Restoration of Function

Helm, P.; Herndon, David N.; deLateur, Barbara J.

doi:10.1097/bcr.0b013e318093e4ca

Cited by 18 publications

(8 citation statements)

References 13 publications

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“…Initially, it was thought that these derangements would subside shortly after the acute hospitalization or the initial resuscitation. More recent research has shown that these responses may last 9–12 months after the initial insult [16], [73], [74]. Here, we demonstrated a significant increase in cardiac work up to three years after the initial injury.…”

Section: Discussionsupporting

confidence: 64%

Long-Term Persistance of the Pathophysiologic Response to Severe Burn Injury

et al. 2011

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BackgroundMain contributors to adverse outcomes in severely burned pediatric patients are profound and complex metabolic changes in response to the initial injury. It is currently unknown how long these conditions persist beyond the acute phase post-injury. The aim of the present study was to examine the persistence of abnormalities of various clinical parameters commonly utilized to assess the degree hypermetabolic and inflammatory alterations in severely burned children for up to three years post-burn to identify patient specific therapeutic needs and interventions.Methodology/Principal FindingsPatients: Nine-hundred seventy-seven severely burned pediatric patients with burns over 30% of the total body surface admitted to our institution between 1998 and 2008 were enrolled in this study and compared to a cohort non-burned, non-injured children. Demographics and clinical outcomes, hypermetabolism, body composition, organ function, inflammatory and acute phase responses were determined at admission and subsequent regular intervals for up to 36 months post-burn. Statistical analysis was performed using One-way ANOVA, Student's t-test with Bonferroni correction where appropriate with significance accepted at p<0.05. Resting energy expenditure, body composition, metabolic markers, cardiac and organ function clearly demonstrated that burn caused profound alterations for up to three years post-burn demonstrating marked and prolonged hypermetabolism, p<0.05. Along with increased hypermetabolism, significant elevation of cortisol, catecholamines, cytokines, and acute phase proteins indicate that burn patients are in a hyperinflammatory state for up to three years post-burn p<0.05.ConclusionsSevere burn injury leads to a much more profound and prolonged hypermetabolic and hyperinflammatory response than previously shown. Given the tremendous adverse events associated with the hypermetabolic and hyperinflamamtory responses, we now identified treatment needs for severely burned patients for a much more prolonged time.

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Section: Discussionsupporting

confidence: 64%

Long-Term Persistance of the Pathophysiologic Response to Severe Burn Injury

et al. 2011

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“…29,30 Some studies investigate the impact of exercise on functional outcome as well. [31][32][33] However, to the best of our knowledge, there are few randomized controlled studies (pediatric or adult) that examine the effects of exercise on ROM. In 2003, Celis et al 34 randomized 53 pediatric patients to either a 12-week hospital-based exercise program or a 12-week homebased physical rehabilitation program without exercise.…”

Section: Discussionmentioning

confidence: 96%

A Pilot Prospective Randomized Control Trial Comparing Exercises Using Videogame Therapy to Standard Physical Therapy

Parry

Painting

Bagley

et al. 2015

Journal of Burn Care & Research

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The objective of this study was to assess current practice patterns and attitudes toward pediatric sedation and analgesia in United States (US) burn centers for critically ill patients. Survey-based questionnaire was sent to 119 Directors at US burn centers that care for pediatric patients. Forty-one surveys (34%) were analyzed. 48.8% of responding centers mandate pediatric consultation for pediatric burn patients based on factors such as age and burn size. The most common sedation and analgesic agents used were midazolam, fentanyl, morphine, ketamine, and diphenhydramine. Written sedation policies exist at 63.4% of centers. 90.2% of centers employ scoring systems to guide agent titration. 60.9% of respondents practice sedation holidays "always" or "usually." 90.2% of centers perceive the medications they routinely use are "always" or "often" efficacious in pediatric sedation and analgesia. 53.7% of respondents reported the presence of withdrawal signs and symptoms in their patient population. The lack of consensus guidelines for sedation and analgesia delivery to pediatric intensive care unit patients results in practice variation. The majority of centers perceive their sedation and analgesia strategies to be efficacious despite the heavy reliance on propofol and midazolam, both of which have questionable safety profiles in critically ill children.

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“…For example, years following a burn injury, fatigue is an “almost universal complaint” as a major barrier preventing such individuals from returning to work and performing activities of daily living. 20 59% of burned individuals report problems with fatigue an average of 17 years post-injury. 21 Other perceived or real barriers to physical activity may include impaired temperature regulation, hypertrophic scars and contractures that may limit range of motion, hyperpigmentation, psychosocial barriers, decreased cutaneous sensation, and a lower quality of life.…”

Section: Discussionmentioning

confidence: 99%

Aerobic Fitness Is Disproportionately Low in Adult Burn Survivors Years After Injury

Ganio

Pearson

Schlader

et al. 2015

Journal of Burn Care & Research

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Objective A maximal aerobic capacity below the 20th percentile is associated with an increased risk of all-cause mortality.1 Adult burn survivors have a lower aerobic capacity compared to non-burned adults when evaluated 38±23 days post-injury.2 However, it is unknown if burn survivors with well-healed skin grafts (i.e., multiple years post injury), also have low aerobic capacity. This project tested the hypothesis that aerobic fitness, as measured by maximal aerobic capacity (VO2max), is reduced in well-healed adult burn survivors when compared to normative values from non-burned individuals. Methods Twenty-five burn survivors (36 ± 12 years old; 13 females) with well-healed split thickness grafts (median: 16 years post-injury, range: 1 to 51 years) covering at least 17% of their body surface area (mean: 40±16%; range: 17 to 75%) performed a graded cycle ergometry exercise test to volitional fatigue. Expired gases and minute ventilation were measured via a metabolic cart for the determination of VO2max. Each subject’s VO2max was compared with sex- and age-matched normative values from population data published by the American College of Sports Medicine (ACSM), the American Heart Association (AHA), and recent epidemiological data.3 Results Subjects had a VO2max of 29.4 ± 10.1 ml O2/kg body mass/min (median: 27.5; range: 15.9 to 53.3). Using ACSM normative values, mean VO2max of the subjects was in the lower 24th percentile (median: 10th percentile). 88% of the subjects had a VO2max below AHA age-adjusted normative values. Similarly 20 of the 25 subjects had a VO2max in the lower 25% percentile of recent epidemiological data. Conclusions Relative to non-grafted subjects, 80–88% of the evaluated skin graft subjects had a very low aerobic capacity. Based upon these findings, adult burn survivors are disproportionally unfit relative to the general U.S. population, and this puts them at an increased risk of all-cause mortality.1

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Restoration of Function

Cited by 18 publications

References 13 publications

Long-Term Persistance of the Pathophysiologic Response to Severe Burn Injury

Long-Term Persistance of the Pathophysiologic Response to Severe Burn Injury

A Pilot Prospective Randomized Control Trial Comparing Exercises Using Videogame Therapy to Standard Physical Therapy

Aerobic Fitness Is Disproportionately Low in Adult Burn Survivors Years After Injury

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