A New Bromelain-Enriched Proteolytic Enzymes Concentrate Treatment in Patients With Extensive Burns: Romanian Consensus

Abstract

In the light of the recent studies, enzymatic debridement is associated with an increased safety profile, an enriched capacity for selective debridement of burn injuries, a significant reduction of blood loss during therapy and a marked decrease of the classical surgical excisions needs. In order to evaluate the results, to establish and extend the indications of enzymatic debridement (ED), a national meeting was organized, with experts who have gained significant experience regarding the use of enzymatic debridement during the therapeutic protocol of burned patients. The main objective of the meeting was to establish a national consensus regarding the enzymatic debridement based on the experience gained during the treatment of 342 patients within 7 Romanian health units. The consensus panel included Romanian experts with an extended experience in treating burns. The following parameters were analysed: optimal time for application, the used technique, pain management, and recommended behaviour after debridement, relationship between enzymatic debridement and grafting, analysis of haematological parameters, learning curve and learning technique. This consensus paperwork may attend as initial testimonial for the employment of enzymatic debridement with user-oriented references until forward proof and formal guiding principle are available. RezumatÎn ceea ce privește debridarea enzimatică, studiile recente arată că aceasta se asociază cu un profil crescut de siguranță, o capacitate crescută de debridare selectivă a leziunilor de arsură, o reducere semnificativă a pierderilor sanguine asociate actului terapeutic, precum și o scădere marcată a necesității efectuării exciziilor chirurgicale clasice. Pentru evaluarea rezultatelor, stabilirea și extinderea indicațiilor debridării enzimatice a fost organizată la nivel național o întâlnire cu experți care au acumulat o experiență semnificativă în ceea ce privește utilizarea debridării enzimatice în protocolul terapeutic al pacienților cu arsuri. Obiectivul principal a fost elaborarea unui consens național, pe baza experienței acumulate în timpul efectuării debridării enzimatice în cazul a 342 de pacienți care au beneficiat de tratament în cadrul a 7 unități sanitare din România. În vederea stabilirii conduitei optime în ceea ce privește debridarea enzimatică au fost analizați următorii parametrii: timpul optim de aplicare, tehnica utilizată, managementul durerii, conduita recomandată după debridare, relația dintre debridarea enzimatică și grefare, analizarea parametrilor hematologici, curba și tehnica de învățare. Acest consens poate fi considerat un ghid preliminar pentru utilizarea debridării enzimatice cu recomandări orientate către pacient până când sunt disponibile dovezi suplimentare și ghiduri sistematice.

Enzymatic Debridement of Deep Thermal Burns in the Russian Federation: First Experience

“…In recent years, due to the widespread introduction of minimally invasive technologies, surgical treatment of burns has given way to alternative and less aggressive interventions, in particular enzymatic debridement [ 17 , 18 , 22 , 23 ]. The method of enzymatic debridement using NexoBrid ® was studied elaborately for decades [ 24 ], and since 2012, after initially being approved for use in Europe [ 16 ], it has been gaining acceptance as standard practice in many countries around the world [ 17 , 18 , 25 , 26 , 27 , 28 , 29 ]. Early use of this bromelain-based gel has been reported to result in rapid, selective, efficient, and safe (compared to standard treatment methods) eschar removal without damaging the uninjured dermis.…”

Bromelain‐based enzymatic burn debridement: A systematic review of clinical studies on patient safety, efficacy and long‐term outcomes

“…Since then, approximately 10 000 patients have been successfully treated with NXB for deep thermal burns. European consensus guidelines 39,40 and individual European country guidelines have been published, including Spain, 41,42 Italy, 43 Romania, 44 and Poland 45 . It is currently approved for use in forty‐four countries worldwide, most recently in the United States, 46 and in pre‐approval stages in Australia 47…”

An Up-to-Date on Povidone-Iodine With Focus on Wound Management: Current Available Data and New Approaches

“…One of the most commonly used antiseptics is povidoneiodine (PVI), an iodophor, composed of iodine and a water soluble synthetic polymer called polyvinylpyrrolidone, that acts as a carrier. Within an aqueous solution, the iodine is released from the complex and binds to the cell membrane, and also, affects the electron transport chain [5][6][7]. Although having a broad-spectrum activity and a widely use, PVI in wound management remains disputed and controversial [8].…”