from the medical records and from personal recollections of the individual members of the multidisciplinary team as well as from the patient. The clinical course and management of complications are described chronologically as a series of overlapping phases from admission to discharge.

Burn rehabilitation and research: proceedings of a consensus summit.

Burn rehabilitation is an essential component of successful patient care. In May 2008, a group of burn rehabilitation clinicians met to discuss the status and future needs of burn rehabilitation. Fifteen topic areas pertinent to clinical burn rehabilitation were addressed. Consensus positions and suggested future research directions regarding the physical aspects of burn rehabilitation are shared.

Augmented exercise in the treatment of deconditioning from major burn injury.

OBJECTIVE: To investigate the efficacy of a 12-week exercise program in producing greater improvement in aerobic capacity in adult burn survivors, relative to usual care. DESIGN: Randomized, controlled, double-blinded trial. SETTING: Burn center. PARTICIPANTS: A population-based sample of 35 adult patients admitted to a burn center for treatment of a serious burn injury. INTERVENTION: A 12-week, 36-session, aerobic treadmill exercise program where work to quota (WTQ) participants intensified their exercise according to preset quotas and work to tolerance (WTT) participants continued to their tolerance. Participants completed a maximal stress test at baseline and 12 weeks to measure physical fitness. MAIN OUTCOME MEASURE: Maximal aerobic capacity. RESULTS: The WTT and the WTQ exercise groups both made significant improvements in aerobic capacity from baseline to 12 weeks (t=-3.60, P< or =.01; t=-3.17, P< or =.01, respectively). The control group did not (t=-1.39, P=.19). WTT and WTQ participants demonstrated significantly greater improvements in aerobic capacity in comparison to the control group members (F=4.6, P< or =.05). The WTT and WTQ groups did not differ significantly from each other with regard to their respective improvements in aerobic capacity (F=.014, P=.907). CONCLUSIONS: The aerobic capacity of adult burn survivors can be improved with participation in a structured, 12-week exercise program after injury.

Inhaled nitric oxide in infants and children.

NO has been used successfully to treat PPHN, reducing the need for ECMO. NO has also been used in the cardiac catheterization laboratory to determine if pulmonary hypertension will decrease with NO. Patients who do not respond to NO are at higher risk after open-heart surgery, because their pulmonary hypertension will be difficult to treat. Postoperatively, NO can be used to determine if pulmonary hypertension is caused by vasoconstriction or by an obstruction. Inhaled Nitric Oxide at a Glance: ACTION: Selective pulmonary vasodilation without systemic vasodilation. USE: Treatment of pulmonary hypertension. CONCENTRATION AND ROUTE: Lowest concentration that will produce pulmonary vasodilation and improved oxygenation. Concentration should be kept < 80 ppm. CONTRAINDICATION: Neonate that is ductal-dependent. TOXIC EFFECTS: Keep methemoglobin level < 5%. Keep nitric dioxide, which can cause lung damage, < 7 ppm. Risk of bleeding. MONITOR: Levels of NO/NO2. Platelets. Arterial blood gas (ABG). Methemoglobin. WEANING: Decrease NO by 20%, monitoring ABG at 3- to 4-hour intervals. If there is a decrease in oxygenation, increase NO. Increase FIO2 20% when NO is discontinued. Unsuccessful treatment with NO--keep on NO until ECMO is available.