Background: Early excision and grafting has been the preferred method of managing major burns around the world since 1970. Considering the advances in health care and the development of new antibiotics over the past 5...Background: Early excision and grafting has been the preferred method of managing major burns around the world since 1970. Considering the advances in health care and the development of new antibiotics over the past 50 years, delayed grafting as a technique for the management of burns over 15%-20% of total body surface area (TBSA) could have comparable results to that of early excision. This study aims to highlight the outcomes of practicing delayed grafting in burn patients. Methods: A case series analysis was performed of 51 patients who were admitted to the burns unit in Sultan Qaboos Hospital Salalah with over 20% TBSA between January 2014 and December 2019. The patients received prophylactic antibiotics and silver sulphadiazine dressing until the burn eschar had completely separated, followed by grafting. Results: Two patients were lost during the entire duration of the study. The mortality rate was comparable to that of early excision, while the rate of hypertrophic scarring was lower than the range reported by other studies. Conclusion: In the management of patients with over 20% TBSA, delayed grafting after complete separation of eschar is still a valid technique.展开更多
To investigate the effect of hypertonic saline / dextran 70 (HSD) on cardiac function in delayed resuscitation of burn shock. Methods: HSD was used for resuscitation 6 h postburn in dogs and its effect on cardiac func...To investigate the effect of hypertonic saline / dextran 70 (HSD) on cardiac function in delayed resuscitation of burn shock. Methods: HSD was used for resuscitation 6 h postburn in dogs and its effect on cardiac function was evaluated byvolume load,MAP, LVSP,LVEDP, + dp/dtmax, -dp/dtmax, CO and SVR. Results: The volume of HSD was 30.50% less duringfirst 24 h postburn and 59.50% less during 4 h after resuscitation than that of lactated Ringer’s solution (LR’s). MAP, LVSP,LVEDP, + dp/dtmax, -dp/dtmax and CO increased and SVR reduced in HSD resuscitation. Conclnsion: Smaller volume of HSD canexpand plasma volume significantly and improve cardiac function in delayed resuscitation of burn shock.展开更多
Objective: To research the expression of hypoxia inducible factor-1 alpha (HIF-1 alpha) on the apoptosis and number of T lymphocyte in Peyer’s patches after severe burn on plateau in rats. Methods: Wistar rats (n = 1...Objective: To research the expression of hypoxia inducible factor-1 alpha (HIF-1 alpha) on the apoptosis and number of T lymphocyte in Peyer’s patches after severe burn on plateau in rats. Methods: Wistar rats (n = 130) were subjected to deep thickness burn injury (30% TBSA, III degree), at two different altitudes. 60 of them were given delayed fluid resuscitation (DFR, n = 30 at each altitude) 6 h after burn at different altitude;60 of them were carried out immediate fluid resuscitation (IFR, n = 30 at each altitude);10 rats were subjected to 37°C warm water as sham burn (SG, n = 10). The Peyer’s patches were harvested from the ileum of rats at different time point after burn respectively. The expression of HIF-1 alpha, CD3(+) and the apoptosis and number of T lymphocyte in Peyer’s patches were detected by tissue microarray technology and immunohistochemistry. Results: The apoptosis was higher in DFR group than that in IFR group. The increase in HIF-1 alpha expression was observed mainly on cell nucleus in T lymphocytes. The expression levels of HIF-1 alpha in Peyer’s patches were much higher in DFR group and IFR group than those in SG, and they were higher at high altitude (3848 metres) than those at lower altitude (1517 metres), and also higher in DFR group compared with IFR group (all P < 0.05). The expression levels of CD3<sup>+</sup> in Peyer’s patches were much lower in DFR group and IFR group than those in sham group, and the lowest value appeared at 12 hours after burn (all P < 0.05). Conclusion: High expression of HIF-1 alpha may induce the apoptosis of T lymphocytes in Peyer’s patches after severe burn with delayed fluid resuscitation in rats at plateau.展开更多
Objectives: Evaluation of the effects of withholding plasma during the initial part of the burn shock period (the shock period in the study is estimated as the first 36 hours following the burns) when it will be lost ...Objectives: Evaluation of the effects of withholding plasma during the initial part of the burn shock period (the shock period in the study is estimated as the first 36 hours following the burns) when it will be lost into the interstitial tissues through the permeable capillaries. During that time crystalloids are administered. Another objective is to evaluate the effect of administering normal saline as the crystalloid resuscitation fluid during the initial part of the shock period. Design: A Retrospective 4 years study compares the use of normal saline as the resuscitative intravenous fluid during the first 12 hours post burns followed by intravenous 5% Purified Plasma Protein Fraction (PPPF) during the rest of the shock period i.e. the remaining 24 hours, with the use of the PPPF throughout the burns shock period according to Muir and Barclay formula. Setting: The Plastic Surgery Department and the Department of Laboratory, Directorate General of Khoula Tertiary Hospital, Muscat, Sultanate of Oman. Patients and Methods: The study included 2 groups of patients;Group A: Patients who received 5% Plasma (Human PPPF) throughout the shock period and Group B: Patients who received crystalloids in the form of normal saline during the first 12 hours post burn followed by plasma for the next 24 hours. Monitoring of the patients in both groups was done by using clinical signs of pulse, blood pressure, temperature and urine output and by using laboratory investigations in the form of the haematocrit value, sodium, potassium, chloride, total proteins and albumin levels in the blood at the time of admission and at the end of the shock period. Results: 140 patients were included in the study;64 in Group A and 76 in Group B. There was no mortality and the vital signs were maintained during the shock period in both groups. The mean values of urine output were nearer to the normal level in Group B compared to Group A. The same was observed regarding the Haematocrit value. In both groups the mean values showed no hypoproteinaemia or hypoalbuminaemia at the end of the shock period. There was no hypernatraemia in spite of giving 150 mmol/L of Na during the initial 12 hours post burns in Group B. The mean values of potassium and chloride levels were normal in both groups at the end of the shock period. Conclusion: Giving plasma during the first 12 hours of the burn shock period when the capillary leakage is maximum has no significant benefit. The plasma usage can be reduced by 50% compared to the use of the Muir and Barclay Formula from the beginning of the shock period with reduction of the costs and the possibility of transmission of undetected pathogens by nearly the same value if crystalloids are given during the first 12 hours of burns shock period. The use of isotonic normal saline during the first 12 hours appears more appropriate as it maintains adequate sodium balance to correct the hyponatraemia and at the same time prevents elevation of the serum potassium during the period when potassium is released from the cells. In addition, it does not have a significant reduction on the level of the serum proteins.展开更多
Objective To create a new fluid resuscitation technique for burn injury patient which makes burninjury patient pass smoothly the acute phase with less edema. Methods Mathematical model of fluid and proteinbalance of b...Objective To create a new fluid resuscitation technique for burn injury patient which makes burninjury patient pass smoothly the acute phase with less edema. Methods Mathematical model of fluid and proteinbalance of burn injured patient in acute phase was adopted and computer simulation of the system control wasutilized. The fluid resuscitation protocol designed by computer simulation were applied to twelvepatients.Results The new method has better effects with less side- effects. Conclusion The computer- simulationdesigned fluid therapy protocol provide a better resuscitation than the fluid therapy protocol produced by usingempirical formula.展开更多
AIM： To sum up the recent 30-year experience in the prevention and treatment of gastrointestinal dysfunction in severe burn patients, and propose practicable guidelines for the prevention and treatment of gastrointes...AIM： To sum up the recent 30-year experience in the prevention and treatment of gastrointestinal dysfunction in severe burn patients, and propose practicable guidelines for the prevention and treatment of gastrointestinal （GI） dysfunction. METHODS： From 1980 to 2007, a total of 219 patients with large area and extraordinarily large area burns （LAB） were admitted, who were classified into three stages according the therapeutic protocols used at the time： Stage 1 from 1980 to 1989, stage 2 from 1990 to 1995, and stage 3 from 1996 to 2007. The occurrence and mortality of GI dysfunction in patients of the three stages were calculated and the main causes were analyzed. RESULTS： The occurrence of stress ulcer in patients with LAB was 8.6% in stage 1, which was significantly Dower than that in stage 1 （P 〈 0.05）. No massive hemorrhage from severe stress ulcer and enterogenic infections occurred in stages 2 and 3. The occurrence of abdominal distension and stress ulcer and the mortality in stage 3 patients with extraordinarily LAB was 7.1%, 21.4% and 28.5%, respectively, which were significantly lower than those in stage 1 patients （P 〈 0.05 or P 〈 0.01）, and the occurrence of stress ulcer was also significantly lower than that in stage 2 patients （P 〈 0.05）. CONCLUSION： Comprehensive fluid resuscitation, early excision of necrotic tissue, staged food ingestion, and administration of specific nutrients are essential strategies for preventing gastrointestinal complications and lowering mortality in severely burned patients.展开更多
Burn injury is a leading cause of unintentional death and injury in children, with the majority being minor (less than 10%). However, a significant number of children sustain burns greater than 15%total body surface a...Burn injury is a leading cause of unintentional death and injury in children, with the majority being minor (less than 10%). However, a significant number of children sustain burns greater than 15%total body surface area (TBSA), leading to the initiation of the systemic inflammatory response syndrome. These patients require IV fluid resuscitation to prevent burn shock and death. Prompt resuscitation is critical in pediatric patients due to their small circulating blood volumes. Delays in resuscitation can result in increased complications and increased mortality. The basic principles of resuscitation are the same in adults and children, with several key differences. The unique physiologic needs of children must be adequately addressed during resuscitation to optimize outcomes. In this review, we will discuss the history of fluid resuscitation, current resuscitation practices, and future directions of resuscitation for the pediatric burn population.展开更多
Purpose:Acute burn resuscitation in initial 24 h remains a challenge to plastic surgeons.Though various formulae for fluid infusion are available but consensus is still lacking,resulting in under resuscitation or over...Purpose:Acute burn resuscitation in initial 24 h remains a challenge to plastic surgeons.Though various formulae for fluid infusion are available but consensus is still lacking,resulting in under resuscitation or over resuscitation.Parkland formula is widely used but recently its adequacy is questioned in studies.This study was conducted to see how closely the actual volume of fluid given in our center matches with that of calculated volume by Parkland formula.Methods:All patients admitted with more than 20% flame burn injury and within 8 h of incident were included in this study.Crystalloid solution for infusion was calculated as per Parkland formula;however,it was titrated according to the urine output.Data on fluid infusion were collected from patient's inpatient records and analyzed.Results:The study included a total of 90 patients,about 86.7% (n =78) of the patients received fluid less than the calculated Parkland formula.Rate of fluid administered over 24 h in our study was 3.149 mL/kg/ h.Mean hourly urine output was found to be 0.993 mL/kg/h.The mean difference between fluid administered and fluid calculated by Parkland formula was 3431.825 mL which was significant (p < 0.001).Conclusion:The study showed a significant difference in the fluid infused based on urine output and the fluid calculated by Parkland formula.This probably is because fluid infused based on end point of resuscitation was more physiological than fluid calculated based on formulae.展开更多
Background: Accurate total body surface area burned (TBSAB) estimation is a crucial aspect of early burn management. It helps guide resuscitation and is essential in the calculation of fluid requirements. Conventional...Background: Accurate total body surface area burned (TBSAB) estimation is a crucial aspect of early burn management. It helps guide resuscitation and is essential in the calculation of fluid requirements. Conventional methods of estimation can often lead to large discrepancies in burn percentage estimation. We aim to compare a new method of TBSAB estimation using a three-dimensional smart-phone application named 3D Burn Resuscitation (3D Burn) against conventional methods of estimation—Rule of Palm, Rule of Nines and the Lund and Browder chart. Methods: Three volunteer subjects were moulaged with simulated burn injuries of 25%, 30% and 35% total body surface area (TBSA), respectively. Various healthcare workers were invited to use both the 3D Burn application as well as the conventional methods stated above to estimate the volunteer subjects’burn percentages. Results: Collective relative estimations across the groups showed that when used, the Rule of Palm, Rule of Nines and the Lund and Browder chart all over-estimated burns area by an average of 10.6%, 19.7%, and 8.3% TBSA, respectively, while the 3D Burn application under-estimated burns by an average of 1.9%. There was a statistically significant difference between the 3D Burn application estimations versus all three other modalities (p<0.05). Time of using the application was found to be significantly longer than traditional methods of estimation. Conclusions: The 3D Burn application, although slower, allowed more accurate TBSAB measurements when compared to conventional methods. The validation study has shown that the 3D Burn application is useful in improving the accuracy of TBSAB measurement. Further studies are warranted, and there are plans to repeat the above study in a different centre overseas as part of a multi-centre study, with a view of progressing to a prospective study that compares the accuracy of the 3D Burn application against conventional methods on actual burn patients.展开更多
The management of serious burn injuries during pregnancy is an unsolved clinical problem because of the low incidence of this disease.Although it has been documented that the effect of burns on fetal and maternal surv...The management of serious burn injuries during pregnancy is an unsolved clinical problem because of the low incidence of this disease.Although it has been documented that the effect of burns on fetal and maternal survival is detrimental,there have been conflicting reports among the different burn centers regarding the mortality of burned pregnant women and the management of burn patients during pregnancy.We report a case of severe burn in late pregnancy treated at our burn center.Additionally,we searched and summarized the literature concerning the management of pregnant patients to provide useful information for their treatment.展开更多
Despite significant advances in perinatal medicine, the management of extremely preterm infants in the delivery room remains a challenge. There is an increasing evidence for improved outcomes regarding the resuscitati...Despite significant advances in perinatal medicine, the management of extremely preterm infants in the delivery room remains a challenge. There is an increasing evidence for improved outcomes regarding the resuscitation and stabilisation of extremely preterm infants but there is a lack of evidence in the periviable(gestational age 23-25 wk) preterm subgroup. Presence of an experienced team during the delivery of extremely preterm infant to improve outcome is reviewed. Adaptation from foetal to neonatal cardiorespiratory haemodynamics is dependent on establishing an optimal functional residual capacity in the extremely preterm infants, thus enabling adequate gas exchange. There is sufficient evidence for a gentle approach to stabilisation of these fragile infants in the delivery room. Evidence for antenatal steroids especially in the periviable infants, delayed cord clamping, strategies to establish optimal functional residual capacity, importance of temperature control and oxygenation in delivery room in extremely premature infants is reviewed in this article.展开更多
文摘Background: Early excision and grafting has been the preferred method of managing major burns around the world since 1970. Considering the advances in health care and the development of new antibiotics over the past 50 years, delayed grafting as a technique for the management of burns over 15%-20% of total body surface area (TBSA) could have comparable results to that of early excision. This study aims to highlight the outcomes of practicing delayed grafting in burn patients. Methods: A case series analysis was performed of 51 patients who were admitted to the burns unit in Sultan Qaboos Hospital Salalah with over 20% TBSA between January 2014 and December 2019. The patients received prophylactic antibiotics and silver sulphadiazine dressing until the burn eschar had completely separated, followed by grafting. Results: Two patients were lost during the entire duration of the study. The mortality rate was comparable to that of early excision, while the rate of hypertrophic scarring was lower than the range reported by other studies. Conclusion: In the management of patients with over 20% TBSA, delayed grafting after complete separation of eschar is still a valid technique.
文摘To investigate the effect of hypertonic saline / dextran 70 (HSD) on cardiac function in delayed resuscitation of burn shock. Methods: HSD was used for resuscitation 6 h postburn in dogs and its effect on cardiac function was evaluated byvolume load,MAP, LVSP,LVEDP, + dp/dtmax, -dp/dtmax, CO and SVR. Results: The volume of HSD was 30.50% less duringfirst 24 h postburn and 59.50% less during 4 h after resuscitation than that of lactated Ringer’s solution (LR’s). MAP, LVSP,LVEDP, + dp/dtmax, -dp/dtmax and CO increased and SVR reduced in HSD resuscitation. Conclnsion: Smaller volume of HSD canexpand plasma volume significantly and improve cardiac function in delayed resuscitation of burn shock.
文摘Objective: To research the expression of hypoxia inducible factor-1 alpha (HIF-1 alpha) on the apoptosis and number of T lymphocyte in Peyer’s patches after severe burn on plateau in rats. Methods: Wistar rats (n = 130) were subjected to deep thickness burn injury (30% TBSA, III degree), at two different altitudes. 60 of them were given delayed fluid resuscitation (DFR, n = 30 at each altitude) 6 h after burn at different altitude;60 of them were carried out immediate fluid resuscitation (IFR, n = 30 at each altitude);10 rats were subjected to 37°C warm water as sham burn (SG, n = 10). The Peyer’s patches were harvested from the ileum of rats at different time point after burn respectively. The expression of HIF-1 alpha, CD3(+) and the apoptosis and number of T lymphocyte in Peyer’s patches were detected by tissue microarray technology and immunohistochemistry. Results: The apoptosis was higher in DFR group than that in IFR group. The increase in HIF-1 alpha expression was observed mainly on cell nucleus in T lymphocytes. The expression levels of HIF-1 alpha in Peyer’s patches were much higher in DFR group and IFR group than those in SG, and they were higher at high altitude (3848 metres) than those at lower altitude (1517 metres), and also higher in DFR group compared with IFR group (all P < 0.05). The expression levels of CD3<sup>+</sup> in Peyer’s patches were much lower in DFR group and IFR group than those in sham group, and the lowest value appeared at 12 hours after burn (all P < 0.05). Conclusion: High expression of HIF-1 alpha may induce the apoptosis of T lymphocytes in Peyer’s patches after severe burn with delayed fluid resuscitation in rats at plateau.
文摘Objectives: Evaluation of the effects of withholding plasma during the initial part of the burn shock period (the shock period in the study is estimated as the first 36 hours following the burns) when it will be lost into the interstitial tissues through the permeable capillaries. During that time crystalloids are administered. Another objective is to evaluate the effect of administering normal saline as the crystalloid resuscitation fluid during the initial part of the shock period. Design: A Retrospective 4 years study compares the use of normal saline as the resuscitative intravenous fluid during the first 12 hours post burns followed by intravenous 5% Purified Plasma Protein Fraction (PPPF) during the rest of the shock period i.e. the remaining 24 hours, with the use of the PPPF throughout the burns shock period according to Muir and Barclay formula. Setting: The Plastic Surgery Department and the Department of Laboratory, Directorate General of Khoula Tertiary Hospital, Muscat, Sultanate of Oman. Patients and Methods: The study included 2 groups of patients;Group A: Patients who received 5% Plasma (Human PPPF) throughout the shock period and Group B: Patients who received crystalloids in the form of normal saline during the first 12 hours post burn followed by plasma for the next 24 hours. Monitoring of the patients in both groups was done by using clinical signs of pulse, blood pressure, temperature and urine output and by using laboratory investigations in the form of the haematocrit value, sodium, potassium, chloride, total proteins and albumin levels in the blood at the time of admission and at the end of the shock period. Results: 140 patients were included in the study;64 in Group A and 76 in Group B. There was no mortality and the vital signs were maintained during the shock period in both groups. The mean values of urine output were nearer to the normal level in Group B compared to Group A. The same was observed regarding the Haematocrit value. In both groups the mean values showed no hypoproteinaemia or hypoalbuminaemia at the end of the shock period. There was no hypernatraemia in spite of giving 150 mmol/L of Na during the initial 12 hours post burns in Group B. The mean values of potassium and chloride levels were normal in both groups at the end of the shock period. Conclusion: Giving plasma during the first 12 hours of the burn shock period when the capillary leakage is maximum has no significant benefit. The plasma usage can be reduced by 50% compared to the use of the Muir and Barclay Formula from the beginning of the shock period with reduction of the costs and the possibility of transmission of undetected pathogens by nearly the same value if crystalloids are given during the first 12 hours of burns shock period. The use of isotonic normal saline during the first 12 hours appears more appropriate as it maintains adequate sodium balance to correct the hyponatraemia and at the same time prevents elevation of the serum potassium during the period when potassium is released from the cells. In addition, it does not have a significant reduction on the level of the serum proteins.
文摘Objective To create a new fluid resuscitation technique for burn injury patient which makes burninjury patient pass smoothly the acute phase with less edema. Methods Mathematical model of fluid and proteinbalance of burn injured patient in acute phase was adopted and computer simulation of the system control wasutilized. The fluid resuscitation protocol designed by computer simulation were applied to twelvepatients.Results The new method has better effects with less side- effects. Conclusion The computer- simulationdesigned fluid therapy protocol provide a better resuscitation than the fluid therapy protocol produced by usingempirical formula.
基金The National Natural Science Foundation of China, No. C30600646
文摘AIM： To sum up the recent 30-year experience in the prevention and treatment of gastrointestinal dysfunction in severe burn patients, and propose practicable guidelines for the prevention and treatment of gastrointestinal （GI） dysfunction. METHODS： From 1980 to 2007, a total of 219 patients with large area and extraordinarily large area burns （LAB） were admitted, who were classified into three stages according the therapeutic protocols used at the time： Stage 1 from 1980 to 1989, stage 2 from 1990 to 1995, and stage 3 from 1996 to 2007. The occurrence and mortality of GI dysfunction in patients of the three stages were calculated and the main causes were analyzed. RESULTS： The occurrence of stress ulcer in patients with LAB was 8.6% in stage 1, which was significantly Dower than that in stage 1 （P 〈 0.05）. No massive hemorrhage from severe stress ulcer and enterogenic infections occurred in stages 2 and 3. The occurrence of abdominal distension and stress ulcer and the mortality in stage 3 patients with extraordinarily LAB was 7.1%, 21.4% and 28.5%, respectively, which were significantly lower than those in stage 1 patients （P 〈 0.05 or P 〈 0.01）, and the occurrence of stress ulcer was also significantly lower than that in stage 2 patients （P 〈 0.05）. CONCLUSION： Comprehensive fluid resuscitation, early excision of necrotic tissue, staged food ingestion, and administration of specific nutrients are essential strategies for preventing gastrointestinal complications and lowering mortality in severely burned patients.
文摘Burn injury is a leading cause of unintentional death and injury in children, with the majority being minor (less than 10%). However, a significant number of children sustain burns greater than 15%total body surface area (TBSA), leading to the initiation of the systemic inflammatory response syndrome. These patients require IV fluid resuscitation to prevent burn shock and death. Prompt resuscitation is critical in pediatric patients due to their small circulating blood volumes. Delays in resuscitation can result in increased complications and increased mortality. The basic principles of resuscitation are the same in adults and children, with several key differences. The unique physiologic needs of children must be adequately addressed during resuscitation to optimize outcomes. In this review, we will discuss the history of fluid resuscitation, current resuscitation practices, and future directions of resuscitation for the pediatric burn population.
文摘Purpose:Acute burn resuscitation in initial 24 h remains a challenge to plastic surgeons.Though various formulae for fluid infusion are available but consensus is still lacking,resulting in under resuscitation or over resuscitation.Parkland formula is widely used but recently its adequacy is questioned in studies.This study was conducted to see how closely the actual volume of fluid given in our center matches with that of calculated volume by Parkland formula.Methods:All patients admitted with more than 20% flame burn injury and within 8 h of incident were included in this study.Crystalloid solution for infusion was calculated as per Parkland formula;however,it was titrated according to the urine output.Data on fluid infusion were collected from patient's inpatient records and analyzed.Results:The study included a total of 90 patients,about 86.7% (n =78) of the patients received fluid less than the calculated Parkland formula.Rate of fluid administered over 24 h in our study was 3.149 mL/kg/ h.Mean hourly urine output was found to be 0.993 mL/kg/h.The mean difference between fluid administered and fluid calculated by Parkland formula was 3431.825 mL which was significant (p < 0.001).Conclusion:The study showed a significant difference in the fluid infused based on urine output and the fluid calculated by Parkland formula.This probably is because fluid infused based on end point of resuscitation was more physiological than fluid calculated based on formulae.
文摘Background: Accurate total body surface area burned (TBSAB) estimation is a crucial aspect of early burn management. It helps guide resuscitation and is essential in the calculation of fluid requirements. Conventional methods of estimation can often lead to large discrepancies in burn percentage estimation. We aim to compare a new method of TBSAB estimation using a three-dimensional smart-phone application named 3D Burn Resuscitation (3D Burn) against conventional methods of estimation—Rule of Palm, Rule of Nines and the Lund and Browder chart. Methods: Three volunteer subjects were moulaged with simulated burn injuries of 25%, 30% and 35% total body surface area (TBSA), respectively. Various healthcare workers were invited to use both the 3D Burn application as well as the conventional methods stated above to estimate the volunteer subjects’burn percentages. Results: Collective relative estimations across the groups showed that when used, the Rule of Palm, Rule of Nines and the Lund and Browder chart all over-estimated burns area by an average of 10.6%, 19.7%, and 8.3% TBSA, respectively, while the 3D Burn application under-estimated burns by an average of 1.9%. There was a statistically significant difference between the 3D Burn application estimations versus all three other modalities (p<0.05). Time of using the application was found to be significantly longer than traditional methods of estimation. Conclusions: The 3D Burn application, although slower, allowed more accurate TBSAB measurements when compared to conventional methods. The validation study has shown that the 3D Burn application is useful in improving the accuracy of TBSAB measurement. Further studies are warranted, and there are plans to repeat the above study in a different centre overseas as part of a multi-centre study, with a view of progressing to a prospective study that compares the accuracy of the 3D Burn application against conventional methods on actual burn patients.
文摘The management of serious burn injuries during pregnancy is an unsolved clinical problem because of the low incidence of this disease.Although it has been documented that the effect of burns on fetal and maternal survival is detrimental,there have been conflicting reports among the different burn centers regarding the mortality of burned pregnant women and the management of burn patients during pregnancy.We report a case of severe burn in late pregnancy treated at our burn center.Additionally,we searched and summarized the literature concerning the management of pregnant patients to provide useful information for their treatment.
文摘Despite significant advances in perinatal medicine, the management of extremely preterm infants in the delivery room remains a challenge. There is an increasing evidence for improved outcomes regarding the resuscitation and stabilisation of extremely preterm infants but there is a lack of evidence in the periviable(gestational age 23-25 wk) preterm subgroup. Presence of an experienced team during the delivery of extremely preterm infant to improve outcome is reviewed. Adaptation from foetal to neonatal cardiorespiratory haemodynamics is dependent on establishing an optimal functional residual capacity in the extremely preterm infants, thus enabling adequate gas exchange. There is sufficient evidence for a gentle approach to stabilisation of these fragile infants in the delivery room. Evidence for antenatal steroids especially in the periviable infants, delayed cord clamping, strategies to establish optimal functional residual capacity, importance of temperature control and oxygenation in delivery room in extremely premature infants is reviewed in this article.
