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To investigate early hemodynamics of severely burned patients via PiCCO and to discuss clinical significance of hemodynamic monitoring for burn shock resuscitation, 55 extensive burn patients were enrolled in this retrospective study. The fluid resuscitation was guided according to Chinese General Formula and adjusted with urinary output of 0.5-1.0 ml/h/kg as a resuscitation goal. All patients were diagnosed within a relatively stable condition during burn shock stage, and they received PiCCO monitoring within 6 hours after burn. The preload parameter intrathoracic blood volume index was low at first, then returned to normal. The flow parameter cardiac index and myocardial contractility parameter dPmax were gradually changed from low level in the early stage to high level in the fluid reabsorption stage. The afterload parameter systemic vascular resistance index had completely opposite tendency. The lung-related parameters extravascular lung water index and pulmonary vascular permeability index were roughly in the normal range. The change of cardiac index had a linear regression relationship with dPmax and systemic vascular resistance index but had no significant relationship with intrathoracic blood volume index. Under effective fluid resuscitation, the early hemodynamics after burn is still in dynamically changing status, characterized as transition from low cardiac output (CO)-high vascular resistance in early shock stage to high CO-low vascular resistance in fluid reabsorption stage. CO mainly depends on the myocardial contractility and vascular resistance, but not on the blood volume. Excessive fluid resuscitation cannot get normal CO. The normal value of hemodynamics cannot be used as end point of burn shock resuscitation. Dynamic observation of hemodynamics is of great importance. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To explore the risk factors relating to lower digestive tract haemorrhage in severe burns and summarise the experience in clinical diagnosis and treatment. Method: General data of 103 patients with severe extensive burns (EBs) admitted to our burn centre in Shanghai between 1997 and 2009 were reviewed retrospectively. The risk factors relating to EB-complicated lower digestive tract haemorrhage were analysed systematically with respect to the clinical features and experiences in treatment, and prognosis. Results: Of the 103 severe EBs, five developed lower digestive tract haemorrhage with an occurrence of 4.9%. Four of them were proved to have multiple mucosal erosions in caecum, colon and rectum, and the remaining one was proved rectal ulcerative haemorrhage. In comparison with upper digestive tract haemorrhage, lower digestive tract haemorrhage in the present group was characterised by a longer duration (median 4.0 days, interquartile range (IQR) 1.5–14.5 days vs. median 2.0 days (IQR 1.0–3.0 days), P <0.05). Deep burns, especially fourth-degree burns, with complications of severe systemic infection, formed the main risk factors relating to lower digestive tract haemorrhage in severe EB patients. Conclusion: Severe EB-complicated lower digestive tract haemorrhage is a critical condition in burns, which usually have deep wounds with severe infection surfaces that are difficult to deal with. Enteroscopic haemostasis in controlling lower digestive tract haemorrhage is usually ineffective. Clinical experiences indicate that early management of the wound with effective preventive and therapeutive measures for infection control may be a good choice in the prevention and treatment of lower digestive tract haemorrhage leading to improvement in its prognosis. [Copyright &y& Elsevier]

Abstract: The 105 patients admitted to our Burn Institute from 1st January 1996 to 31st December 2007, with ship fire-related burns were studied retrospectively. The mean age was 30.2±12.6 years with a range of 1–58. One hundred and three patients (98.1%) were men and 2 (1.9%) women. The mean total burn surface area (TBSA) was 46.5%, mostly deep burns. The most common areas of burn were the head, neck and upper limb. Summer months July, August, June and September were times of highest incidence. Fifty-seven (54.3%) patients had inhalation injury, 42 received tracheotomy, and 38 received mechanical ventilation. The treatment was complex, difficult, long, and costly. The interval between burn and start of resuscitation ranged from 2.1 to 67h with a mean of (5.9±4.4)h. Forty-two patients (40%) started intravenous fluid resuscitation 6h after burn. Twenty-four patients (23%) received insufficient fluid resuscitation developed hypotension and severe shock at admission. Ninety-two (87.6%) patients required operations including tracheotomy, debridement and grafting, per patient was 5.2. The mean length of hospital stay was 44.2 days. Pulmonary edema was the most common complication during the early post-burn period (within 7 days), and sepsis during the later period (>7 days). Nine patients died of MODS or sepsis, giving a mortality rate of 8.57%. Conclusion: Caution and preventive measures are needed for persons in ships for fire-related burns. [Copyright &y& Elsevier]