112 results on '"Renz EM"'
Search Results
2. High risk but not always lethal: the effect of cirrhosis on thermally injured adults.
- Author
-
Burns CJ, Chung KK, Aden JK, Lundy JB, Nitzschke SL, Renz EM, Cancio LC, Burns, Christopher J, Chung, Kevin K, Aden, James K, Lundy, Jonathan B, Nitzschke, Stephanie L, Renz, Evan M, and Cancio, Leopoldo C
- Published
- 2013
- Full Text
- View/download PDF
3. Prone positioning improves oxygenation in adult burn patients with severe acute respiratory distress syndrome.
- Author
-
Hale DF, Cannon JW, Batchinsky AI, Cancio LC, Aden JK, White CE, Renz EM, Blackbourne LH, and Chung KK
- Published
- 2012
- Full Text
- View/download PDF
4. Resuscitation of severely burned military casualties: fluid begets more fluid.
- Author
-
Chung KK, Wolf SE, Cancio LC, Alvarado R, Jones JA, McCorcle J, King BT, Barillo DJ, Renz EM, and Blackbourne LH
- Published
- 2009
- Full Text
- View/download PDF
5. Identification of cutaneous functional units related to burn scar contracture development.
- Author
-
Richard RL, Lester ME, Miller SF, Bailey JK, Hedman TL, Dewey WS, Greer M, Renz EM, Wolf SE, Blackbourne LH, Richard, Reginald L, Lester, Mark E, Miller, Sidney F, Bailey, J Kevin, Hedman, Travis L, Dewey, William S, Greer, Michelle, Renz, Evan M, Wolf, Steven E, and Blackbourne, Lorne H
- Published
- 2009
- Full Text
- View/download PDF
6. Military return to duty and civilian return to work factors following burns with focus on the hand and literature review.
- Author
-
Chapman TT, Richard RL, Hedman TL, Chisholm GB, Quick CD, Baer DG, Dewey WS, Jones JS, Renz EM, Barillo DJ, Cancio LC, Chung KK, Holcomb JB, Wolf SE, Chapman, Ted T, Richard, Reg L, Hedman, Travis L, Chisholm, Gary B, Quick, Charles D, and Baer, David G
- Published
- 2008
- Full Text
- View/download PDF
7. A clarion to recommit and reaffirm burn rehabilitation.
- Author
-
Richard RL, Hedman TL, Quick CD, Barillo DJ, Cancio LC, Renz EM, Chapman TT, Dewey WS, Dougherty ME, Esselman PC, Forbes-Duchart L, Franzen BJ, Hunter H, Kowalske K, Moore ML, Nakamura DY, Nedelec B, Niszczak J, Parry I, and Serghiou M
- Published
- 2008
- Full Text
- View/download PDF
8. Burn center treatment of patients with severe anhydrous ammonia injury: case reports and literature review.
- Author
-
White CE, Park MS, Renz EM, Kim SH, Ritenour AE, Wolf SE, Cancio LC, White, Christopher E, Park, Myung S, Renz, Evan M, Kim, Seung H, Ritenour, Amber E, Wolf, Steven E, and Cancio, Leopoldo C
- Published
- 2007
- Full Text
- View/download PDF
9. Evolution of burn resuscitation in operation Iraqi freedom.
- Author
-
Chung KK, Blackbourne LH, Wolf SE, White CE, Renz EM, Cancio LC, Holcomb JB, Barillo DJ, Chung, Kevin K, Blackbourne, Lorne H, Wolf, Steven E, White, Christopher E, Renz, Evan M, Cancio, Leopoldo C, Holcomb, John B, and Barillo, David J
- Published
- 2006
- Full Text
- View/download PDF
10. Image of the month. Send serum for coagulation studies and obtain computed tomographic imaging of the brain.
- Author
-
Renz EM, Ling G, Mork KJ, and Ecklund JM
- Published
- 2012
11. Comparison of traditional burn wound mapping with a computerized program.
- Author
-
Williams JF, King BT, Aden JK, Serio-Melvin M, Chung KK, Fenrich CA, Salinas J, Renz EM, Wolf SE, Blackbourne LH, Cancio LC, Williams, James F, King, Booker T, Aden, James K, Serio-Melvin, Maria, Chung, Kevin K, Fenrich, Craig A, Salinas, José, Renz, Evan M, and Wolf, Steven E
- Published
- 2013
- Full Text
- View/download PDF
12. The US Army burn center: Professional service during 10 years of war.
- Author
-
Renz EM, King BT, Chung KK, White CE, Lundy JB, Lairet KF, Maani CF, Young AW, Stout LR, Chan RK, Wolf SE, Baer DG, Cancio LC, and Blackbourne LH
- Published
- 2012
- Full Text
- View/download PDF
13. Prehospital interventions performed in a combat zone: a prospective multicenter study of 1,003 combat wounded.
- Author
-
Lairet JR, Bebarta VS, Burns CJ, Lairet KF, Rasmussen TE, Renz EM, King BT, Fernandez W, Gerhardt R, Butler F, DuBose J, Cestero R, Salinas J, Torres P, Minnick J, and Blackbourne LH
- Published
- 2012
- Full Text
- View/download PDF
14. Advances in surgical care: management of severe burn injury.
- Author
-
White CE and Renz EM
- Abstract
BACKGROUND: Management of combat casualties with severe burns and associated traumatic injuries requires a coordinated interaction of surgical, critical care, and evacuation assets. These patients present enormous challenges to the entire medical system as a result of the severity of injury combined with the great distance required for transport to definitive care. OBJECTIVE: The objective of this study was to review and highlight some of the advances in burn critical care experienced during recent combat operations. This review focuses on initial resuscitation, respiratory support, care of the burn wound, and long range evacuation. DATA SOURCE: The authors conducted a search of the MEDLINE database and manual review of published articles and abstracts from national and international meetings in addition to Institute of Surgical Research Burn Center registry. CONCLUSIONS: Fluid resuscitation during the first 24 to 48 hrs after injury remains a significant challenge for all who manage burn casualties. Guidelines have been developed in an effort to standardize fluid resuscitation during this time. These guidelines along with the standardization of burn wound care and continued provider education have resulted in decreased morbidity and mortality in severely burned patients returning from war zones. This system of care for severely burned patients facilitates the transfer of the burn casualty between healthcare providers and facilities and is now being integrated into the catchment area for the Institute of Surgical Research Burn Center. [ABSTRACT FROM AUTHOR]
- Published
- 2008
- Full Text
- View/download PDF
15. Comparison of Silverlon dressing to Xeroform gauze in the treatment of skin graft donor site wounds.
- Author
-
Albrecht MC, Renz EM, Cancio LC, White CE, Blackbourne LH, Chung KK, Bielke P, Baer D, Wolf SE, and Holcomb JB
- Published
- 2008
16. Resuscitation of severely burned military casualties: fluid begets more fluid.
- Author
-
Chung KK, Alvarado RA, Renz EM, Cancio LC, Ennis J, Barillo DJ, Holcomb JB, and Wolf SE
- Published
- 2008
17. The rule of ten: a simplified approach to calculating the initial fluid rate in adults.
- Author
-
Chung KK, Blackbourne LH, Renz EM, Alvarado RA, Chisolm BG, Zarzabal L, Albrecht MC, Cancio LC, Holcolm JB, and Wolf SE
- Published
- 2008
18. Incidence of primary blast injury among soldiers burned in combat explosions.
- Author
-
Ritenour AE, Blackbourne LH, Ritenour JS, Renz EM, Eastridge BJ, Chung KK, Holcomb JB, Wold SE, and Wade CE
- Published
- 2007
19. Atlas of burn scar contractures: a patient education tool.
- Author
-
Richard RL, Hedman TL, Chapman TT, Renz EM, Williams JF, Wolf SE, and Holbomb JB
- Published
- 2007
20. Infectious complications of noncombat trauma patients provided care at a military trauma center.
- Author
-
Yun HC, Blackbourne LH, Jones JA, Holcomb JB, Hospenthal DR, Wolf SE, Renz EM, Murray CK, Yun, Heather C, Blackbourne, Lorne H, Jones, John A, Holcomb, John B, Hospenthal, Duane R, Wolf, Steven E, Renz, Evan M, and Murray, Clinton K
- Abstract
Infectious complications are reported frequently in combat trauma patients treated at military hospitals. Infections in 4566 noncombat related trauma patients treated at a military trauma center were retrospectively reviewed from 1/2003 to 5/2007 using registry data. Burns, penetrating, and blunt trauma accounted for 17%, 19%, and 64%, respectively; the median age was 38 and 22% were female. Pulmonary infections were present in 4.2% of patients, 2.4% had cellulitis and wound infections, 2.2% urinary infections, and 0.7% sepsis. On univariate analysis, infected patients were more likely to be admitted to the ICU, have longer ICU and hospital lengths of stay (LOS), and to die (p < 0.05). Multivariate analysis revealed associations between infection and hospital LOS, preexisting medical conditions, and lower Glasgow Coma Scale in nonburned patients. In burned patients, infection was associated with total body surface area burned and preexisting conditions (p < 0.01). Enhanced infection control in targeted trauma populations may improve outcomes. [ABSTRACT FROM AUTHOR]
- Published
- 2010
- Full Text
- View/download PDF
21. Burns sustained in combat explosions in Operations Iraqi and Enduring Freedom (OIF/OEF explosion burns)
- Author
-
Kauvar DS, Wolf SE, Wade CE, Cancio LC, Renz EM, and Holcomb JB
- Abstract
BACKGROUND: Burns comprise 5% of casualties evacuated from Operations Iraqi and Enduring Freedom (OIF and OEF). Many OIF/OEF burns result from the enemy's detonation of explosives. We reviewed these to evaluate mission impact and provide recommendations for improved combat burn protection. Data were compared to those from the Vietnam War. METHODS: All OIF/OEF patients with significant burns are treated at the U.S. Army Institute of Surgical Research (ISR). A review from April 2003 to April 2005 was undertaken. Records were obtained and demographics, burn severity and pattern, and early outcomes recorded. RESULTS: Two hundred and seventy-four OIF/OEF burn patients were treated, 142 (52%) sustained burns in explosions from hostile action. Age was 26+/-7 years (mean+/-S.D.). Mortality was 4%. The annual rate of combat explosion as a cause for burns increased from 18% to 69%, total body surface area burned increased from 15+/-12 to 21+/-23%, injury severity score rose from 8+/-11 to 17+/-18, and frequency of inhalation injury rose from 5% to 26%. Improvised explosive devices caused 55% of casualties, car bombs 16%, rocket-propelled grenades 15% and 14% other. The hands (80% of patients) and the face (77%) were the most frequently burned body areas. Burns were isolated to the hands in 6% of patients and to the face and hands in 15%. An average of 52+/-30% of the surface area of the hands and 45+/-26% of the face was burned. Mean length of stay was 24+/-25 days (median 14). Though 77% of patients were discharged without global disability, only 36% returned to full military duty. A similar pattern of injury and disposition was seen at the Army burn center in Vietnam (1966-1968), but mortality was higher (7.9%). CONCLUSION: Burns resulting from combat explosions increased in frequency, size and injury severity. Burns were concentrated on areas not protected by clothing or equipment. These injuries created long hospital stays and frequently prevented soldiers from returning to duty. While wound distribution has not changed, combat burn care has improved, and continued emphasis on military protective equipment for the hands and face is warranted. [ABSTRACT FROM AUTHOR]
- Published
- 2006
- Full Text
- View/download PDF
22. Burn Casualty Care in the Deployed Setting.
- Author
-
Driscoll IR, Mann-Salinas EA, Boyer NL, Pamplin JC, Serio-Melvin ML, Salinas J, Borgman MA, Sheridan RL, Melvin JJ, Peterson WC, Graybill JC, Rizzo JA, King BT, Chung KK, Cancio LC, Renz EM, and Stockinger ZT
- Subjects
- Anti-Bacterial Agents therapeutic use, Antibiotic Prophylaxis methods, Burns, Chemical drug therapy, Burns, Electric therapy, Guidelines as Topic, Humans, Military Medicine methods, Physical Examination methods, Burns therapy, Warfare
- Abstract
Management of wartime burn casualties can be very challenging. Burns frequently occur in the setting of other blunt and penetrating injuries. This clinical practice guideline provides a manual for burn injury assessment, resuscitation, wound care, and specific scenarios including chemical and electrical injuries in the deployed or austere setting. The clinical practice guideline also reviews considerations for the definitive care of local national patients, including pediatric patients, who are unable to be evacuated from theater. Medical providers are encouraged to contact the US Army Institute of Surgical Research (USAISR) Burn Center when caring for a burn casualty in the deployed setting.
- Published
- 2018
- Full Text
- View/download PDF
23. Postdischarge Cause-of-Death Analysis of Combat-Related Burn Patients.
- Author
-
Escolas SM, Archuleta DJ, Orman JA, Chung KK, and Renz EM
- Subjects
- Adult, Afghanistan, Age Factors, Burn Units, Burns diagnosis, Burns etiology, Burns therapy, Cohort Studies, Female, Humans, Incidence, Iraq, Male, Patient Discharge, Retrospective Studies, Sex Factors, Young Adult, Blast Injuries complications, Burns mortality, Cause of Death, Military Personnel statistics & numerical data, Registries, Warfare
- Abstract
Combat operations in Iraq and Afghanistan have resulted in up to 8.8% of combat-related casualties suffering burns. From World War I through Desert Storm, burns have been associated with approximately 4% of the combat-related deaths. Experiencing a blast injury and exposure to killing and death while deployed has been shown to increase suicide risk. Although several studies of military populations have investigated risk factors for death among burn patients during the acute phase, no studies have reported mortality rates, cause-of-death, or the prevalence of suicide after hospital discharge. This study examined the case fatality rate, causes of death, and the prevalence of suicide among 830 combat burn patients discharged from the sole burn center in the U.S. Department of Defense, between March 7, 2003 and March 6, 2013. Cause-of-death was determined through the Armed Forces Medical Examiner's Office and the Office of the Secretary of Defense's National Death Index. A total of 11 deaths occurred among the 830 burn survivors, for an overall case fatality rate of 1.3%. Of the 11 who died, five deaths were related to accidental poisoning by exposure to drugs; three were related to operations of war (two after returning to the war zone), and the remaining three died from other accidental causes (one explosion and two vehicle crashes). There was no indication of suicide or suspicion of suicide as a cause-of-death for the former patients included in this study, suggesting that combat burn injury did not appear to increase the risk of death by suicide in our study population. Further research is needed to understand the factors that contribute to the apparent resilience of combat burn survivors., Competing Interests: The authors have no conflicts of interest to declare. No funding was received from the National Institutes of Health, Wellcome Trust, and the Howard Hughes Medical Institute. The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the Department of the Army or the Department of Defense.
- Published
- 2017
- Full Text
- View/download PDF
24. Traumatic Injuries Incidental to Hydraulic Well Fracturing: A Case Series.
- Author
-
Williams JF, Lundy JB, Chung KK, Chan RK, King BT, Renz EM, and Cancio LC
- Subjects
- Adult, Burns therapy, Explosions, Female, Geologic Sediments, Humans, Male, Middle Aged, United States epidemiology, Wounds and Injuries therapy, Burns epidemiology, Hydraulic Fracking, Oil and Gas Industry, Wounds and Injuries epidemiology
- Published
- 2016
- Full Text
- View/download PDF
25. Inability to determine tissue health is main indication of allograft use in intermediate extent burns.
- Author
-
Fletcher JL, Cancio LC, Sinha I, Leung KP, Renz EM, and Chan RK
- Subjects
- Adolescent, Adult, Allografts, Body Surface Area, Burn Units, Humans, Intensive Care Units, Length of Stay, Logistic Models, Male, Military Personnel, Reoperation, Retrospective Studies, Trauma Severity Indices, Treatment Failure, Young Adult, Burns surgery, Registries, Skin Transplantation methods, Transplantation, Autologous methods, Transplantation, Homologous methods
- Abstract
Introduction: Cutaneous allograft is commonly used in the early coverage of excised burns when autograft is unavailable. However, allograft is also applied in intermediate-extent burns (25-50%), during cases in which it is possible to autograft. In this population, there is a paucity of data on the indications for allograft use. This study explores the indications for allograft usage in moderate size burns., Methods: Under an IRB-approved protocol, patients admitted to our burn unit between March 2003 and December 2010 were identified through a review of the burn registry. Data on allograft use, total burn surface area, operation performed, operative intent, number of operations, intensive care unit length of stay, and overall length of stay were collected and analyzed. Data are presented as means±standard deviations, except where noted., Results: In the study period, 146 patients received allograft during their acute hospitalization. Twenty-five percent of allograft recipients sustained intermediate-extent burns. Patients with intermediate-extent burns received allograft later in their hospitalization than those with large-extent (50-75% TBSA) burns (6.8 days vs. 3.4 days, p=0.01). Allografted patients with intermediate-extent burns underwent more operations (10.8 vs. 6.1, p=0.002) and had longer hospitalizations (78.3 days vs. 40.9 days, p<0.001) than non-allografted patients, when controlled for TBSA. Clinical rationale for placement of allograft in this population included autograft failure, uncertain depth of excision, lack of autograft donor site, and wound complexity. When uncertain depth of excision was the indication, allograft was universally applied onto the face. In half of allografted intermediate-extent burn patients the inability to identify a viable recipient bed was the ultimate reason for allograft use., Conclusions: Unlike large body surface area burns, allograft skin use in intermediate-extent injury occurs later in the hospitalization and is driven by the inability to determine wound bed suitability for autograft application. Allograft application can be utilized to test recipient site viability in cases of autograft failure or uncertain depth of excision., (Published by Elsevier Ltd.)
- Published
- 2015
- Full Text
- View/download PDF
26. A novel approach to graft loss in burn using the CelluTome™ epidermal harvesting system for spot grafting: a case report.
- Author
-
Howarth AL, Bell BE, Peterson WC, Renz EM, King BT, and Chan RK
- Subjects
- Adult, Graft Survival, Humans, Male, Burns surgery, Epidermis transplantation, Skin Transplantation methods, Tissue and Organ Harvesting methods
- Published
- 2015
- Full Text
- View/download PDF
27. Elevations in inflammatory cytokines are associated with poor outcomes in mechanically ventilated burn patients.
- Author
-
Shelhamer MC, Rowan MP, Cancio LC, Aden JK, Rhie RY, Merrill GA, Wolf SE, Renz EM, and Chung KK
- Subjects
- Adult, Aged, Female, Humans, Immunoassay, Intensive Care Units, Male, Middle Aged, Pneumonia, Ventilator-Associated blood, Predictive Value of Tests, Prognosis, Prospective Studies, Survival Analysis, Biomarkers blood, Burns blood, Burns mortality, Cytokines blood, Respiration, Artificial methods
- Abstract
Background: The treatment of burn patients who undergo mechanical ventilation is complicated by many factors; patient outcomes and mortality could potentially be improved with predictive biomarkers. Severe burn provokes a systemic inflammatory response characterized by the release of a host of cytokines. Recent studies evaluated the prognostic value of temporal changes in cytokine levels in several patient populations, but few have compared differences in the cytokine profiles of survivors and nonsurvivors following severe burn. We previously compared high-frequency percussive ventilation and low-tidal-volume ventilation and found no difference in mortality or cytokine levels between the two treatments. Since it is unknown whether cytokine levels are predictive of mortality in these patients, we performed a post hoc analysis comparing cytokine levels in survivors and nonsurvivors., Methods: We evaluated plasma levels of several cytokines (interleukin 1β [IL-1β], IL-6, IL-8, granulocyte-macrophage colony-stimulating factor, and tumor necrosis factor α) for their prognostic biomarker potential related to mortality at 0, 3, and 7 days in survivors and nonsurvivors of burns., Results: While the majority of values for IL-1β, granulocyte-macrophage colony-stimulating factor, and tumor necrosis factor α fell below the limit of quantification, univariate analysis demonstrated higher plasma levels of IL-6 and IL-8 in nonsurvivors on Day 7. Logistic regression revealed that elevated plasma IL-8 was independently associated with an increased likelihood of the composite end point of death or ventilator-associated pneumonia with odds ratios of 7.9, 26, and 7.3 on Days 0, 3, and 7, respectively., Conclusion: Early increases in plasma IL-8 are associated with a multifold increase in death or ventilator-associated pneumonia in mechanically ventilated burn patients., Level of Evidence: Prognostic/epidemiologic study, level IV; therapeutic study, level IV.
- Published
- 2015
- Full Text
- View/download PDF
28. Are visceral proteins valid markers for nutritional status in the burn intensive care unit?
- Author
-
Shields BA, Pidcoke HF, Chung KK, Wade CE, Martini WZ, Renz EM, and Wolf SE
- Subjects
- Adult, Aged, Biomarkers metabolism, Burns therapy, Female, Humans, Male, Middle Aged, Monitoring, Physiologic, Nutrition Assessment, Parenteral Nutrition, Prospective Studies, Young Adult, Burns metabolism, Dietary Proteins administration & dosage, Nitrogen metabolism, Nutritional Status
- Abstract
The aim of this study was to determine whether visceral protein levels increase under positive nitrogen balance during times of decrease in acute-phase reactant levels in patients with burn injury. This was a post hoc analysis of a prospective, interventional study approved by the local institutional review board. A total of 10 subjects between the ages of 18 and 72 with ≥ 20% total body surface area burn were enrolled over a 14-month period. Data were collected for five subjects (average age of 28 ± 8 years and total body surface area burn of 69 ± 15%) who met the inclusion criteria. Changes in visceral protein levels were examined along with nitrogen balance and acute-phase reactants when the subjects were on enteral nutrition, and the proteins were not examined during times of acute kidney injury. Descriptive statistics were performed, and linear regression was used to analyze the association of visceral proteins and nitrogen balance during times that acute-phase reactant levels were decreasing. The subjects received an average of 3044 ± 1613 kcal/day (39 ± 20 kcal/kg), meeting 72% of caloric goals and achieving positive nitrogen balance during 68% of the 40 weekly measurements, with 174 ± 85 g of protein intake per day (2.2 ± 1.1 g/kg). There was a weak relationship between nitrogen balance and changes in visceral protein levels during times that the acute-phase reactant levels were decreasing (P > .05). Visceral proteins were found to be poor markers of nutritional status. This study is unique because the subjects were able to achieve positive nitrogen balance despite severe burns.
- Published
- 2015
- Full Text
- View/download PDF
29. Operative utilization following severe combat-related burns.
- Author
-
Chan RK, Aden J, Wu J, Hale RG, Renz EM, and Wolf SE
- Subjects
- Adult, Amputation, Traumatic epidemiology, Autografts, Burns epidemiology, Burns, Inhalation surgery, Confidence Intervals, Facial Injuries epidemiology, Humans, Intensive Care Units statistics & numerical data, Length of Stay statistics & numerical data, Logistic Models, Male, Odds Ratio, United States, Young Adult, Body Surface Area, Burns surgery, Injury Severity Score
- Abstract
The goal of burn surgical therapy is to minimize mortality and to return survivors to their preinjury state. Prompt removal of the burn eschar, early durable coverage, and late corrections of functional deformities are the basic surgical principles. The operative burden, while presumed to be substantial and significant, is neither well described nor quantified. The burn registry at the U.S. Institute of Surgical Research Burn Center was queried from March 2003 to August 2011 for all active duty burn admissions; active duty subjects were chosen to eliminate subject follow-up as a significant variable. Subject demographics including age, sex, branch of service, injury type, injury severity score, transfusion, allograft use, length of stay, mechanism of injury, and survival were tabulated as were their percentage TBSA, specific body region involvement, and nature and dates of operations performed. Univariate analysis and multiple logistic regressions were performed to determine independent factors which predict early and late operative burden. In the 8-year study period, 864 active duty patients were admitted to the burn center. Among them, 569 (66%) were operative in nature. The operations that were performed during acute hospitalization were 62%, while the remaining 38% were performed following discharge. A linear relationship exists between TBSA and the number of acute operations with an average of one acute operation required per 5% TBSA. No direct relationships however were found between TBSA and the number of reconstructive operations. Based on multiple logistic regression, battle vs nonbattle (odds ratio [OR], 0.559; 95% confidence interval [CI], 0.298-1.050; P = .0706), injury severity score (OR, 1.021; 95% CI, 1.003-1.039; P = .0222), intensive care unit length of stay (OR, 1.076; 95% CI, 1.053-1.099; P ≤ .0001), allograft use (OR, 2.610; 95% CI, 1.472-4.628; P = .0010), and TBSA of the trunk (OR, 0.982; 95% CI, 0.965-1.000; P = .0439) (but not overall TBSA) were associated with a high acute operative burden. Battle vs nonbattle (OR, 0.546; 95% CI, 0.360-0.829; P = .0045), and TBSA of the upper extremities (OR, 1.008; 95% CI, 1.002-1.013; P = .0042) were noted to be significant variables in predicting late reconstruction operations. The operative burden of burn, not previously well characterized, consists of operations performed during as well as after the initial hospitalization. While injury severity and truncal involvement are significant determinants of acute surgical therapy, the presence of upper extremity burns is a significant determinant of reconstruction following discharge.
- Published
- 2015
- Full Text
- View/download PDF
30. Mucormycosis attributed mortality: a seven-year review of surgical and medical management.
- Author
-
Mitchell TA, Hardin MO, Murray CK, Ritchie JD, Cancio LC, Renz EM, and White CE
- Subjects
- Adult, Amputation, Surgical, Blast Injuries complications, Body Surface Area, Burn Units, Burns complications, Burns, Inhalation complications, Burns, Inhalation therapy, Humans, Mucormycosis etiology, Mucormycosis therapy, Retrospective Studies, Trauma Severity Indices, Wound Infection etiology, Wound Infection therapy, Young Adult, Antifungal Agents therapeutic use, Blast Injuries therapy, Burns therapy, Debridement, Military Personnel statistics & numerical data, Mucormycosis mortality, Wound Infection mortality
- Abstract
Introduction: Historically, mucormycosis infections have been associated with high mortality. The purpose of this study was to determine the incidence, associated mortality, and management strategies of mucormycosis in a major burn center., Methods: A retrospective review was performed via obtaining all patients with mucormycosis admitted from January 2003 to November 2009 at our adult burn center was performed obtaining demographic data relevant to fungal burn wound infection or colonization., Results: The incidence of mucormycosis at our facility was 4.9 per 1000 admissions; specifically, 11 military casualties and one civilian were diagnosed with mucormycosis. The median percentage Total Body Surface Area (TBSA) burned, 11 patients, or open wound, one patient, was 60 (IQR, 54.1-80.0), and the incidence of documented inhalation injury was 66.7% (8 of 12). Ten patients had surgical amputations. A median of eight days (IQR, 3.5-74.5) elapsed from diagnosis of mucormycosis until death in the 11 patients who expired. The overall mortality was 92%; however, autopsy attributed mucormycosis mortality was 54.5% (6 of 11) with all six patients having invasive mucormycosis., Conclusion: Aggressive surgical intervention should be undertaken for invasive mucormycosis; additionally, implementation of standardized protocols for patients with large soft tissue injuries may mitigate mucormycosis superimposition., (Published by Elsevier Ltd.)
- Published
- 2014
- Full Text
- View/download PDF
31. Extracorporeal membrane oxygenation in a patient with refractory acute respiratory distress syndrome secondary to toxic epidermal necrolysis.
- Author
-
Sine CR, Chung KK, Pamplin JC, Batchinsky AI, Hull JE, King BT, Derdak S, Walker J, McNeil JD, Renz EM, and Cannon JW
- Subjects
- Adult, Diagnosis, Differential, Female, Humans, Extracorporeal Membrane Oxygenation, Respiratory Distress Syndrome etiology, Respiratory Distress Syndrome therapy, Stevens-Johnson Syndrome complications, Stevens-Johnson Syndrome therapy
- Published
- 2014
- Full Text
- View/download PDF
32. Evaluation of an oxygen-diffusion dressing for accelerated healing of donor-site wounds.
- Author
-
Lairet KF, Baer D, Leas ML, Renz EM, and Cancio LC
- Subjects
- Adult, Burns diagnosis, Female, Hospitals, Military, Humans, Injury Severity Score, Male, Middle Aged, Pain Measurement, Prognosis, Prospective Studies, Risk Assessment, Skin Transplantation adverse effects, Time Factors, Treatment Outcome, Wound Infection prevention & control, Young Adult, Bandages, Burns surgery, Oxygen therapeutic use, Skin Transplantation methods, Transplant Donor Site surgery, Wound Healing physiology
- Abstract
Accelerating the healing process and reducing pain during healing are beneficial for the following reasons: faster return to work, lower risk of wound infection, improved quality of life, and possibly reduced need for analgesia. This clinical study assessed the effectiveness of a new oxygen-diffusion dressing (OxyBand; Oxyband Technologies, St. Louis, MO) compared with standard Xeroform gauze dressings (Convidien, Mansfield, MA), in the care of skin-graft donor sites in burn patients. Time to healing was the primary endpoint, and pain scores and cosmetic outcome were also assessed. This was a prospective, randomized, controlled study of burn patients undergoing harvesting of two donor sites. Patients were followed at predetermined time points for 30 to 45 days to determine the time to reepithelialization, cosmetic appearance, and pain. Subjects were adult burn patients with less than 30% TBSA burns admitted to the burn center, who required excision and grafting. Twenty patients were enrolled, of whom 17 completed the study. Average age was 35 years. Average burn size was 9.2% TBSA. Patients underwent harvesting of split-thickness skin grafts with one donor wound dressed with OxyBand and the other dressed in Xeroform gauze. Wounds were inspected and photographed on postoperative days 4 and 8, and then every 2 days until the donor wounds were healed. Pain scores at each site were also collected at these visits (rated by patients on a scale from 0 to 10). Mean time to wound healing for OxyBand was 9.3 ± 1.7 days; for Xeroform, 12.4 ± 2.7 days (P < .001). Pain scores were lower (P < .01) at the OxyBand site compared with the Xeroform site at all time points during postoperative days 4 to 12. There was no difference in the cosmetic outcome of the wounds at 30 to 45 days postoperatively. This study revealed a decrease in the time to healing and in pain at donor sites dressed with an oxygen-diffusion dressing.
- Published
- 2014
- Full Text
- View/download PDF
33. Acute respiratory distress syndrome in wartime military burns: application of the Berlin criteria.
- Author
-
Belenkiy SM, Buel AR, Cannon JW, Sine CR, Aden JK, Henderson JL, Liu NT, Lundy JB, Renz EM, Batchinsky AI, Cancio LC, and Chung KK
- Subjects
- Adult, Afghan Campaign 2001-, Burns mortality, Burns, Inhalation complications, Burns, Inhalation mortality, Female, Humans, Injury Severity Score, Iraq War, 2003-2011, Logistic Models, Male, Military Personnel statistics & numerical data, Prevalence, Respiration, Artificial, Respiratory Distress Syndrome classification, Respiratory Distress Syndrome epidemiology, Respiratory Distress Syndrome mortality, Retrospective Studies, Risk Factors, Severity of Illness Index, United States, Burns complications, Respiratory Distress Syndrome etiology
- Abstract
Background: Acute respiratory distress syndrome (ARDS) prevalence and related outcomes in burned military casualties from Iraq and Afghanistan have not been described previously. The objective of this article was to report ARDS prevalence and its associated in-hospital mortality in military burn patients., Methods: Demographic and physiologic data were collected retrospectively on mechanically ventilated military casualties admitted to our burn intensive care unit from January 2003 to December 2011. Patients with ARDS were identified in accordance with the new Berlin definition of ARDS. Subjects were categorized as having mild, moderate, or severe ARDS. Multivariate logistic regression identified independent risk factors for developing moderate-to-severe ARDS. The main outcome measure was the prevalence of ARDS in a cohort of patients burned as a result of recent combat operations., Results: A total of 876 burned military casualties presented during the study period, of whom 291 (33.2%) required mechanical ventilation. Prevalence of ARDS in this cohort was 32.6%, with a crude overall mortality of 16.5%. Mortality increased significantly with ARDS severity: mild (11.1%), moderate (36.1%), and severe (43.8%) compared with no ARDS (8.7%) (p < 0.001). Predictors for the development of moderate or severe ARDS were inhalation injury (odds ratio [OR], 1.90; 95% confidence interval [CI], 1.01-3.54; p = 0.046), Injury Severity Score (ISS) (OR, 1.04; 95% CI, 1.01-1.07; p = 0.0021), pneumonia (OR, 198; 95% CI, 1.07-3.66; p = 0.03), and transfusion of fresh frozen plasma (OR, 1.32; 95% CI, 1.01-1.72; p = 0.04). Size of burn was associated with moderate or severe ARDS by univariate analysis but was not an independent predictor of ARDS by multivariate logistic regression (p > 0.05). Age, size of burn, and moderate or severe ARDS were independent predictors of mortality., Conclusion: In this cohort of military casualties with thermal injuries, nearly a third required mechanical ventilation; of those, nearly one third developed ARDS, and nearly one third of patients with ARDS did not survive. Moderate and severe ARDS increased the odds of death by more than fourfold and ninefold, respectively., Level of Evidence: Epidemiologic/prognostic study, level III.
- Published
- 2014
- Full Text
- View/download PDF
34. Citation classics in the burn literature during the past 55 years.
- Author
-
Nam JJ, Chung KK, King BT, Jones JA, Cancio LC, Baer DG, Renz EM, Blackbourne LH, and Orman JA
- Subjects
- Humans, Bibliometrics, Burns, Periodicals as Topic statistics & numerical data, Publishing statistics & numerical data
- Abstract
The objective of this study was to identify the 100 most cited, peer-reviewed burn-related articles over the past half century. Burn care presents ongoing challenges to both U.S. civilian and military healthcare personnel. Improvements in burn survival and quality of life are the result of advances in burn research. The Web of Science (including Science Citation Index) was searched for the most cited articles related to burn care, published from 1955 to the present. The most cited article was "Permanent coverage of large burn wounds with autologous cultured human epithelium," by G.G. Gallico et al, New England Journal of Medicine, 1984 (711 citations). Between the 1970s and the 1990s, there was a near doubling of the number of highly cited publications with each subsequent decade. A total of 85% of the articles were on the topics of pathophysiology (37%), wounds, tissue, or dressings (31%), or organ failure/sepsis (17%). B.A. Pruitt Jr. (2320 citations), D.N. Herndon (1972 citations), and A.D. Mason Jr. (1435 citations) were the most cited authors. This study identified some of the most important contributions to burn research and the areas of greatest scientific interest to the specialty during the past five decades, and highlights key research that has contributed to the evolution of modern burn care.
- Published
- 2014
- Full Text
- View/download PDF
35. Silver-coated nylon dressing plus active DC microcurrent for healing of autogenous skin donor sites.
- Author
-
Malin EW, Galin CM, Lairet KF, Huzar TF, Williams JF, Renz EM, Wolf SE, and Cancio LC
- Subjects
- Anti-Infective Agents administration & dosage, Burns complications, Burns therapy, Double-Blind Method, Female, Humans, Male, Pain etiology, Pain prevention & control, Prospective Studies, Skin Care methods, Surgical Mesh, Transplantation, Autologous, Treatment Outcome, Wound Healing physiology, Bandages, Coated Materials, Biocompatible, Electric Stimulation Therapy methods, Silver Sulfadiazine administration & dosage, Skin Transplantation methods, Tissue and Organ Procurement, Wound Infection prevention & control
- Abstract
Introduction: Burn wounds are a significant cause of morbidity and mortality, and improved outcomes are demonstrated with early closure of both primary burn wounds and skin donor sites. Thus, technology that decreases the healing time of burns and donor sites would be potentially lifesaving. We present the results of a single-center, prospective, double-blinded, randomized controlled trial to evaluate the efficacy of silver-coated dressing with active microcurrent in comparison to silver-coated dressing with sham microcurrent on wound-closure time for autogenous skin donor sites., Methods: Four hundred five patients were screened for treatment of their donor sites using a silver-coated nylon dressing with either sham or active microcurrent stimulation. Thirty patients were enrolled in the study and then randomized. Of these, 5 patients were removed from analysis due to protocol deviations. Differences in time-to-closure were analyzed using Kaplan-Meier analysis and the proportional hazard regression model. Subjective verbal pain rating scores (0-10; 0, no pain; 10, worst pain) were also recorded. All devices were blinded and programmed at an outside facility, so that every patient had either an active or sham device. The study was unblinded only after the final patient's donor site had healed. All patients achieved donor-site healing before postoperative day 20. The 14 patients in the active microcurrent group [mean, 10.8 (2.9) days; range, 7-15 days] experienced no difference in time to wound healing as compared to the remaining patients in the sham microcurrent group [mean, 11.1 (2.0) days; range, 8-14 days; P = 0.75]. There were no differences in pain from one group compared to the other. None of the donor sites exhibited clinical signs of infection., Conclusions: In a sample size of 25 burn patients, the addition of direct microcurrent to silver-nylon dressings did not decrease time to wound closure of skin donor sites, and it did not show a difference in reported pain levels.
- Published
- 2013
- Full Text
- View/download PDF
36. Anaphylactoid reaction during first hemofiltration with a PUREMA polysulfone membrane.
- Author
-
Heegard KD, Tilley MA, Stewart IJ, Edgecombe HP, Lundy JB, Renz EM, and Chung KK
- Subjects
- Adult, Anaphylaxis diagnosis, Anaphylaxis therapy, Cardiopulmonary Resuscitation, Epinephrine therapeutic use, Female, Humans, Treatment Outcome, Acute Kidney Injury therapy, Anaphylaxis chemically induced, Hemofiltration adverse effects, Hemofiltration instrumentation, Membranes, Artificial, Polymers adverse effects, Sulfones adverse effects
- Abstract
Adverse reactions during hemodialysis are extremely common and include a wide range of clinical presentations from mild to life threatening. We present a case of a 34 year old woman in the Burn Intensive Care Unit, who developed acute kidney injury requiring renal replacement therapy. She was placed on continuous veno-venous hemofiltration with the NxStage machine which uses a synthetic PUREMA polyethersulfone filter sterilized by gamma radiation. Within two minutes of initiating hemofiltration, the patient complained of pruritus as well as dyspnea and became flushed and agitated. She subsequently developed hypotension ultimately resulting in cardiopulmonary arrest. Cardiopulmonary resuscitation was initiated and the patient was given epinephrine with return of spontaneous circulation. The following day, the patient was rechallenged with a PUREMA filter, and had a similar reaction with flushing, dyspnea, pruritus and hypotension requiring treatment to be discontinued. The patient was transitioned to the Prismaflex filter, another synthetic membrane, which she tolerated well and continued to utilize through the remainder of her hospital course without complication. Her clinical presentation was consistent with an anaphylactoid reaction, though a tryptase level was not obtained and a radioallergosorbent test performed with membrane material was negative. This case shows the difficulty of identifying the cause of hypersensitivity reactions involving synthetic membranes not sterilized by ethylene oxide, a commonly use sterilizing agent known to cause hypersensitivity reactions. This rare, but potentially fatal reaction has not previously been reported with a PUREMA filter and this case should raise awareness of hypersensitivity reactions with this widely used method of renal replacement therapy.
- Published
- 2013
- Full Text
- View/download PDF
37. Association of rhabdomyolysis with renal outcomes and mortality in burn patients.
- Author
-
Stewart IJ, Cotant CL, Tilley MA, Huzar TF, Aden JK, Snow BD, Gisler C, Kramer KW, Sherratt JR, Murray CK, Blackbourne LH, Renz EM, and Chung KK
- Subjects
- Adult, Chi-Square Distribution, Creatine Kinase blood, Female, Glomerular Filtration Rate, Humans, Injury Severity Score, Logistic Models, Male, Retrospective Studies, Statistics, Nonparametric, Acute Kidney Injury etiology, Burns complications, Rhabdomyolysis complications
- Abstract
The contribution of rhabdomyolysis to acute kidney injury (AKI) in the context of burn injury is poorly studied. We sought to determine the impact of rhabdomyolysis on AKI (defined by the AKI Network classification), renal replacement therapy (RRT), and death. Patients admitted to the burn unit at our institution were examined. Information on sex, age, presence of inhalation injury, electrical burn, percentage TBSA burned, percentage of full-thickness burns, Injury Severity Score, and peak creatine kinase (CK) were recorded. These variables were examined via multivariate logistic regression analysis against AKI Network stage, RRT, and death. Of 1973 consecutive admissions meeting the inclusion criteria, 525 met our eligibility criteria. Log peak CK was found to be correlated with any stage of AKI (odds ratio [OR], 1.71; 95% confidence interval [CI], 1.36-2.16; P < .0001), moderate to severe AKI (OR, 2.09; 95% CI, 1.40-3.11; P = .0003), need for RRT (OR, 1.67; 95% CI, 1.16-2.40; P = .0057), and mortality (OR, 1.49; 95% CI, 1.01-2.20; P = .0441), after adjustment. Each 10-fold increase in peak CK was associated with a 70% increase in the odds of AKI, more than a 100% increase in the odds of moderate to severe AKI, a nearly 70% increase in the odds of RRT, and an almost 50% increase in the odds of mortality in patients with burn injury.
- Published
- 2013
- Full Text
- View/download PDF
38. Complications of male circumcision treated at a military hospital in Afghanistan.
- Author
-
Gurney JM, Jaszczak N, Perkins JH, Lentz-Kapua SL, Soderdahl DW, and Renz EM
- Subjects
- Afghanistan, Child, Preschool, Humans, Infant, Male, United States, Circumcision, Male, Hospitals, Military, Postoperative Complications surgery
- Abstract
Circumcision of male infants and children is a common ritual in Afghanistan. As in many other developing countries, there are few safeguards relating to the procedure, particularly in rural areas. Performance of ritual circumcision may result in complications requiring treatment beyond the capabilities of the practitioner performing the initial procedure. It is not uncommon for local nationals to seek care at deployed military medical facilities for a wide variety of problems, and complications related to attempted circumcision are no exception. We describe 2 such cases recently presented to a US Army combat support hospital in rural Afghanistan for surgical treatment of the unintended consequences of male circumcision. We offer a review of the most common complications associated with circumcision and treatment options for each. It is valuable for the surgeon operating at the military medical hospital in remote areas of the world to be familiar with the management of the most common complications of circumcision.
- Published
- 2013
39. The authors reply.
- Author
-
Salinas J, Cancio LC, Renz EM, Chung KK, Mann-Salinas EA, Serio-Melvin M, and Wolf SE
- Subjects
- Female, Humans, Male, Burns therapy, Decision Making, Computer-Assisted, Fluid Therapy methods
- Published
- 2013
- Full Text
- View/download PDF
40. Dysnatremias and survival in adult burn patients: a retrospective analysis.
- Author
-
Stewart IJ, Morrow BD, Tilley MA, Snow BD, Gisler C, Kramer KW, Aden JK, Renz EM, and Chung KK
- Subjects
- Adult, Burns mortality, Female, Humans, Hypernatremia mortality, Hyponatremia mortality, Incidence, Male, Middle Aged, Retrospective Studies, United States epidemiology, Young Adult, Burns complications, Hypernatremia etiology, Hyponatremia etiology
- Abstract
Background/aims: Dysnatremias have been evaluated in many populations and have been found to be significantly associated with mortality. However, this relationship has not been well described in the burn population., Methods: Admissions to the burn center at our institution from January 2003 to December 2008 were examined. Independent variables included gender, age, percentage total body surface area burned (%TBSA), percentage of third-degree burn, inhalation injury, injury severity score (ISS), Acute Kidney Injury Network (AKIN) stage, hypernatremia, and hyponatremia. They were examined via Cox proportional hazard regression models against death. Moderate to severe hypo- and hypernatremia were defined as serum sodium <130 and >150 mmol/l, respectively., Results: In 1,969 subjects with a mean age of 36.3 ± 16.4 years, a median %TBSA of 9 (interquartile range 4-20) and a median ISS of 5 (interquartile range 1-16) hypernatremia occurred in 9.9% (n = 194), while hyponatremia occurred in 6.8% (n = 134) with mortality rates of 33.5 and 13.8%, respectively. Patients without a dysnatremia had a mortality rate of 4.3%. On Cox proportional hazard regression age, %TBSA, ISS, and AKIN stage were found to be significant predictors of mortality. Hypernatremia (HR 2.00, 95% CI 1.212-3.31; p = 0.0066), but not hyponatremia (HR 1.72, 95% CI 0.89-3.34; p = 0.1068) was associated with mortality., Conclusions: In the burn population, hypernatremia, but not hyponatremia, is an independent predictor of mortality.
- Published
- 2013
- Full Text
- View/download PDF
41. Risk factors for hypotension in urgently intubated burn patients.
- Author
-
Dennis CJ, Chung KK, Holland SR, Yoon BS, Milligan DJ, Nitzschke SL, Maani CV, Hansen JJ, Aden JK, and Renz EM
- Subjects
- Adult, Burn Units, Burns complications, Burns mortality, Critical Care methods, Female, Fluid Therapy statistics & numerical data, Hospital Mortality, Humans, Hypnotics and Sedatives adverse effects, Length of Stay, Logistic Models, Male, Middle Aged, Retrospective Studies, Risk Factors, Sepsis complications, Time Factors, Vasoconstrictor Agents administration & dosage, Burns therapy, Hypotension etiology, Intubation, Intratracheal adverse effects
- Abstract
Background: When urgently intubating patient in the burn intensive care unit (BICU), various induction agents, including propofol, are utilized that may induce hemodynamic instability., Methods: A retrospective review was performed of consecutive critically ill burn patients who underwent urgent endotracheal intubation in BICU. Basic burn-related demographic data, indication for intubation, and induction agents utilized were recorded. The primary outcomes of interest were clinically significant hypotension requiring immediate fluid resuscitation, initiation or escalation of vasopressors immediately after intubation. Secondary outcomes included ventilator days, stay length, and in-hospital mortality., Results: Between January 2003 and August 2010, we identified 279 urgent intubations in 204 patients. Of these, the criteria for presumed sepsis were met in 60% (n=168) of the intubations. After intubation, 117 patients (42%) experienced clinically significant hypotension. Propofol (51%) was the most commonly utilized induction agent followed by etomidate (23%), ketamine (15%), and midazolam (11%). On multiple logistic regression, %TBSA (OR 1.016, 95% CI 1.004-1.027, p<0.001) and presumed sepsis (OR 1.852, 95% CI 1.100-3.117, p=0.02) were the only significant predictors of hypotension. None of the induction agents, including propofol, were significantly associated with hypotension in patients with or without presumed sepsis., Conclusions: In critically ill burn patients undergoing urgent endotracheal intubation, specific induction agents, including propofol, were not associated with clinically significant hypotension. Presumed sepsis and %TBSA were the most important risk factors., (Published by Elsevier Ltd.)
- Published
- 2012
- Full Text
- View/download PDF
42. Military medical revolution: deployed hospital and en route care.
- Author
-
Blackbourne LH, Baer DG, Eastridge BJ, Renz EM, Chung KK, Dubose J, Wenke JC, Cap AP, Biever KA, Mabry RL, Bailey J, Maani CV, Bebarta VS, Rasmussen TE, Fang R, Morrison J, Midwinter MJ, Cestero RF, and Holcomb JB
- Subjects
- Delivery of Health Care, Emergency Treatment, Female, Humans, Male, Military Personnel statistics & numerical data, Organizational Innovation, Quality Control, United States, Warfare, Hospitals, Military organization & administration, Mass Casualty Incidents statistics & numerical data, Military Medicine organization & administration, Mobile Health Units organization & administration
- Published
- 2012
- Full Text
- View/download PDF
43. Serum vancomycin levels resulting from continuous or intermittent infusion in critically ill burn patients with or without continuous renal replacement therapy.
- Author
-
Akers KS, Cota JM, Chung KK, Renz EM, Mende K, and Murray CK
- Subjects
- Adult, Anti-Bacterial Agents administration & dosage, Burns mortality, Chi-Square Distribution, Critical Illness, Female, Hospital Mortality, Humans, Infusions, Intravenous, Male, Propensity Score, Renal Replacement Therapy, Retrospective Studies, Sepsis mortality, Statistics, Nonparametric, Vancomycin administration & dosage, Anti-Bacterial Agents blood, Burns complications, Sepsis drug therapy, Sepsis etiology, Vancomycin blood
- Abstract
We evaluated vancomycin levels as recent guidelines for therapeutic monitoring of vancomycin (not available at the time these data were collected) recommend trough levels of 15 to 20 μg/mL; however, this may be more difficult to achieve in patients with accelerated vancomycin clearance, such as burn patients or recipients of continuous venovenous hemofiltration (CVVH) therapy. We retrospectively studied 2110 serum vancomycin levels of 171 patients admitted to the burn intensive care unit for more than 4 years and who received vancomycin by continuous infusion (CI) or intermittent infusion (II), with or without simultaneous CVVH. In-hospital mortality, 14- and 28-day mortality following vancomycin therapy were not different between dosing methods, although increased mortality was observed in the subgroup of patients receiving CI vancomycin empirically for clinical sepsis with negative blood cultures. More vancomycin was delivered to patients daily by CI than II, and therapeutic drug monitoring costs were similar. After controlling for differences in vancomycin dose by case matching with propensity scores, mean vancomycin levels were 20.0 ± 3.8 μg/mL for CI, vs 14.8 ± 4.4 μg/mL for II (P < .001). CI dosing resulted in similar levels with or without CVVH, whereas in II dosing, CVVH appeared to significantly decrease vancomycin levels. Although CI dosing was associated with higher vancomycin levels in general and fewer levels of <10 μg/mL, significant nephrotoxicity or neutropenia was not observed. Fifty-seven patients (33.3%) developed bacteremia, and 106 Gram-positive bacteria were recovered, including 63 Staphylococcus aureus. Recurrent bacteremia while receiving vancomycin was infrequent. The 90th percentile minimum inhibitory concentration (MIC₉₀) for vancomycin of 36 available S. aureus isolates tested by broth microdilution was 1.5 μg/mL. CI produced more frequent therapeutic vancomycin levels and less frequent subtherapeutic levels compared to II. However, therapeutic vancomycin levels were achieved infrequently by either method of dosing. Given equivalent therapeutic drug monitoring costs and the lack of a clear clinical benefit, the role of CI dosing remains to be defined in spite of practical and theoretical advantages, particularly when administered in the setting of CVVH.
- Published
- 2012
- Full Text
- View/download PDF
44. An experience in the management of the open abdomen in severely injured burn patients.
- Author
-
Hardin MO, Mace JE, Ritchie JD, Chung KK, Markell KW, Renz EM, Wolf SE, Blackbourne LH, and White CE
- Subjects
- Abdominal Injuries diagnosis, Abdominal Wound Closure Techniques, Adult, Burns diagnosis, Cause of Death, Cohort Studies, Female, Follow-Up Studies, Hospital Mortality trends, Humans, Injury Severity Score, Laparotomy methods, Male, Military Personnel statistics & numerical data, Retrospective Studies, Risk Assessment, Surgical Mesh, Survival Rate, Treatment Outcome, Wound Healing physiology, Young Adult, Abdominal Injuries mortality, Abdominal Injuries surgery, Burns mortality, Burns surgery, Negative-Pressure Wound Therapy methods
- Abstract
Few descriptions of temporary abdominal closure for planned relaparotomy have been reported in burned patients. The purpose of this study is to describe our experience and outcomes in the management of burned patients with an open abdomen. The authors performed a retrospective review of all admissions to our burn center from March 2003 to June 2008, identifying patients treated by laparotomy with temporary abdominal closure. The authors collected data on patient demographics, indication for laparotomy, methods of temporary and definitive abdominal closure, and outcomes. Of 2,104 patients admitted, 38 underwent a laparotomy with temporary abdominal closure. Their median TBSA was 55%, and the incidence of inhalation injury was 58%. Abdominal compartment syndrome was the most common indication for laparotomy (82%) followed by abdominal trauma (16%). The in-hospital mortality associated with an open abdomen was 68%. Temporary abdominal closure was performed most commonly using negative pressure wound therapy (90%). Fascial closure was performed in 21 patients but was associated with a 38% rate of failure requiring reexploration. Of 12 survivors, fascial closure was achieved in seven patients and five were managed with a planned ventral hernia. Burned patients who necessitate an open abdomen management strategy have a high morbidity and mortality. Fascial closure was associated with a high rate of failure but was successful in a select group of patients. Definitive abdominal closure with a planned ventral hernia was associated with no increased mortality and remains an option when "tension-free" fascial closure cannot be achieved.
- Published
- 2012
- Full Text
- View/download PDF
45. The Acute Kidney Injury Network (AKIN) criteria applied in burns.
- Author
-
Chung KK, Stewart IJ, Gisler C, Simmons JW, Aden JK, Tilley MA, Cotant CL, White CE, Wolf SE, and Renz EM
- Subjects
- Acute Kidney Injury complications, Acute Kidney Injury therapy, Adult, Burn Units, Burns complications, Burns therapy, Cause of Death, Cohort Studies, Confidence Intervals, Creatinine blood, Critical Care methods, Critical Illness classification, Critical Illness therapy, Databases, Factual, Female, Follow-Up Studies, Hospital Mortality, Humans, Intensive Care Units, Logistic Models, Male, Middle Aged, Multivariate Analysis, Renal Dialysis methods, Renal Dialysis statistics & numerical data, Retrospective Studies, Risk Assessment, Survival Analysis, Time Factors, Treatment Outcome, United States, Young Adult, Acute Kidney Injury classification, Acute Kidney Injury mortality, Burns classification, Burns mortality, Creatinine classification
- Abstract
In 2007, the Acute Kidney Injury Network (AKIN) developed a modified standard for diagnosing and classifying acute kidney injury (AKI). This classification system is a modification of the previously described risk, injury, failure, loss, and end-stage (RIFLE) criteria. Among other modifications, the AKIN staging requires an absolute serum creatinine change of 0.3 mg/dl in a 48-hour period to establish the diagnosis of AKI. The purpose of this study was to apply these new criteria in the severely burned population and to compare the prevalence, stage, and mortality impact of these criteria to the RIFLE criteria. The authors performed a retrospective analysis of consecutive patients with burns admitted to their burn center for at least 24 hours from June 2003 through December 2008. Each patient was classified by both the AKIN and RIFLE criteria by three referees. Both univariate and multivariate analyses were performed to determine the impact of the various AKI stages on mortality. A total of 1973 patients met inclusion and exclusion criteria and were included in the analysis. The average age, %TBSA, injury severity score, and percent with smoke inhalation injury were 36 ± 16, 16 ± 18, 10 ± 12, and 13%, respectively. Overall, the prevalence of AKI was 33% using the AKIN criteria and 24% using the RIFLE criteria with an associated mortality of 21 and 25%, respectively. Of those meeting criteria for AKIN stage 1 (N = 434), 41% (N = 180) would have been categorized as not having AKI on the basis of the RIFLE criteria. In this cohort of patients, mortality increased by almost 8-fold when compared with those without AKI (odds ratio 7.8 [95% confidence interval (CI) 3.7-16.2], P < .0001). The area under the receiver operator characteristic curve for in-hospital mortality was significantly higher for the AKIN criteria at 0.877 (95% CI 0.848-0.906) when compared to the RIFLE criteria at 0.838 (95% CI 0.801-0.874; P = .0007). Burn patients identified as having AKI by the AKIN criteria missed by RIFLE appear to be an important cohort. On the basis of our study, AKIN criteria may be more precise and are more predictive of death than the RIFLE criteria in this population. Prospective validation is needed.
- Published
- 2012
- Full Text
- View/download PDF
46. Prehospital burn management in a combat zone.
- Author
-
Lairet KF, Lairet JR, King BT, Renz EM, and Blackbourne LH
- Subjects
- Adult, Burns diagnosis, Burns mortality, Female, Hospitals, Military, Humans, Injury Severity Score, Iraq War, 2003-2011, Male, Middle Aged, Needs Assessment, Pain Management methods, Registries, Retrospective Studies, Risk Assessment, Survival Rate, Treatment Outcome, Young Adult, Burns therapy, Emergency Medical Services methods, Fluid Therapy, Military Medicine methods, Military Personnel statistics & numerical data, Resuscitation methods
- Abstract
Objective: The purpose of this article is to provide a descriptive study of the management of burns in the prehospital setting of a combat zone., Methods: A retrospective chart review was performed of U.S. casualties with >20% total-body-surface-area thermal burns, transported from the site of injury to Ibn Sina Combat Support Hospital (CSH) between January 1, 2006, and August 30, 2009., Results: Ibn Sina CSH received 225 burn casualties between January 2006 and August 2009. Of these, 48 met the inclusion criteria. The mean Injury Severity Score was 31.7 (range 4 to 75). Prehospital vascular access was obtained in 24 casualties (50%), and 20 of the casualties received fluid resuscitation. Out of the 48 casualties enrolled, 28 (58.3%) did not receive prehospital fluid resuscitation. Of the casualties who received fluid resuscitation, nearly all received volumes in excess of the guidelines established by the American Burn Association and those recommended by the Committee for Tactical Combat Casualty Care. With regard to pain management in the prehospital setting, 13 casualties (27.1%) received pain medication., Conclusions: With regard to the prehospital fluid resuscitation of primary thermal injury in the combat zone, two extremes were noted. The first group did not receive any fluid resuscitation; the second group was resuscitated with fluid volumes higher than those expected if established guidelines were utilized. Pain management was not uniformly provided to major burn casualties, even in several with vascular access. These observations support improved education of prehospital personnel serving in a combat zone.
- Published
- 2012
- Full Text
- View/download PDF
47. Association of AKI with adverse outcomes in burned military casualties.
- Author
-
Stewart IJ, Tilley MA, Cotant CL, Aden JK, Gisler C, Kwan HK, McCorcle J, Renz EM, and Chung KK
- Subjects
- Acute Kidney Injury blood, Acute Kidney Injury diagnosis, Acute Kidney Injury mortality, Adult, Afghan Campaign 2001-, Age Factors, Biomarkers blood, Burn Units, Burns diagnosis, Burns mortality, Burns, Inhalation epidemiology, Creatinine blood, Female, Hospitals, Military, Humans, Incidence, Iraq War, 2003-2011, Logistic Models, Male, Multivariate Analysis, Odds Ratio, Prevalence, Prognosis, Retrospective Studies, Risk Assessment, Risk Factors, Severity of Illness Index, United States, Young Adult, Acute Kidney Injury epidemiology, Burns epidemiology, Military Personnel statistics & numerical data
- Abstract
Background and Objectives: Although associated with increased morbidity and mortality, AKI has not been systematically examined in military personnel injured from combat operations in Iraq and Afghanistan., Design, Settings, Participants, & Measurements: Patients evacuated from Iraq and Afghanistan to a burn unit were examined. AKI was classified by the Acute Kidney Injury Network (AKIN) and Risk-Injury-Failure-Loss-End Stage (RIFLE) schemas. Age, sex, percentage of total body surface area burned (TBSA), percentage of full-thickness burn, inhalation injury, and injury severity score were recorded. Additional data that could be associated with poor outcomes were recorded for patients with TBSA ≥20%. Multivariate logistic regression analyses were performed to determine factors associated with morbidity and mortality., Results: AKI prevalence rates by the RIFLE and AKIN criteria were 23.8% and 29.9%, respectively. After logistic regression, RIFLE categories of risk (odds ratio [OR], 15.34; 95% confidence interval [CI], 1.75-134; P=0.01), injury (OR, 46.28; 95% CI, 5.02-427; P<0.001), and failure (OR, 126; 95% CI, 13.39->999; P<0.001); AKIN-2 (OR, 23.70; 95% CI, 2.32-242; P=0.008); and AKIN-3 (OR, 130; 95% CI, 13.38->999; P<0.001) were significantly associated with death. AKIN-3, injury, and failure remained significant in the subset of patients with ≥20% TBSA. There was also a strong interaction between TBSA and the stage of AKI with respect to ventilator and intensive care unit days., Conclusions: AKI is prevalent in military casualties with burn injury and is independently associated with morbidity and mortality after adjustment for factors associated with injury severity.
- Published
- 2012
- Full Text
- View/download PDF
48. Development of a vascularized skin construct using adipose-derived stem cells from debrided burned skin.
- Author
-
Chan RK, Zamora DO, Wrice NL, Baer DG, Renz EM, Christy RJ, and Natesan S
- Abstract
Large body surface area burns pose significant therapeutic challenges. Clinically, the extent and depth of burn injury may mandate the use of allograft for temporary wound coverage while autografts are serially harvested from the same donor areas. The paucity of donor sites in patients with burns involving large surface areas highlights the need for better skin substitutes that can achieve early and complete coverage and retain normal skin durability with minimal donor requirements. We have isolated autologous stem cells from the adipose layer of surgically debrided burned skin (dsASCs), using a point-of-care stem cell isolation device. These cells, in a collagen-polyethylene glycol fibrin-based bilayer hydrogel, differentiate into an epithelial layer, a vascularized dermal layer, and a hypodermal layer. All-trans-retinoic acid and fenofibrate were used to differentiate dsASCs into epithelial-like cells. Immunocytochemical analysis showed a matrix- and time-dependent change in the expression of stromal, vascular, and epithelial cell markers. These results indicate that stem cells isolated from debrided skin can be used as a single autologous cell source to develop a vascularized skin construct without culture expansion or addition of exogenous growth factors. This technique may provide an alternative approach for cutaneous coverage after extensive burn injuries.
- Published
- 2012
- Full Text
- View/download PDF
49. High-frequency percussive ventilation for intercontinental aeromedical evacuation.
- Author
-
Barillo DJ, Renz EM, Wright GR, Broger KP, Chung KK, Thompson CK, and Cancio LC
- Subjects
- Adult, Afghan Campaign 2001-, Female, Humans, Injury Severity Score, Iraq War, 2003-2011, Male, Monitoring, Physiologic methods, Patient Care Team, Treatment Outcome, Air Ambulances, Burns, Inhalation therapy, High-Frequency Ventilation methods, Military Medicine methods
- Abstract
High-frequency percussive ventilation (HFPV) has been used for the management of patients with smoke inhalation injury for more than 20 years and is considered a standard of care at many burn centers. Because the ventilator is powered by air and oxygen rather than electricity, prehospital use has been limited by large-volume medical gas requirements. Since 2003, Operations Iraqi Freedom and Enduring Freedom have created a need for long-range aeromedical transfer of service members with severe burn and inhalation injuries. Unique to these conflicts is the availability of US Air Force C-17 cargo aircraft as the primary long-distance airframe. Because C-17 aircraft have a built-in medical oxygen supply, transcontinental patient transport using HFPV has become feasible. In this study, the authors report their initial experiences with the aeromedical transportation of 33 burn patients over a combined distance of 174,145 air miles using HFPV. HFPV is safe and efficacious for transcontinental flight when used by an experienced medical transport team.
- Published
- 2011
- Full Text
- View/download PDF
50. Pythium aphanidermatum infection following combat trauma.
- Author
-
Calvano TP, Blatz PJ, Vento TJ, Wickes BL, Sutton DA, Thompson EH, White CE, Renz EM, and Hospenthal DR
- Subjects
- Afghanistan, DNA, Fungal chemistry, DNA, Fungal genetics, DNA, Ribosomal chemistry, DNA, Ribosomal genetics, Fatal Outcome, Histocytochemistry, Humans, Male, Microscopy, Molecular Sequence Data, Mycology methods, Pythiosis microbiology, Sequence Analysis, DNA, Wound Infection microbiology, Young Adult, Pythiosis diagnosis, Pythiosis pathology, Pythium isolation & purification, Wound Infection diagnosis, Wound Infection pathology, Wounds and Injuries complications
- Abstract
Pythium aphanidermatum is a fungus-like plant pathogen which has never been reported as a cause of human infection. We report a case of P. aphanidermatum invasive wound infection in a 21-year-old male injured during combat operations in Afghanistan.
- Published
- 2011
- Full Text
- View/download PDF
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.