Management of severe burns injuries—a metabolic perspective

Sim, K.

doi:10.1054/cacc.2002.0383

Cited by 7 publications

(3 citation statements)

References 31 publications

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“…As previously above, EOC may contain some proteins that have beneficial effects on immunological responses. Sim (2002) reported that the nutrients possessing these actions include amino acids (arginine, glutamine and glycine), fatty acids such as n-3 PUFA and antioxidants such as vitamins C and E. Minehira et al (2000) also found that immune function could be moderated by the selection and combination of dietary protein. The presence of proteins, vitamins and nutrients in EOC, along with the known rich content of the active dipeptides carnosine and anserine (Candlish, 1998), support its potential in enhancing immune function.…”

Section: Discussionmentioning

confidence: 99%

The enhancing effects of a chicken-meat extract on serum Ig concentrations in normal and scalded animals

et al. 2005

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The aim of the study was to investigate the effects of a chicken-meat extract known as Essence of Chicken (EOC) on immune function in a normal and scalded animal model. In this experimental study, 120 rats were randomly allocated into three groups: a SHAM group (inflicted with a sham wound), a BURN group (inflicted with a full-thickness scald wound covering 30 % of total body surface area) and a CONTROL group. Rats in the SHAM and BURN groups were further divided into normal saline (NS)-fed and EOC-fed groups. They were fed by force-feeding with a feeding needle and blood samples were taken from each group on days 1, 8, 15 and 22 postburn. Serum IgG, IgA and IgM concentrations were determined by ELISA and the results of the EOC-fed and NS-fed cohorts of both the SHAM and BURN groups were compared. The level of significance was set at P,0·05. Serum IgG level of both SHAM-EOC and BURN-EOC cohorts showed significant elevation on day 8. IgA exhibited a significant increase in the SHAM-EOC group on day 15 and in the BURN-EOC group on day 22. A significant increase of IgM level was found on days 1 and 22 for the SHAM-EOC group and on day 15 for the BURN-EOC group. Conclusively, EOC was shown to have an enhancing effect on serum Ig levels for both normal and tissue-stressed rats. It is suggested that EOC may help improve immune function when the immune system is at normal status or when it faces a challenge.

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Section: Discussionmentioning

confidence: 99%

The enhancing effects of a chicken-meat extract on serum Ig concentrations in normal and scalded animals

et al. 2005

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“…Other measures to control physiological changes such as growth hormone, adrenergic receptor blockade, or anabolic steroids are difficult to evaluate across the broad spectrum of burns; their use in children remains contentious. 3…”

Section: General Pathophysiologymentioning

confidence: 99%

Burns in children

Fenlon

Nene²

2007

Continuing Education in Anaesthesia Critical Care & Pain

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Burns make a significant contribution to paediatric hospital admissions; in 1 year, around 50,000 such patients attended accident and emergency departments and of these approximately 6400 attend a burns unit. 1 Most burns occur at home, usually in the kitchen and bathroom. The aetiology changes with age; younger children suffer more scalds, older children more flame burns. Outwardly, burns treatment for children is similar to that for adults, but there are significant physical, psychological, and social differences. Paediatric surgical services are no longer an appendage to those for adults, and the burns team must be able to manage these different needs. A given injury inflicts a greater burn on a child. Children have thinner skin, lose proportionately more fluid, are more prone to hypothermia, and mount a greater systemic inflammatory response. Their youthfulness does make possible early, aggressive surgery and they demonstrate extraordinary ability to adapt to injury and survive extensive burns that are fatal to most adults. The focus of this article is the immediate and day-today management of children requiring admission to hospital for burns. The prolonged management of massive burns and inhalation injury is beyond the scope of this paper. Local pathophysiology Burns are usually caused by contact with a source of heat; in infants and children, temperatures as low as 408C can rapidly inflict a significant injury. At the area of contact, there is coagulation of tissues surrounded by capillary stasis, aggravating the extent of cell injury by hypoxaemia. The depth to which dermal elements are destroyed affects their ability to regenerate from deeper elements; destruction of all dermal cells, including sweat glands and hair follicles, results in permanent loss of skin. Classification Although not always easy to assess in the first few hours, the site, depth, and extent of burns are critical factors in management, healing, and outcome. Essentially, specialist services are required for full-thickness burns exceeding 5% of body surface area (BSA), partial thickness exceeding 10% inhalation burns or burns to the airway, face, hands, feet, and perineum. Any concern of non-accidental injury or lack of care at home for the child necessitates admission to hospital.

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“…These children pose well-recognised physiological and psychological challenges. 1 Although management of the physiological adverse effects of burns on patients is reasonably well established, 1,3 little attention has been paid to the pivotal role that communication can play in enhancing a sense of control, recovery, and the optimisation of patient comfort.…”

Section: Introductionmentioning

confidence: 99%

Little words BIG impact: Perioperative communication for children with burns

Cyna

2020

Anaesth Intensive Care

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Anaesthetists are key members of teams caring for burn-injured children in almost every aspect of their management. Their role can involve initial resuscitation, intensive care, analgesia, and anaesthesia for multiple procedures both acutely and subsequently for scar management. As key members of burns management teams, effective communication with patients and their families as well as other members of the burn care team is vital. There is little guidance, however, addressing how the anaesthetist might communicate and optimise anaesthetic burns care of children pre-, intra-, and postoperatively. Advances in the understanding of the neurobiology of communication suggests that we need to consider positive (placebo) or negative (nocebo) subconscious processes. Learnable language structures GREAT (Greeting, Rapport, Expectations, Addressing concerns, Tacit agreement) and LAURS (Listening, Acceptance, Utilisation, Reframing, Suggestion) can facilitate any patient or family interaction ensuring children and their parents feel they are being heard and understood. Talking about finishing rather than starting when about to perform a potentially painful procedure can also facilitate burns care with children. Other strategies include the avoidance of nocebo communications or apologising before a painful procedure and, instead, focusing on therapeutic (placebo) alternatives. Children do not view pain in the same way as adults do, and techniques such as play therapy and hypnosis can be valuable adjuncts to traditional analgesia administration in burns care, with the added benefit of minimising side-effects. The use of regular time-outs during prolonged burns surgeries is a helpful communication strategy between the anaesthetist and other members of the burns team that can optimise patient safety. Communication is a core clinical skill in the practice of anaesthesia during paediatric burns care and is an area for future research.

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Management of severe burns injuries—a metabolic perspective

Cited by 7 publications

References 31 publications

The enhancing effects of a chicken-meat extract on serum Ig concentrations in normal and scalded animals

The enhancing effects of a chicken-meat extract on serum Ig concentrations in normal and scalded animals

Burns in children

Little words BIG impact: Perioperative communication for children with burns

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