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Sjöberg, F., Elmasry, M., Abdelrahman, I., Nyberg, G., T-Elserafi, A., Ursing, E. & Steinvall, I. (2024). The impact and validity of the Berlin criteria on burn-induced ARDS: Examining mortality rates, and inhalation injury influences. A single center observational cohort study.. Burns, Article ID S0305-4179(24)00149-9.
Open this publication in new window or tab >>The impact and validity of the Berlin criteria on burn-induced ARDS: Examining mortality rates, and inhalation injury influences. A single center observational cohort study.
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2024 (English)In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, article id S0305-4179(24)00149-9Article in journal (Refereed) Epub ahead of print
Abstract [en]

BACKGROUND: As several recent studies have shown low mortality rates in burn injury induced ARDS early (≤7 days) after the burn, the Berlin criteria for the ARDS diagnosis in this setting may be disputed. Related to this issue, the present study investigated the incidence, trajectory and risk factors of early Acute Respiratory Distress Syndrome (ARDS) and outcome in burn patients, as per the Berlin criteria, along with the concurrent prevalence and influence of inhalation injury, and ventilator-acquired pneumonia (VAP).

METHODS: Over a 2.5-year period, burn patients with Total Burn Surface Area (TBSA) exceeding 10% admitted to a national burn center were included. The subgroup of interest comprised patients with more than 48 h of ventilatory support. This group was assessed for ARDS, inhalation injury, and VAP.

RESULTS: Out of 292 admissions, 62 sustained burns > 10% TBSA. Of these, 28 (45%) underwent ventilatory support for over 48 h, almost all, 24 out of 28, meeting the criteria for ARDS early, within 7 days post-injury and with a PaO2/FiO2 (PF) ratio nadir at day 5. The mortality rate for this early ARDS group was under 10%, regardless of PF ratios (mean TBSA% 34,8%). Patients with concurrent inhalation injury and early ARDS showed significantly lower PF ratios (p < 0.001), and higher SOFA scores (p = 0.004) but without impact on mortality. Organ failure, indicated by SOFA scores, peaked early (day 3) and declined in the first week, mirroring PF ratio trends (p < 0.001).

CONCLUSIONS: The low mortality associated with early ARDS in burn patients in this study challenges the Berlin criteria's for the early ARDS diagnosis, which for its validity relies on that higher mortality is linked to worsening PF ratios. The finding suggests alternative mechanisms, leading to the early ARDS diagnosis, such as the significant impact of inhalation injury on early PF ratios and organ failure, as seen in this study. The concurrence of early organ failure with declining PF ratios, supports, as expected, the hypothesis of trauma-induced inflammation/multi-organ failure mechanisms contributing to early ARDS. The study highlights the complexity in differentiating between the contributions of inhalation injury to early ARDS and the related organ dysfunction early in the burn care trajectory. The Berlin criteria for the ARDS diagnosis may not be fully applicable in the burn care setting, where the low mortality significantly deviates from that described in the original Berlin ARDS criteria publication but is as expected when considering the actual not very extensive burn injury sizes/Baux scores as in the present study.

Place, publisher, year, edition, pages
Elsevier, 2024
Keywords
ARDS, Burns, Inhalation injury, Mortality ventilatory acquired pneumonia
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:liu:diva-203817 (URN)10.1016/j.burns.2024.05.005 (DOI)38777667 (PubMedID)
Note

Funding agencies: The Carnegie Foundation, Stockholm, Sweden. King Gustaf the Vth and Queen Victoria Foundation, Stockholm and King Gustaf foundation, “Frimurarestiftelsen” Stockholm Sweden. Linköping University Hospital and Linköping University, Linköping Sweden.

Available from: 2024-05-27 Created: 2024-05-27 Last updated: 2024-05-28
Dogan, S., Elmasry, M., Elserafy, A. T., Sjöberg, F., Vuola, J., Kankuri, E., . . . Lindford, A. (2022). A prospective dual-centre intra-individual controlled study for the treatment of burns comparing dermis graft with split-thickness skin auto-graft. Scientific Reports, 12(1), Article ID 21666.
Open this publication in new window or tab >>A prospective dual-centre intra-individual controlled study for the treatment of burns comparing dermis graft with split-thickness skin auto-graft
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2022 (English)In: Scientific Reports, E-ISSN 2045-2322, Vol. 12, no 1, article id 21666Article in journal (Refereed) Published
Abstract [en]

To investigate if donor and recipient site morbidity (healing time and cosmesis) could be reduced by a novel, modified split-thickness skin grafting (STSG) technique using a dermal component in the STSG procedure (DG). The STSG technique has been used for 150 years in surgery with limited improvements. Its drawbacks are well known and relate to donor site morbidity and recipient site cosmetic shortcomings (especially mesh patterns, wound contracture, and scarring). The Dermal graft technique (DG) has emerged as an interesting alternative, which reduces donor site morbidity, increases graft yield, and has the potential to avoid the mesh procedure in the STSG procedure due to its elastic properties. A prospective, dual-centre, intra-individual controlled comparison study. Twenty-one patients received both an unmeshed dermis graft and a regular 1:1.5 meshed STSG. Aesthetic and scar assessments were done using The Patient and Observer Scar Assessment Scale (POSAS) and a Cutometer Dual MPA 580 on both donor and recipient sites. These were also examined histologically for remodelling and scar formation. Dermal graft donor sites and the STSG donor sites healed in 8 and 14 days, respectively (p < 0.005). Patient-reported POSAS showed better values for colour for all three measurements, i.e., 3, 6, and 12 months, and the observers rated both vascularity and pigmentation better on these occasions (p < 0.01). At the recipient site, (n = 21) the mesh patterns were avoided as the DG covered the donor site due to its elastic properties and rendered the meshing procedure unnecessary. Scar formation was seen at the dermal donor and recipient sites after 6 months as in the standard scar healing process. The dermis graft technique, besides potentially rendering a larger graft yield, reduced donor site morbidity, as it healed faster than the standard STSG. Due to its elastic properties, the DG procedure eliminated the meshing requirement (when compared to a 1:1.5 meshed STSG). This promising outcome presented for the DG technique needs to be further explored, especially regarding the elasticity of the dermal graft and its ability to reduce mesh patterns. Trial registration: ClinicalTrials.gov Identifier (NCT05189743) 12/01/2022. © 2022, The Author(s).

Keywords
burns, cicatrix, dermis, humans, prospective studies, skin transplantation
National Category
Surgery
Identifiers
urn:nbn:se:liu:diva-190855 (URN)10.1038/s41598-022-25346-4 (DOI)001015461100020 ()36522434 (PubMedID)2-s2.0-85144147270 (Scopus ID)
Note

Funding: Linkoping University; Department of Plastic and Hand Surgery Linkoping University Hospital; Department of Biomedical and Clinical Sciences, Linkoping University, Linkoping

Available from: 2023-01-03 Created: 2023-01-03 Last updated: 2024-01-10
Steinvall, I., Elmasry, M., Abdelrahman, I., El-Serafi, A. T., Fredrikson, M. & Sjöberg, F. (2022). ABO blood group and effects on ventilatory time, length of stay and mortality in major burns a retrospective observational outcome study. Burns, 48(4), 785-790
Open this publication in new window or tab >>ABO blood group and effects on ventilatory time, length of stay and mortality in major burns a retrospective observational outcome study
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2022 (English)In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 48, no 4, p. 785-790Article in journal (Refereed) Published
Abstract [en]

Blood group has been found to be important in the development of many diseases and the outcome of several disease processes, especially cardiovascular morbidity and mortality, such as caused by trauma and sepsis. The main reason is claimed to be related to glycobiology and effects mediated through the endothelium. This study investigated the possible effect of blood group (ABO) on burn care outcome. Burn outcome prediction models are extremely accurate and as such can be used to identify outcome effects even in single centre settings. In this retrospective risk adjusted observational study, we investigated the effect of ABO blood group on ventilatory time, length of hospital stay (LOS), and 90 day mortality among patients with burns. RESULTS: A total of 225 patients were included (2008-2019) with median TBSA of 26%; interquartile range (IQR) of 20-37%; median age 45 years (IQR 22-65 years); median Baux score (age + TBSA%); 76 (IQR 53- 97); 168 (75%) were male; median duration of hospital stay was 31 days (IQR 19-56); a total of 138 (61%) received treatment with mechanical ventilation; and 29 (13%) died. In a multivariable regression model, we were unable to isolate any significant effect of any blood group (O, A, B, AB) on the outcome measures studied (ventilatory time, LOS, and mortality). IN SUMMARY: contrary to many other major areas of disease in which ABO blood groups affect outcome, we were unable to find any such effect on patients with burns. Given the precision of the outcome models presented (AUC 0.93) any such an effect, if missed due to the limited study cohort, may be considered limited and to have only a minor clinical impact.

Place, publisher, year, edition, pages
Oxford, United Kingdom: Elsevier, 2022
Keywords
ICU; Large burns; Mortality prediction; Survival; Total Body Surface area burned (TBSA %)
National Category
Surgery
Identifiers
urn:nbn:se:liu:diva-183534 (URN)10.1016/j.burns.2022.02.001 (DOI)000833489400007 ()35227532 (PubMedID)2-s2.0-85125505549 (Scopus ID)
Note

Funding agencies: Carnegie foundation (Stockholm, Sweden); Queen Victoria Foundation (Stockholm, Sweden); Department of Hand Surgery, Plastic Surgery and Burns, Linkoping University Hospital; Linkoping University Linkoping, Sweden

Available from: 2022-03-17 Created: 2022-03-17 Last updated: 2024-01-10Bibliographically approved
Ellabban, M. A., Elmasry, M., Abdelrahman, I., Abdel Kader, G., Steinvall, I., Sjöberg, F., . . . Abdel Fattah, I. O. (2022). Experimental study of the effects of nitroglycerin, botulinum toxin A, and clopidogrel on bipedicled superficial inferior epigastric artery flap survival.. Scientific Reports, 12(1), Article ID 20891.
Open this publication in new window or tab >>Experimental study of the effects of nitroglycerin, botulinum toxin A, and clopidogrel on bipedicled superficial inferior epigastric artery flap survival.
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2022 (English)In: Scientific Reports, E-ISSN 2045-2322, Vol. 12, no 1, article id 20891Article in journal (Refereed) Published
Abstract [en]

Beneficial effects could be achieved by various agents such as nitroglycerin, botulinum toxin A (BoTA), and clopidogrel to improve skin flap ischaemia and venous congestion injuries. Eighty rats were subjected to either arterial ischaemia or venous congestion and applied to a bipedicled U-shaped superficial inferior epigastric artery (SIEA) flap with the administration of nitroglycerin, BoTA, or clopidogrel treatments. After 7 days, all rats were sacrificed for flap evaluation. Necrotic area percentage was significantly minimized in flaps treated with clopidogrel (24.49%) versus the ischemic flaps (34.78%); while nitroglycerin (19.22%) versus flaps with venous congestion (43.26%). With ischemia, light and electron microscopic assessments revealed that nitroglycerin produced degeneration of keratinocytes and disorganization of collagen fibers. At the same time, with clopidogrel administration, there was an improvement in the integrity of these structures. With venous congestion, nitroglycerin and BoTA treatments mitigated the epidermal and dermal injury; and clopidogrel caused coagulative necrosis. There was a significant increase in tissue gene expression and serum levels of vascular endothelial growth factor (VEGF) in ischemic flaps with BoTA and clopidogrel, nitroglycerin, and BoTA clopidogrel in flaps with venous congestion. With the 3 treatment agents, gene expression levels of tumor necrosis factor-α (TNF-α) were up-regulated in the flaps with ischemia and venous congestion. With all treatment modalities, its serum levels were significantly increased in flaps with venous congestion and significantly decreased in ischemic flaps. Our analyses suggest that the best treatment option for ischemic flaps is clopidogrel, while for flaps with venous congestion are nitroglycerin and BoTA.

Place, publisher, year, edition, pages
Nature Publishing Group, 2022
National Category
Surgery
Identifiers
urn:nbn:se:liu:diva-192151 (URN)10.1038/s41598-022-24898-9 (DOI)000969757300018 ()36463303 (PubMedID)
Available from: 2023-03-06 Created: 2023-03-06 Last updated: 2024-01-10Bibliographically approved
Abdelrahman, I., Steinvall, I., Sjöberg, F., Ellabban, M. A., Zdolsek, J. & Elmasry, M. (2022). Pros and Cons of Early and Late Skin Grafting in Children with Burns—Evaluation of Common Concepts. European Burn Journal, 3(1), 180-187
Open this publication in new window or tab >>Pros and Cons of Early and Late Skin Grafting in Children with Burns—Evaluation of Common Concepts
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2022 (English)In: European Burn Journal, E-ISSN 2673-1991, Vol. 3, no 1, p. 180-187Article in journal (Refereed) Published
Abstract [en]

Background: There is no consensus regarding the timing of surgery in children with smallerburn size, specifically in deep dermal burns. Delayed surgery has risks in terms of infection anddelayed wound healing. Early surgery also risks the removal of potentially viable tissue. Our aim wasto investigate the effect of the timing of surgical intervention on the size of the area operated on andthe time to wound healing. Methods: A retrospective analysis for all children (<18 years) with burnsize <20% body surface area (BSA%) during 2009–2020 who were operated on with a split-thicknessskin graft. The patients were grouped by the timing of the first skin graft operation: early = operatedon within 14 days of injury; delayed = operated on more than two weeks after injury. Results: A totalof 84 patients were included in the study, 43 who had an early operation and 41 who had a delayedoperation. There were no differences between the groups regarding burn size, or whether the burnswere superficial or deep. The mean duration of healing time was seven days longer in the group withdelayed operation (p = 0.001). The area operated on was somewhat larger (not significantly so) in thegroup who had early operation. Nine children had two skin graft operations, eight in the early groupand one in the delayed group (p = 0.03). Conclusion: The patients who were operated on early hadthe advantage of a shorter healing time, but there was a higher rate of complementary operationsand a tendency towards a larger burn excision.

Place, publisher, year, edition, pages
MDPI, 2022
Keywords
burns; children; healing time; burn surgery; skin graft
National Category
Surgery
Identifiers
urn:nbn:se:liu:diva-183535 (URN)10.3390/ebj3010015 (DOI)
Available from: 2022-03-17 Created: 2022-03-17 Last updated: 2024-06-24Bibliographically approved
Steinvall, I., Elmasry, M., Abdelrahman, I., Elserafy, A. T. & Sjöberg, F. (2021). Addition of admission lactate levels to Baux score improves mortality prediction in severe burns.. Scientific Reports, 11(1), Article ID 18038.
Open this publication in new window or tab >>Addition of admission lactate levels to Baux score improves mortality prediction in severe burns.
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2021 (English)In: Scientific Reports, E-ISSN 2045-2322, Vol. 11, no 1, article id 18038Article in journal (Refereed) Published
Abstract [en]

Risk adjustment and mortality prediction models are central in optimising care and for benchmarking purposes. In the burn setting, the Baux score and its derivatives have been the mainstay for predictions of mortality from burns. Other well-known measures to predict mortality stem from the ICU setting, where, for example, the Simplified Acute Physiology Score (SAPS 3) models have been found to be instrumental. Other attempts to further improve the prediction of outcome have been based on the following variables at admission: Sequential Organ Failure Assessment (aSOFA) score, determinations of aLactate or Neutrophil to Lymphocyte Ratio (aNLR). The aim of the present study was to examine if estimated mortality rate (EMR, SAPS 3), aSOFA, aLactate, and aNLR can, either alone or in conjunction with the others, improve the mortality prediction beyond that of the effects of age and percentage total body surface area (TBSA%) burned among patients with severe burns who need critical care. This is a retrospective, explorative, single centre, registry study based on prospectively gathered data. The study included 222 patients with median (25th-75th centiles) age of 55.0 (38.0 to 69.0) years, TBSA% burned was 24.5 (13.0 to 37.2) and crude mortality was 17%. As anticipated highest predicting power was obtained with age and TBSA% with an AUC at 0.906 (95% CI 0.857 to 0.955) as compared with EMR, aSOFA, aLactate and aNLR. The largest effect was seen thereafter by adding aLactate to the model, increasing AUC to 0.938 (0.898 to 0.979) (p < 0.001). Whereafter, adding EMR, aSOFA, and aNLR, separately or in combinations, only marginally improved the prediction power. This study shows that the prediction model with age and TBSA% may be improved by adding aLactate, despite the fact that aLactate levels were only moderately increased. Thereafter, adding EMR, aSOFA or aNLR only marginally affected the mortality prediction.

Place, publisher, year, edition, pages
Nature Publishing Group, 2021
National Category
Surgery
Identifiers
urn:nbn:se:liu:diva-179204 (URN)10.1038/s41598-021-97524-9 (DOI)000694868000037 ()34508143 (PubMedID)
Note

Fundin agencies: Open access funding provided by Linköping University. This study was funded by the department of Hand Surgery, Plastic Surgery and Burns, and Linköping University, Linköping, Sweden; The Carnegie Foundation; and the research fund of King Gustaf the 5th and Queen Victoria, Stockholm, Sweden.

Available from: 2021-09-13 Created: 2021-09-13 Last updated: 2024-01-10Bibliographically approved
Ellabban, M. A., Ibrahim, A. M., Gomah, A. A., Salah, O., Abdelrahman, I., Steinvall, I., . . . Aboelnaga, A. M. (2021). Assessment of Freestyle Local Facial Perforator Flaps for Coverage of Facial Defects. The Journal of Craniofacial Surgery, 32(2), e122-e125
Open this publication in new window or tab >>Assessment of Freestyle Local Facial Perforator Flaps for Coverage of Facial Defects
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2021 (English)In: The Journal of Craniofacial Surgery, ISSN 1049-2275, E-ISSN 1536-3732, Vol. 32, no 2, p. e122-e125Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To assess local freestyle facial perforator flaps in the reconstruction of small to medium-sized facial defects.

MATERIALS AND METHODS: In a case series, local freestyle perforator flaps were used in Suez Canal University Hospital to reconstruct 28 facial defects in 26 patients between 2017 and 2019. Adequate perforators were identified near those defects and flaps were designed as propeller or VY advancement. Four scales from the FACE-Q (satisfaction with facial appearance, satisfaction with the outcome, psychological function, and appearance-related psychosocial distress) and 2 scales from the SCAR-Q (Appearance scale and Symptom scale) were used as well as the observer part of the Patient and Observer Scar Assessment Scale. The mean follow up period was 10 months.

RESULTS: Complete reconstruction was achieved in all cases with a high rate of patient satisfaction which was assessed by FACE-Q and SCAR-Q. Moreover, observer assessment by Patient and Observer Scar Assessment Scale score showed high patient satisfaction with the scars with a mean (SD) 15.5 (3.4) and there was a positive correlation between subjective and objective: results (r2 from 0.27 to 0.41, P < 0.01). Regarding complications, bulkiness occurred in 2 flaps, congestion in 2 flaps, dehiscence in 1 flap, and tip necrosis in 5 flaps. Accordingly, secondary intervention in the form of medicinal leech therapy was used in 3 flaps, delayed closure for the dehisced flap and debulking for 1 flap.

CONCLUSIONS: Local freestyle perforator flap reconstruction is one of the recommended techniques for small to medium-sized facial defects which gives a high aesthetic outcome and patient satisfaction.

Place, publisher, year, edition, pages
Wolters Kluwer, 2021
Keywords
Face-Q; facial perforators; facial reconstruction; POSAS; SCAR-Q
National Category
Surgery
Identifiers
urn:nbn:se:liu:diva-173118 (URN)10.1097/SCS.0000000000006848 (DOI)000662269900005 ()33337708 (PubMedID)
Available from: 2021-02-04 Created: 2021-02-04 Last updated: 2024-01-10Bibliographically approved
Ellabban, M. A., Wyckman, A., Abdelrahman, I., Steinvall, I. & Elmasry, M. (2021). Dual Reconstruction of Lumbar and Gluteal Defects with Freestyle Propeller Flap and Muscle Flap. Plastic and Reconstructive Surgery - Global Open, 9(1), Article ID e3376.
Open this publication in new window or tab >>Dual Reconstruction of Lumbar and Gluteal Defects with Freestyle Propeller Flap and Muscle Flap
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2021 (English)In: Plastic and Reconstructive Surgery - Global Open, E-ISSN 2169-7574, Vol. 9, no 1, article id e3376Article in journal (Refereed) Published
Abstract [en]

Background: The reconstruction of complex tissue defects in the lumbar and gluteal areas is a surgical challenge. The use of freestyle perforator-based flaps has gained popularity in the reconstruction of these defects due to several advantages: versatility, minimal donor-site morbidity, and tension-free closure. The present study reports the outcome of using a dual coverage of lumbar and gluteal defects with a gluteus maximus rotation flap as a deep layer and a freestyle propeller perforator-based flap as a superficial layer. Methods: A retrospective analysis of 18 patients who had a dual coverage of complex wounds of the lumbar and the gluteal areas was conducted. Different propeller flaps were used as superior gluteal artery perforator flap (SGAP), inferior gluteal artery perforator flap (IGAP), and posterior thigh perforator flap (PTP). Results: The study included 15 men and 3 women. The mean age was 26.3 years. The causes of the defects were: pressure ulcers in 14 patients and post-traumatic in 4 patients. A total of 28 freestyle flaps was used: 11 patients had 1 flap, 4 had 2 flaps, and 3 had 3 flaps. The mean postoperative follow-up was 12.2 months. The complications registered in the medical records were venous congestion in 2 patients, partial flap necrosis in 2 patients, and wound dehiscence in 1 patient. Conclusions: A freestyle propeller perforator-based flap combined with a gluteus maximus muscle flap is a solution that provides well-padding over bony prominence with a low complication rate. However, a long-term follow-up is needed to verify these results. Published online 26 January 2021. Received for publication October 7, 2020; accepted November 23, 2020. Disclosure: The authors have no financial interest to declare in relation to the content of this article. Mohamed A. Ellabban, MSc, MRCS, MD, FEBOPRAS Plastic and Reconstructive Surgery Unit Surgery Department Faculty of Medicine Suez Canal University Ismailia, Egypt E-mail: Mohamed.ellabban@med.suez.edu.eg This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Copyright © 2021 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Society of Plastic Surgeons. All rights reserved.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2021
National Category
Surgery
Identifiers
urn:nbn:se:liu:diva-173121 (URN)10.1097/GOX.0000000000003376 (DOI)000663824700048 ()33564594 (PubMedID)
Available from: 2021-02-04 Created: 2021-02-04 Last updated: 2024-01-17Bibliographically approved
Abdelrahman, I., Vieweg, R., Irschik, S., Steinvall, I., Sjöberg, F. & Elmasry, M. (2020). Development of delirium: Association with old age, severe burns, and intensive care. Burns, 46(4), 797-803
Open this publication in new window or tab >>Development of delirium: Association with old age, severe burns, and intensive care
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2020 (English)In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 46, no 4, p. 797-803Article in journal (Refereed) Published
Abstract [en]

Background Delirium is defined as a disturbance of attention and awareness that develops over a short period of time, is a change from the baseline, and typically fluctuates over time. Burn care involves a high prevalence of known risk factors for delirium such as sedation, inflammation, and prolonged stay in hospital. Our aim was to explore the extent of delirium and the impact of factors associated with it for adult patients who have been admitted to hospital with burns. Methods In this retrospective study, all adult patients who had been admitted with burns during a four-year period were studied, including both those who were treated with intensive care and intermediate care only (no intensive care). Daily records of the assessment of delirium using the Nursing Delirium Screening Scale (Nu-DESC) were analysed together with age, sex, the percentage of total body surface area burned, operations, and numbers of wound care procedures under anaesthesia, concentrations of plasma C-reactive protein, and other clinical variables. Logistic regression was used to analyse factors that were associated with delirium and its effect on mortality, and linear regression was used to analyse its effect on the duration of hospital stay. Results Fifty-one patients (19%) of the total 262 showed signs of delirium (Nu-DESC score of 2 or more) at least once during their stay in hospital. Signs of delirium were recorded in 42/89 patients (47%) who received intensive care, and in 9/173 (5%) who had intermediate care. Independent factors for delirium in the multivariable regression were: age over 74 years; number of operations and wound care procedures under anaesthesia; and the provision of intensive care (area under the curve 0.940, 95% CI 0.899–0.981). Duration of hospital stay, adjusted for age and burn size, was 13.2 (95% CI 7.4–18.9, p < 0.001) days longer in the group who had delirium. We found no independent effects of delirium on mortality. Conclusion We found a strong association between delirium and older age, provision ofr intensive care, and number of interventions under anaesthesia. A further 5% of patients who did not receive intensive care also showed signs of delirium, which is a finding that deserves to be thoroughly investigated in the future.

Place, publisher, year, edition, pages
Elsevier, 2020
Keywords
Burns, Delirium, Inflammation, Intensive care, Wound care procedures, Old age
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:liu:diva-164415 (URN)10.1016/j.burns.2020.02.013 (DOI)000538860100006 ()
Note

Funding agencies: department of Hand Surgery, Plastic Surgery and Burns; Linkoping University, Linkoping, Sweden

Available from: 2020-03-19 Created: 2020-03-19 Last updated: 2024-01-10Bibliographically approved
Abdelrahman, I., Steinvall, I., Elmasry, M. & Sjöberg, F. (2020). Lidocaine infusion has a 25% opioid-sparing effect on background pain after burns: A prospective, randomised, double-blind, controlled trial. Burns, 46(2), 465-471
Open this publication in new window or tab >>Lidocaine infusion has a 25% opioid-sparing effect on background pain after burns: A prospective, randomised, double-blind, controlled trial
2020 (English)In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 46, no 2, p. 465-471Article in journal (Refereed) Published
Abstract [en]

Background

The pain of a burn mainly results from the inflammatory cascade that is induced by the injured tissue, and is classified as background, breakthrough, procedural and postoperative pain. High doses of opioids are usually needed to treat background pain, so its management includes a combination of types of analgesia to reduce the side effects. Lidocaine given intravenously has been shown in two small, uncontrolled studies to have an appreciable effect on pain after burns.

Objectives

In this prospective double-blind controlled trial we aimed to examine and quantify the opioid-sparing effect of a continuous infusion of lidocaine for the treatment of background pain during the early period after a burn.

Methods

Adult patients injured with burns of >10 total body surface area burned (TBSA%) and treated with a morphine based patient-controlled analgesia device (PCA) were randomised to have either lidocaine infusion starting with a bolus dose (1 mg lidocaine/kg) followed by continuous infusion (180 mg lidocaine/hour) or a placebo infusion, for seven consecutive days. Total daily consumption of opioids (mg) and amount of pain (visual analogue score, VAS) were recorded.

Results

We included 19 patients, 10 of whom were given a lidocaine infusion. There were no differences between groups in VAS, TBSA%, time of enrolment to the study since the initial burn, or duration of hospital stay. The opioid consumption in the lidocaine group declined by roughly 25% during the period of the study.

Conclusion

An intravenous infusion of lidocaine was safe and had an opioid-sparing effect when treating background pain in burns.

Place, publisher, year, edition, pages
Elsevier, 2020
Keywords
Lidocaine infusion, Background pain, Burns, Opioid sparing effect, Randomized controlled trial
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:liu:diva-160128 (URN)10.1016/j.burns.2019.08.010 (DOI)000520838400028 ()31493952 (PubMedID)
Note

Funding agencies: Department of Hand Surgery, Plastic Surgery, and Burns; Linkoping University, Linkoping, Sweden

Available from: 2019-09-06 Created: 2019-09-06 Last updated: 2024-01-10Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-2500-728X

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