Objective: To investigate the protective effects of the atomisation inhalation of edaravone on the lung tissues of rats with smoke inhalation injury. Methods: Forty male Sprague-Dawley (SD) rats were randomly divided ...Objective: To investigate the protective effects of the atomisation inhalation of edaravone on the lung tissues of rats with smoke inhalation injury. Methods: Forty male Sprague-Dawley (SD) rats were randomly divided into four groups of ten rats each: normal control group (group A), normal saline atomisation group (group B), edaravone aerosol group (group C) and edaravone atomisation prevention group (group D). Barring group A, the groups were used to create a model of severe smoke inhalation injury. However, before developing the model, group D rats were made to inhale edaravone (3.6 mg/mL) for 10 min. Six hours following smoke inhalation injury, abdominal artery blood samples were centrifuged, the lung tissue homogenate was prepared and carotid artery blood samples were used for blood gas analysis and oxygenation index (PaO<sub>2</sub>/FiO<sub>2</sub>) calculation. The levels of tumour necrosis factor alpha (TNF-α), interleukin (IL) 6 and IL-10 in serum and the levels of cysteine protease 3 (caspase-3), malondialdehyde (MDA), myeloperoxidase (MPO) and superoxide dismutase (SOD) in lung tissues were examined. The wet-dry ratio (W/D) and water content of the lung tissue were calculated, and the TUNEL method was used to determine the rate of lung tissue apoptosis in each group. Tissue specimens were obtained from the partial lung for histopathological examination. Results: Compared with those in group A, the water content of the lung tissue, the rate of lung tissue apoptosis, W/D and the caspase-3, TNF-α, IL-6, IL-10, MDA and MPO levels were significantly greater in other groups (PP< 0.05).<sup> </sup>Compared with those in group B, the levels of W/D, the water content of the lung tissue, the rate of lung tissue apoptosis and the levels of caspase-3, TNF-α, IL-6, MDA and MPO were significantly low (P and the levels of IL-10, SOD and PaO<sub>2</sub>/FiO<sub>2</sub> were significantly high in groups C and D (P The expression of the aforementioned factors was more evident in Group D (P < 0.05). Histopathological examination revealed that groups C and D had greater levels of inflammatory granulocytes than group B. This was more evident in group D. Conclusions: The inhalation of edaravone can reduce smoke inhalation-induced lung injury. This may be related to the inhibition of apoptosis, the reduction of peroxidation injury and the production/release of inflammatory mediators/free radicals. It exerts a remarkable preventive effect.展开更多
Background:Smoke inhalation injury increases overall burn mortality.Locally applied heparin attenuates lung injury in burn animal models of smoke inhalation.It is uncertain whether local treatment of heparin is benefi...Background:Smoke inhalation injury increases overall burn mortality.Locally applied heparin attenuates lung injury in burn animal models of smoke inhalation.It is uncertain whether local treatment of heparin is benefit for burn patients with inhalation trauma.We systematically reviewed published clinical trial data to evaluate the effectiveness of nebulized heparin in treating burn patients with inhalation injury.Methods:A systematic search was undertaken in PubMed,the Cochrane Library,Embase,Web of Science,the Chinese Journals Full-text Database,the China Biomedical Literature Database and the Wanfang Database to obtain clinical controlled trails evaluating nebulized heparin in the treatment of burn patients with inhalation injury.Patient and clinical characteristics,interventions and physiological and clinical outcomes were recorded.Cochrane Risk of Bias Evaluation Tool and the Newcastle–Ottawa Scale were used to evaluate data quality.Potential publication bias was assessed by Egger’s test.A sensitivity analysis was conducted to assess the stability of the results.The meta-analysis was conducted in R 3.5.1 software.Results:Nine trials were eligible for the systematic review and meta-analysis.Nebulized heparin can reduce lung injury and improve lung function in burn patients with inhalation injury without abnormal coagulation or bleeding,but the findings are still controversial.Mortality in the heparintreated group was lower than that of the traditional treatment group(relative risk(RR)0.75).The duration of mechanical ventilation(DOMV)was shorter in the heparin-treated group compared to the traditional treatment group(standardized mean difference(SMD)−0.78).Length of hospital stay was significantly shorter than that in the traditional treatment group(SMD−0.42),but incidence rates of pneumonia and unplanned reintubation were not significantly different in the study groups(RRs 0.97 and 0.88,respectively).No statistically significant publication biases were detected for the above clinical endpoints(p>0.05).Conclusions:Based on conventional aerosol therapy,heparin nebulization can further reduce lung injury,improve lung function,shorten DOMV and length of hospital stay,and reduce mortality,although it does not reduce the incidence of pneumonia and/or the unplanned reintubation rate.展开更多
Background:Prognostic measures to determine burn mortality are essential in evaluating the severity of individual burn victims.This is an important process of triaging patients with high risk of mortality that may be ...Background:Prognostic measures to determine burn mortality are essential in evaluating the severity of individual burn victims.This is an important process of triaging patients with high risk of mortality that may be nursed in the acute care setting.Malaysian burn research is lacking with only one publication identified which describes the epidemiology of burn victims.Therefore,the objective of this study was to go one step further and identify the predictors of burn mortality from a Malaysian burns intensive care unit(BICU)which may be used to triage patients at higher risk of death.Methods:This is a retrospective cohort study of all admissions to Hospital Sultan Ismail’s BICU from January 2010 till October 2015.Admission criteria were in accordance with the American Burn Association guidelines,and risk factors of interest were recorded.Data was analyzed using simple logistic regression to determine significant predictors of mortality.Survival analysis with time to death event was performed using the Kaplan-Meier survival curve with log-rank test.Results:Through the 6-year period,393 patients were admitted with a male preponderance of 73.8%.The mean age and length of stay were 35.6(±15.72)years and 15.3(±18.91)days.There were 48 mortalities with an overall mortality rate of 12.2%.Significant risk factors identified on simple logistic regression were total body surface area(TBSA)>20%(p<0.001),inhalation injury(p<0.001)and presence of early systemic inflammatory response syndrome(SIRS)(p<0.001).Survival analysis using Kaplan-Meier survival curve showed similar results with TBSA>20%,presence of SIRS,mechanical ventilation and inhalation injury which were associated with poorer survival(p<0.001).Conclusion:The predictors of mortality identified in a Malaysian BICU were TBSA>20%,early SIRS,mechanical ventilation and inhalation injury which were associated with poorer survival outcome.The immunological response differs from individual patients and influenced by the severity of burn injury.Early SIRS on admission is an important predictor of death and may represent the severity of burn injury.Patients who required mechanical ventilation were associated with mortality and it is likely related to the severity of pulmonary insults sustained by individual patients.This data is important for outcome prognostication and mortality risk counselling in severely burned patients.展开更多
Background:Acute respiratory distress syndrome(ARDS)has a reported incidence of 34–43%in ventilated burn patients and is associated with a mortality of 59%in the severe form.The use and experience with extracorporeal...Background:Acute respiratory distress syndrome(ARDS)has a reported incidence of 34–43%in ventilated burn patients and is associated with a mortality of 59%in the severe form.The use and experience with extracorporeal membrane oxygenation(ECMO)in burn patients developing ARDS are still limited.We present our results and discuss the significance of ECMO in treating burn patients.Methods:A retrospective analysis of burn patients treated with ECMO for ARDS between January 2017 and January 2019 was performed.Demographic,clinical,and outcome data were collected and analyzed.Results:Eight burn patients were treated at our institution with ECMO in the designated time period.Of these,all but one patient had inhalation injury,burn percentage of TBSA was 37±23%,ABSI score was 8.4±2,and R-Bauxscore was 98±21.Seven patients developed severe ARDS and one patient moderate ARDS according to the Berlin classification with a PaO_(2)/FiO_(2) ratio upon initiation of ECMO therapy of 62±22 mmHg.ECMO duration was 388±283 h.Three patients died from severe sepsis while five patients survived to hospital discharge.Conclusions:ECMO is a viable therapy option in burn patients developing severe ARDS and can contribute to survival rates similar to ECMO therapy in non-burn-associated severe ARDS.Consequently,patients with severe respiratory insufficiency with unsuccessful conventional treatment and suspected worsening should be transferred to burn units with the possibility of ECMO treatment to improve outcome.展开更多
"American Burn Association Practice Guidelines for Prevention,Diagnosis,and Treatment of Ventilator-Associated Pneumonia in Burn Patients"was published to provide recommendation for the prevention,diagnosis,..."American Burn Association Practice Guidelines for Prevention,Diagnosis,and Treatment of Ventilator-Associated Pneumonia in Burn Patients"was published to provide recommendation for the prevention,diagnosis,and treatment of ventilator-associated pneumonia in burn patients.This article makes interpretations and conclusions for prevention,diagnosis and treatment from this guideline in the combination of domestic burn patients.展开更多
Consensus regarding optimal burns intensive care(BICU)patient management is lacking.This study aimed to assess whether ventilation strategies,cardiovascular support and sedation in BICU patients have changed over time...Consensus regarding optimal burns intensive care(BICU)patient management is lacking.This study aimed to assess whether ventilation strategies,cardiovascular support and sedation in BICU patients have changed over time,and whether this affects outcome.A retrospective observational study comparing two 12-patient BICU cohorts(2005/06 and 2010/11)was undertaken.Demographic and admission characteristics,ventilation parameters,sedation,fluid resuscitation,cardiovascular support and outcome(length of stay,mortality)data were collected from patient notes.Data was analysed using T-tests,Fisher’s exact and Mann-Whitney U tests.In our study cohort groups were equivalent in demographic and admission parameters.There were equal ventilator-free days in the two cohorts 10±12.7 vs.13.3±12.2 ventilator free days;(P=0.447).The 2005/06 cohort were mechanically ventilated more often than in 2010/11 cohort(568 ventilator days/1000 patient BICU days vs.206 ventilator days/1000 patient BICU days;P=0.001).The 2005/06 cohort were ventilated less commonly in tracheostomy group/endotracheal tube spontaneous(17.8%vs.26%;P=0.001)and volumecontrolled modes(34.4%vs.40.8%;P=0.001).Patients in 2010/11 cohort were more heavily sedated(P=0.001)with more long-acting sedative drug use(P=0.001)than the 2005/06 cohort,fluid administration was equivalent.Patient outcome did not vary.Inhalational injury patients were ventilated in volume-controlled(44.5%vs.28.1%;P=0.001)and pressure-controlled modes(18.2%vs.9.5%;P=0.001)more frequently than those without.Outcome did not vary.This study showed there has been shift away from mechanical ventilation,with increased use of tracheostomy/tracheal tube airway spontaneous ventilation.Inhalation injury patients require more ventilatory support though patient outcomes do not differ.Prospective trials are required to establish which strategies confer benefit.展开更多
文摘Objective: To investigate the protective effects of the atomisation inhalation of edaravone on the lung tissues of rats with smoke inhalation injury. Methods: Forty male Sprague-Dawley (SD) rats were randomly divided into four groups of ten rats each: normal control group (group A), normal saline atomisation group (group B), edaravone aerosol group (group C) and edaravone atomisation prevention group (group D). Barring group A, the groups were used to create a model of severe smoke inhalation injury. However, before developing the model, group D rats were made to inhale edaravone (3.6 mg/mL) for 10 min. Six hours following smoke inhalation injury, abdominal artery blood samples were centrifuged, the lung tissue homogenate was prepared and carotid artery blood samples were used for blood gas analysis and oxygenation index (PaO<sub>2</sub>/FiO<sub>2</sub>) calculation. The levels of tumour necrosis factor alpha (TNF-α), interleukin (IL) 6 and IL-10 in serum and the levels of cysteine protease 3 (caspase-3), malondialdehyde (MDA), myeloperoxidase (MPO) and superoxide dismutase (SOD) in lung tissues were examined. The wet-dry ratio (W/D) and water content of the lung tissue were calculated, and the TUNEL method was used to determine the rate of lung tissue apoptosis in each group. Tissue specimens were obtained from the partial lung for histopathological examination. Results: Compared with those in group A, the water content of the lung tissue, the rate of lung tissue apoptosis, W/D and the caspase-3, TNF-α, IL-6, IL-10, MDA and MPO levels were significantly greater in other groups (PP< 0.05).<sup> </sup>Compared with those in group B, the levels of W/D, the water content of the lung tissue, the rate of lung tissue apoptosis and the levels of caspase-3, TNF-α, IL-6, MDA and MPO were significantly low (P and the levels of IL-10, SOD and PaO<sub>2</sub>/FiO<sub>2</sub> were significantly high in groups C and D (P The expression of the aforementioned factors was more evident in Group D (P < 0.05). Histopathological examination revealed that groups C and D had greater levels of inflammatory granulocytes than group B. This was more evident in group D. Conclusions: The inhalation of edaravone can reduce smoke inhalation-induced lung injury. This may be related to the inhibition of apoptosis, the reduction of peroxidation injury and the production/release of inflammatory mediators/free radicals. It exerts a remarkable preventive effect.
文摘Background:Smoke inhalation injury increases overall burn mortality.Locally applied heparin attenuates lung injury in burn animal models of smoke inhalation.It is uncertain whether local treatment of heparin is benefit for burn patients with inhalation trauma.We systematically reviewed published clinical trial data to evaluate the effectiveness of nebulized heparin in treating burn patients with inhalation injury.Methods:A systematic search was undertaken in PubMed,the Cochrane Library,Embase,Web of Science,the Chinese Journals Full-text Database,the China Biomedical Literature Database and the Wanfang Database to obtain clinical controlled trails evaluating nebulized heparin in the treatment of burn patients with inhalation injury.Patient and clinical characteristics,interventions and physiological and clinical outcomes were recorded.Cochrane Risk of Bias Evaluation Tool and the Newcastle–Ottawa Scale were used to evaluate data quality.Potential publication bias was assessed by Egger’s test.A sensitivity analysis was conducted to assess the stability of the results.The meta-analysis was conducted in R 3.5.1 software.Results:Nine trials were eligible for the systematic review and meta-analysis.Nebulized heparin can reduce lung injury and improve lung function in burn patients with inhalation injury without abnormal coagulation or bleeding,but the findings are still controversial.Mortality in the heparintreated group was lower than that of the traditional treatment group(relative risk(RR)0.75).The duration of mechanical ventilation(DOMV)was shorter in the heparin-treated group compared to the traditional treatment group(standardized mean difference(SMD)−0.78).Length of hospital stay was significantly shorter than that in the traditional treatment group(SMD−0.42),but incidence rates of pneumonia and unplanned reintubation were not significantly different in the study groups(RRs 0.97 and 0.88,respectively).No statistically significant publication biases were detected for the above clinical endpoints(p>0.05).Conclusions:Based on conventional aerosol therapy,heparin nebulization can further reduce lung injury,improve lung function,shorten DOMV and length of hospital stay,and reduce mortality,although it does not reduce the incidence of pneumonia and/or the unplanned reintubation rate.
文摘Background:Prognostic measures to determine burn mortality are essential in evaluating the severity of individual burn victims.This is an important process of triaging patients with high risk of mortality that may be nursed in the acute care setting.Malaysian burn research is lacking with only one publication identified which describes the epidemiology of burn victims.Therefore,the objective of this study was to go one step further and identify the predictors of burn mortality from a Malaysian burns intensive care unit(BICU)which may be used to triage patients at higher risk of death.Methods:This is a retrospective cohort study of all admissions to Hospital Sultan Ismail’s BICU from January 2010 till October 2015.Admission criteria were in accordance with the American Burn Association guidelines,and risk factors of interest were recorded.Data was analyzed using simple logistic regression to determine significant predictors of mortality.Survival analysis with time to death event was performed using the Kaplan-Meier survival curve with log-rank test.Results:Through the 6-year period,393 patients were admitted with a male preponderance of 73.8%.The mean age and length of stay were 35.6(±15.72)years and 15.3(±18.91)days.There were 48 mortalities with an overall mortality rate of 12.2%.Significant risk factors identified on simple logistic regression were total body surface area(TBSA)>20%(p<0.001),inhalation injury(p<0.001)and presence of early systemic inflammatory response syndrome(SIRS)(p<0.001).Survival analysis using Kaplan-Meier survival curve showed similar results with TBSA>20%,presence of SIRS,mechanical ventilation and inhalation injury which were associated with poorer survival(p<0.001).Conclusion:The predictors of mortality identified in a Malaysian BICU were TBSA>20%,early SIRS,mechanical ventilation and inhalation injury which were associated with poorer survival outcome.The immunological response differs from individual patients and influenced by the severity of burn injury.Early SIRS on admission is an important predictor of death and may represent the severity of burn injury.Patients who required mechanical ventilation were associated with mortality and it is likely related to the severity of pulmonary insults sustained by individual patients.This data is important for outcome prognostication and mortality risk counselling in severely burned patients.
文摘Background:Acute respiratory distress syndrome(ARDS)has a reported incidence of 34–43%in ventilated burn patients and is associated with a mortality of 59%in the severe form.The use and experience with extracorporeal membrane oxygenation(ECMO)in burn patients developing ARDS are still limited.We present our results and discuss the significance of ECMO in treating burn patients.Methods:A retrospective analysis of burn patients treated with ECMO for ARDS between January 2017 and January 2019 was performed.Demographic,clinical,and outcome data were collected and analyzed.Results:Eight burn patients were treated at our institution with ECMO in the designated time period.Of these,all but one patient had inhalation injury,burn percentage of TBSA was 37±23%,ABSI score was 8.4±2,and R-Bauxscore was 98±21.Seven patients developed severe ARDS and one patient moderate ARDS according to the Berlin classification with a PaO_(2)/FiO_(2) ratio upon initiation of ECMO therapy of 62±22 mmHg.ECMO duration was 388±283 h.Three patients died from severe sepsis while five patients survived to hospital discharge.Conclusions:ECMO is a viable therapy option in burn patients developing severe ARDS and can contribute to survival rates similar to ECMO therapy in non-burn-associated severe ARDS.Consequently,patients with severe respiratory insufficiency with unsuccessful conventional treatment and suspected worsening should be transferred to burn units with the possibility of ECMO treatment to improve outcome.
文摘"American Burn Association Practice Guidelines for Prevention,Diagnosis,and Treatment of Ventilator-Associated Pneumonia in Burn Patients"was published to provide recommendation for the prevention,diagnosis,and treatment of ventilator-associated pneumonia in burn patients.This article makes interpretations and conclusions for prevention,diagnosis and treatment from this guideline in the combination of domestic burn patients.
文摘Consensus regarding optimal burns intensive care(BICU)patient management is lacking.This study aimed to assess whether ventilation strategies,cardiovascular support and sedation in BICU patients have changed over time,and whether this affects outcome.A retrospective observational study comparing two 12-patient BICU cohorts(2005/06 and 2010/11)was undertaken.Demographic and admission characteristics,ventilation parameters,sedation,fluid resuscitation,cardiovascular support and outcome(length of stay,mortality)data were collected from patient notes.Data was analysed using T-tests,Fisher’s exact and Mann-Whitney U tests.In our study cohort groups were equivalent in demographic and admission parameters.There were equal ventilator-free days in the two cohorts 10±12.7 vs.13.3±12.2 ventilator free days;(P=0.447).The 2005/06 cohort were mechanically ventilated more often than in 2010/11 cohort(568 ventilator days/1000 patient BICU days vs.206 ventilator days/1000 patient BICU days;P=0.001).The 2005/06 cohort were ventilated less commonly in tracheostomy group/endotracheal tube spontaneous(17.8%vs.26%;P=0.001)and volumecontrolled modes(34.4%vs.40.8%;P=0.001).Patients in 2010/11 cohort were more heavily sedated(P=0.001)with more long-acting sedative drug use(P=0.001)than the 2005/06 cohort,fluid administration was equivalent.Patient outcome did not vary.Inhalational injury patients were ventilated in volume-controlled(44.5%vs.28.1%;P=0.001)and pressure-controlled modes(18.2%vs.9.5%;P=0.001)more frequently than those without.Outcome did not vary.This study showed there has been shift away from mechanical ventilation,with increased use of tracheostomy/tracheal tube airway spontaneous ventilation.Inhalation injury patients require more ventilatory support though patient outcomes do not differ.Prospective trials are required to establish which strategies confer benefit.
