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1. Choosing wisely in burn care

Author

Rogers, A.D., primary, Amaral, A., additional, Cartotto, R., additional, El Khatib, A., additional, Fowler, R., additional, Logsetty, S., additional, Malic, C., additional, Mason, S., additional, Nickerson, D., additional, Papp, A., additional, Rasmussen, J., additional, and Wallace, D., additional

Published
2022
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7. 44 Inhalation Injury Does Not Increase Blood Transfusion Requirements Following Burn Injury in Adults

Author

Cartotto, R, primary, Taylor, S L, additional, Holmes IV, J H, additional, Arnoldo, B, additional, Peck, M, additional, Cochran, A, additional, King, B T, additional, Dominic, W, additional, Bhavsar, D, additional, Tredget, E E, additional, Stapelberg, F, additional, Mozingo, D, additional, Friedman, B, additional, Greenhalgh, D G, additional, Pollock, B H, additional, and Palmieri, T L, additional

Published
2019
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8. Transfusion Requirement in Burn Care Evaluation (TRIBE)

Author

Palmieri, TL, Holmes, JH, Arnoldo, B, Peck, M, Potenza, B, Cochran, A, King, BT, Dominic, W, Cartotto, R, Bhavsar, D, Kemalyan, N, Tredget, E, Stapelberg, F, Mozingo, D, Friedman, B, Greenhalgh, DG, Taylor, SL, and Pollock, BH

Abstract

© 2017 Wolters Kluwer Health, Inc. All rights reserved. Objective: Our objective was to compare outcomes of a restrictive to a liberal red cell transfusion strategy in 20% or more total body surface area (TBSA) burn patients. We hypothesized that the restrictive group would have less blood stream infection (BSI), organ dysfunction, and mortality. Background: Patients with major burns have major (>1 blood volume) transfusion requirements. Studies suggest that a restrictive blood transfusion strategy is equivalent to a liberal strategy. However, major burn injury is precluded from these studies. The optimal transfusion strategy in major burn injury is thus needed but remains unknown. Methods: This prospective randomized multicenter trial block randomized patients to a restrictive (hemoglobin 7-8 g/dL) or liberal (hemoglobin 10-11 g/dL) transfusion strategy throughout hospitalization. Data collected included demographics, infections, transfusions, and outcomes. Results: Eighteen burn centers enrolled 345 patients with 20% or more TBSA burn similar in age, TBSA burn, and inhalation injury. A total of 7054 units blood were transfused. The restrictive group received fewer blood transfusions: mean 20.3 ± 32.7 units, median = 8 (interquartile range: 3, 24) versus mean 31.8 ± 44.3 units, median = 16 (interquartile range: 7, 40) in the liberal group (P < 0.0001, Wilcoxon rank sum). BSI incidence, organ dysfunction, ventilator days, and time to wound healing (P > 0.05) were similar. In addition, there was no 30-day mortality difference: 9.5% restrictive versus 8.5% liberal (P = 0.892, χ 2 test). Conclusions: A restrictive transfusion strategy halved blood product utilization. Although the restrictive strategy did not decrease BSI, mortality, or organ dysfunction in major burn injury, these outcomes were no worse than the liberal strategy (Clinicaltrials.gov identifier NCT01079247).

Published
2017

9. Inhalation Injury Does Not Influence the Amount of Blood Transfused to Major Burn Patients: A Secondary Analysis from the Transfusion Requirement in Burn Care Evaluation Study.

Author

Cartotto, Robert, Taylor, Sandra L, Holmes, James H, Arnoldo, Brett, Peck, Michael, Cochran, Amalia, Col, Booker T King, Bhavsar, Dhaval, Tredget, Edward E, Stapelberg, Francois, Friedman, Bruce, Mozingo, David, Greenhalgh, David, Pollock, Bradley H, Palmieri, Tina L, Cartotto, R, Taylor, S L, Holmes, J H, Arnoldo, B, and Peck, M

Subjects
INHALATION injuries, RED blood cell transfusion, BURN patients, SECONDARY analysis, BLOOD transfusion, TREATMENT for burns & scalds, BACTEREMIA, PNEUMONIA, RESEARCH, AGE distribution, BURNS & scalds, RESEARCH methodology, SMOKE inhalation injuries, HEALTH status indicators, APACHE (Disease classification system), EVALUATION research, MEDICAL cooperation, HOSPITAL mortality, ARTIFICIAL respiration, COMPARATIVE studies, TRAUMA severity indices
Abstract

Patients with major burn injuries typically require numerous blood transfusions. It is not known if an inhalation injury (INHI) directly influences the need for blood transfusion. The purpose of this study was to determine whether INHI increases the amount of blood transfused to major burn patients. A secondary analysis from the Transfusion Requirement in Burn Care Evaluation (TRIBE) study was conducted. Patients with INHI were compared with patients without INHI. The number of red blood cell (RBC) transfusions per day (RBC per day) between INHI and No INHI was analyzed with a multivariable regression. Patients with INHI (n = 78) had significantly larger burns (P = .0004), larger full-thickness burns (P = .0007), greater admission APACHE score (P < .0001), higher admission multiple organ dysfunction scores (P < .0001), and were transfused more RBC per day (P = .009) than No INHI patients (n = 267). In the multivariable regression analysis, RBC per day was significantly associated with the %TBSA burn (P < .0001), age of the patient (P = .004), the need for more than 1 day of mechanical ventilation (P < .0001), the occurrence of at least one blood stream infection (BSI; P = .044), and being assigned to the liberal transfusion arm of TRIBE (P < .001) but not the presence of INHI (P = .056). The null hypothesis that INHI exerts no influence on the amount of blood transfused could not be rejected. Larger burn size, advanced patient age, mechanical ventilation, and BSIs are important determinants of the blood transfusion rate in major burn patients. [ABSTRACT FROM AUTHOR]

Published
2019
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12. 5 Does the Storage Age of Blood Transfused to Burn Patients Matter?

Author

Cartotto, R, primary, Taylor, S L, additional, Holmes, J H, additional, Arnoldo, B, additional, Peck, M, additional, Potenza, B, additional, Cochran, A, additional, King Col, B T, additional, Dominic, W, additional, Bhavsar, D, additional, Kemalyan, N, additional, Tredget, E E, additional, Stapelberg, F, additional, Friedman, B, additional, Mozingo, D, additional, Greenhalgh, D, additional, Palmieri, T L, additional, and Pollock, B H, additional

Published
2018
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14. Major psychological complications and decreased health-related quality of life among survivors of Stevens-Johnson syndrome and toxic epidermal necrolysis

Author

Dodiuk-Gad, R.P., primary, Olteanu, C., additional, Feinstein, A., additional, Hashimoto, R., additional, Alhusayen, R., additional, Whyte-Croasdaile, S., additional, Finkelstein, Y., additional, Burnett, M., additional, Sade, S., additional, Cartotto, R., additional, Jeschke, M., additional, and Shear, N.H., additional

Published
2016
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15. The Use of Biosynthetic Skin Substitute (Biobrane) in the Treatment of Exfoliative Skin Disorders

Author

Tobbia, D., Sattler, T., and Cartotto, R.

Subjects
stomatognathic diseases, integumentary system, ddc: 610, 610 Medical sciences, Medicine
Abstract

Introduction: Toxic epidermal necrolysis (TEN) is a rare dermatologic disease that is part of a spectrum of drug related exfoliative disorders including Steven-Johnson syndrome (SJS) and SJS/TEN overlap. These are characterized by a variable degree of epidermal detachment at the dermoepidermal [for full text, please go to the a.m. URL], 126. Kongress der Deutschen Gesellschaft für Chirurgie

Published
2009

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