An objective measure for the assessment and management of fluid shifts in acute major burns

Kenworthy, Pippa; Phillips, Michael; Grisbrook, Tiffany L.; Gibson, William; Wood, Fiona; Edgar, Dale W.

doi:10.1186/s41038-017-0105-9

Cited by 6 publications

(6 citation statements)

References 46 publications

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“…The invasive or cost- and time-intensive nature of many of these methods, however, likely hinders their implementation into clinical practice. Other novel and promising methods that have been developed for the use in the ICU setting are bioelectrical impedance and musculoskeletal ultrasound [ 69–71 ]. Both are practical, non-invasive, bedside tools that have shown to be valid and related to a variety of clinical outcomes, such as mortality and morbidity in critically ill adults [ 72–80 ].…”

Section: Discussionmentioning

confidence: 99%

Status of adult inpatient burn rehabilitation in Europe: are we neglecting metabolic outcomes?

et al. 2021

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Background Hypermetabolism, muscle wasting and insulin resistance are challenging yet important rehabilitation targets in the management of burns. In the absence of concrete practice guidelines, however, it remains unclear how these metabolic targets are currently managed. This study aimed to describe the current practice of inpatient rehabilitation across Europe. Methods An electronic survey was distributed by the European Burn Association to burn centres throughout Europe, comprising generic and profession-specific questions directed at therapists, medical doctors and dieticians. Questions concerned exercise prescription, metabolic management and treatment priorities, motivation and knowledge of burn-induced metabolic sequelae. Odds ratios were computed to analyse associations between data derived from the responses of treatment priorities and knowledge of burn-induced metabolic sequelae. Results Fifty-nine clinicians with 12.3 ± 9 years of professional experience in burns, representing 18 out of 91 burn centres (response rate, 19.8%) across eight European countries responded. Resistance and aerobic exercises were only provided by 42% and 38% of therapists to intubated patients, 87% and 65% once out-of-bed mobility was possible and 97% and 83% once patients were able to leave their hospital room, respectively. The assessment of resting energy expenditure by indirect calorimetry, muscle wasting and insulin resistance was carried out by only 40.7%, 15.3% and 7.4% respondents, respectively, with large variability in employed frequency and methods. Not all clinicians changed their care in cases of hypermetabolism (59.3%), muscle wasting (70.4%) or insulin resistance (44.4%), and large variations in management strategies were reported. Significant interdisciplinary variation was present in treatment goal importance ratings, motivation and knowledge of burn-induced metabolic sequelae. The prevention of metabolic sequelae was regarded as the least important treatment goal, while the restoration of functional status was rated as the most important. Knowledge of burn-induced metabolic sequelae was linked to higher importance ratings of metabolic sequelae as a therapy goal (odds ratio, 4.63; 95% CI, 1.50–14.25; p < 0.01). Conclusion This survey reveals considerable non-uniformity around multiple aspects of inpatient rehabilitation across European burn care, including, most notably, a potential neglect of metabolic outcomes. The results contribute to the necessary groundwork to formulate practice guidelines for inpatient burn rehabilitation.

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Section: Discussionmentioning

confidence: 99%

Status of adult inpatient burn rehabilitation in Europe: are we neglecting metabolic outcomes?

et al. 2021

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“…There are a number of instruments that can be utilised to measure the components of the concept of burn care. For example, fluid status can be evaluated by using bioimpedance spectroscopy (BIS) (63). The visual analog and numeric rating scales are helpful to assess pain in patients with burn (64).…”

Section: Define Empirical Referentsmentioning

confidence: 99%

A concept analysis of burn care in nursing

Subrata

2020

Scandinavian Caring Sciences

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A concept analysis of burn care in nursing Background: Burn is a life-threatening injury that requires long-term treatment and concomitant hospital stay. Relevant clinical studies in burns have been accomplished and published in the literature. However, none of these studies reported the concept analysis of burn care in nursing. Therefore, analysing the concept of burn care acts as an imperative strategy to provide comprehensive management of burn injury. Objective: The study aims to describe the concept of burn care in nursing. Method: Walker and Avant's method (2013) was used to achieve the objective of the study. Findings: A model of burn care in nursing was generated that consists of assessment and diagnosis, intervention and evaluation. In addition, the biopsychosocial model developed by George L. Engel (1977) was also integrated to examine how these aspects play a significant role in burn care. Conclusion: Implementing the concept of burn care will improve the quality of nursing care, cosmetic outcomes and vice versa, reduce the comorbidities on burn injury.

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“…Transpulmonary thermodilution is one such noninvasive method that has been validated in burns [14]. Other methods include extra-vascular lung water, intrathoracic blood volume, pulse contour cardiac output (PiCCO), arterial waveform monitoring (LiDCO) devices and bioimpedance spectroscopy [1,12,15,16] (Figure 1). However, certain studies have shown that use of arterial waveform monitoring devices such as LiDCO systems had lower fluid requirement than what was calculated by Parkland formula [12,17].…”

Section: Goal-directed Fluid Therapy and Haemodynamic Monitoringmentioning

confidence: 99%

Critical care management in burns: A review of current evidence and guidelines -Part 1

2020

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Recent literature on the management of critically ill patients have altered the beliefs and clinical behaviours, questioning many dogmas that were practiced without much evidence. The critical care in a severely burn-injured patient requires special attention in resuscitation, haemodynamic monitoring, management of complications, organ support and determinants of outcome. The goal of resuscitation is to maintain intravascular volume and tone while correcting the reversible changes in altered physiology, aided by early debridement of burned tissue and elimination of the source of physiological derangement. Practitioners should target resuscitation based on goal-directed therapy using noninvasive markers of cardiac output. The management requires the input of a multidisciplinary team to achieve critical care and early surgical intervention and management of complications and organ support. Methods We performed a literature search on PubMed and Google Scholar, and looked for published original articles, review articles and guidelines on critical care management in burns, up to November 2019. Our search was limited to articles in English. Correspondence, dissertations and unpublished materials were not considered. The information were summarised and presented qualitatively (narratively) under subheadings. Contents: Fluid resuscitation in severe burns Goal-directed fluid therapy and Haemodynamic monitoring Evidence on choice of fluid for resuscitation Management of coagulopathy in severe burns Thromboprophylaxis in burns The role of suppressing hypermetabolism in severe burns Glycaemic control in severe burns Nutritional support in severe burns Sepsis and infection control in burns Management of inhalational injuries and acute respiratory distress syndrome (ARDS) Early surgical debridement and soft tissue cover Pain management in severe burns Palliative care in severe burns

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An objective measure for the assessment and management of fluid shifts in acute major burns

Cited by 6 publications

References 46 publications

Status of adult inpatient burn rehabilitation in Europe: are we neglecting metabolic outcomes?

Status of adult inpatient burn rehabilitation in Europe: are we neglecting metabolic outcomes?

A concept analysis of burn care in nursing

Critical care management in burns: A review of current evidence and guidelines -Part 1

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