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Juan P. Barret - One of the best experts on this subject based on the ideXlab platform.
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effects of Burn Wound excision on bacterial colonization and invasion
Plastic and Reconstructive Surgery, 2003Co-Authors: David N. Herndon, Juan P. BarretAbstract:Rates of survival after thermal injury have improved in the past two decades, and rates of Wound infections and sepsis have decreased during the same period. Early excision has been advocated as one of the major factors, but its safety and efficacy and the exact timing of Burn excision are still under debate. It was hypothesized that acute Burn Wound excision (in the first 24 hours after Burning) would be superior to conservative treatment and delayed excision in preventing bacterial colonization and invasion.,juries were Twenty consecutive patients with thermal injuries were studied. Twelve patients underwent acute Burn Wound excision, and eight patients underwent conservative treatment and delayed excision. The second group of patients received topical treatments in another facility and underwent delayed excision after transfer to our set-vice, on postBurn day 6. Quantitative bacteriological assessments of the excised Wound and biopsy samples of the Wound bed, obtained before autografting and/or homografting, were performed. The effects of time on bacterial counts, differences between superficial and deep biopsy samples, and the effects of early versus late debridement were studied. Patients admitted early exhibited bacterial counts of less than 105 bacteria per grain of tissue. Patients in this group did not experience infection or graft loss. Patients admitted late exhibited counts of more than 105 bacteria (p = 0.001, compared with early admission). Three patients in the late excision group experienced infection and graft loss (p <0.05, compared with the early excision group). Burn Wound excision significantly decreased bacterial colonization for all patients (p <0.001). Greater bacterial colonization and higher rates of infection were correlated with topical treatment and late excision (p <0.001). It is concluded that Burn Wound excision significantly reduces bacterial colonization. Patients who undergo topical treatment and delayed Burn Wound excision exhibit greater bacterial colonization and increased rates of infection. Acute Burn Wound excision should be considered for all full-thickness Burns.
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effects of Burn Wound excision on bacterial colonization and invasion
Plastic and Reconstructive Surgery, 2003Co-Authors: Juan P. Barret, David N. HerndonAbstract:Rates of survival after thermal injury have improved in the past two decades, and rates of Wound infections and sepsis have decreased during the same period. Early excision has been advocated as one of the major factors, but its safety and efficacy and the exact timing of Burn excision are still under debate. It was hypothesized that acute Burn Wound excision (in the first 24 hours after Burning) would be superior to conservative treatment and delayed excision in preventing bacterial colonization and invasion. Twenty consecutive patients with thermal injuries were studied. Twelve patients underwent acute Burn Wound excision, and eight patients underwent conservative treatment and delayed excision. The second group of patients received topical treatments in another facility and underwent delayed excision after transfer to our service, on postBurn day 6. Quantitative bacteriological assessments of the excised Wound and biopsy samples of the Wound bed, obtained before autografting and/or homografting, were performed. The effects of time on bacterial counts, differences between superficial and deep biopsy samples, and the effects of early versus late debridement were studied. Patients admitted early exhibited bacterial counts of less than 10 bacteria per gram of tissue. Patients in this group did not experience infection or graft loss. Patients admitted late exhibited counts of more than 10 bacteria (p = 0.001, compared with early admission). Three patients in the late excision group experienced infection and graft loss (p < 0.05, compared with the early excision group). Burn Wound excision significantly decreased bacterial colonization for all patients (p < 0.001). Greater bacterial colonization and higher rates of infection were correlated with topical treatment and late excision (p < 0.001). It is concluded that Burn Wound excision significantly reduces bacterial colonization. Patients who undergo topical treatment and delayed Burn Wound excision exhibit greater bacterial colonization and increased rates of infection. Acute Burn Wound excision should be considered for all full-thickness Burns.
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modulation of inflammatory and catabolic responses in severely Burned children by early Burn Wound excision in the first 24 hours
Archives of Surgery, 2003Co-Authors: Juan P. Barret, David N. HerndonAbstract:Hypothesis: Early Burn Wound excision modulates the hypermetabolic response in severe pediatric Burn injuries. Design: Before-after trial. Setting: A 30-bed Burn referral center in a private, university-affiliated hospital. Methods: We studied 35 severely Burned children who were divided into 2 groups. One group (n = 20) was treated with early Burn Wound excision within 24 hours after the injury. The second group (n = 15) was treated conservatively with silver sulfadiazine in other Burn facilities for 5 days, and Burn Wounds were surgically excised when patients were admitted to our Burn center on day 6 after the injury. Data compiled included oxygen consumption and acute-phase protein, interleukin 1beta; interleukin 6, interleukin 10, tumor necrosis factor alpha, and anabolic hormone (growth hormone, insulinlike growth factor type 1) levels preoperatively and 24 hours and 5 days postoperatively. Main Outcome Measures: Acute-phase and hypermetabolic responses. Results: Early Burn Wound excision abrogated the hypermetabolic response in pediatric Burn patients. Patients who underwent conservative treatment had a significantly more severe inflammatory and hypermetabolic response at the same time interval and significantly lower levels of anabolic hormones. Conclusions: Early Burn Wound excision is a safe therapeutic approach that modulates the hypermetabolic response after Burn injury. It was superior to the conservative treatment of silver sulfadiazine and delayed excision, and it should be considered when treating all severe full-thickness Burns.
David N. Herndon - One of the best experts on this subject based on the ideXlab platform.
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insulin increases resistance to Burn Wound infection associated sepsis
Critical Care Medicine, 2010Co-Authors: David N. Herndon, Gerd G Gauglitz, Tracy Toliverkinsky, Felicia N Williams, Juquan Song, Weihua Cui, Marc G JeschkeAbstract:Severe Burn trauma is a devastating injury associated with hypermetabolism and a profound catabolic state. Furthermore, it causes substantial perturbations in the immune system through the systemic inflammatory response, often resulting in suboptimal innate and adaptive immune responses (1-3). These changes in the immune system and destruction of the skin barrier increase the Burn patient’s susceptibility to Burn Wound infections and may lead to systemic bacterial dissemination, causing sepsis, multiorgan failure, and increased mortality (1, 4, 5). Various patient factors, such as age, immune status, extent of injury, and depth of Burn, in combination with microbial factors, such as type and number of organisms, enzyme and toxin production, and motility, determine the likelihood of invasive Burn Wound infection (6). Advances in topical and systemic antibiotics have improved the treatment of Burn-associated infections. However, the subsequent development and use of broad-spectrum antibiotics has propagated the colonization of antibiotic-resistant microorganisms, in particular Pseudomonas aeruginosa, one of the most commonly identified organisms in systemic or localized Burn Wound infections (6-8). Therefore, infectious complications remain a leading cause of death for patients with Burns greater than 40% total body surface area (TBSA) (1, 7, 8). Treatment options that attenuate the systemic inflammatory response to Burn trauma and enhance host resistance to infection may provide an alternative for severely Burned patients. A recent milestone study found that intensive insulin therapy decreased mortality in critically ill patients. Insulin given at doses to maintain blood glucose below 110 mg/dL prevented the incidence of multiorgan failure and thus improved clinical outcome and rehabilitation (9). However, since strict blood glucose control, in order to maintain normoglycemia, was required to obtain the most clinical benefit, a dialogue has emerged between those who believe that tight glucose control is beneficial for patient outcome and others who fear that high doses of insulin may lead to increased risks for hypoglycemic events and its associated consequences in these patients (9, 10). Studies conducted by our group further indicated that insulin improves hypermetabolism by decreasing proinflammatory cytokine and hepatic acute-phase proteins production postBurn (11, 12). Since insulin has potential as a treatment for reducing hypermetabolism in severely Burned patients, it is important to assess the effects of insulin on responses to infection in the susceptible Burn patient population. Through attenuation of systemic inflammation, insulin may have immunomodulatory properties that could improve clinical outcome postBurn. This study was designed to determine the effects of insulin treatment after Burn injury on the host response to infection in a lethal rodent model of Burn Wound infection.
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effects of Burn Wound excision on bacterial colonization and invasion
Plastic and Reconstructive Surgery, 2003Co-Authors: David N. Herndon, Juan P. BarretAbstract:Rates of survival after thermal injury have improved in the past two decades, and rates of Wound infections and sepsis have decreased during the same period. Early excision has been advocated as one of the major factors, but its safety and efficacy and the exact timing of Burn excision are still under debate. It was hypothesized that acute Burn Wound excision (in the first 24 hours after Burning) would be superior to conservative treatment and delayed excision in preventing bacterial colonization and invasion.,juries were Twenty consecutive patients with thermal injuries were studied. Twelve patients underwent acute Burn Wound excision, and eight patients underwent conservative treatment and delayed excision. The second group of patients received topical treatments in another facility and underwent delayed excision after transfer to our set-vice, on postBurn day 6. Quantitative bacteriological assessments of the excised Wound and biopsy samples of the Wound bed, obtained before autografting and/or homografting, were performed. The effects of time on bacterial counts, differences between superficial and deep biopsy samples, and the effects of early versus late debridement were studied. Patients admitted early exhibited bacterial counts of less than 105 bacteria per grain of tissue. Patients in this group did not experience infection or graft loss. Patients admitted late exhibited counts of more than 105 bacteria (p = 0.001, compared with early admission). Three patients in the late excision group experienced infection and graft loss (p <0.05, compared with the early excision group). Burn Wound excision significantly decreased bacterial colonization for all patients (p <0.001). Greater bacterial colonization and higher rates of infection were correlated with topical treatment and late excision (p <0.001). It is concluded that Burn Wound excision significantly reduces bacterial colonization. Patients who undergo topical treatment and delayed Burn Wound excision exhibit greater bacterial colonization and increased rates of infection. Acute Burn Wound excision should be considered for all full-thickness Burns.
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effects of Burn Wound excision on bacterial colonization and invasion
Plastic and Reconstructive Surgery, 2003Co-Authors: Juan P. Barret, David N. HerndonAbstract:Rates of survival after thermal injury have improved in the past two decades, and rates of Wound infections and sepsis have decreased during the same period. Early excision has been advocated as one of the major factors, but its safety and efficacy and the exact timing of Burn excision are still under debate. It was hypothesized that acute Burn Wound excision (in the first 24 hours after Burning) would be superior to conservative treatment and delayed excision in preventing bacterial colonization and invasion. Twenty consecutive patients with thermal injuries were studied. Twelve patients underwent acute Burn Wound excision, and eight patients underwent conservative treatment and delayed excision. The second group of patients received topical treatments in another facility and underwent delayed excision after transfer to our service, on postBurn day 6. Quantitative bacteriological assessments of the excised Wound and biopsy samples of the Wound bed, obtained before autografting and/or homografting, were performed. The effects of time on bacterial counts, differences between superficial and deep biopsy samples, and the effects of early versus late debridement were studied. Patients admitted early exhibited bacterial counts of less than 10 bacteria per gram of tissue. Patients in this group did not experience infection or graft loss. Patients admitted late exhibited counts of more than 10 bacteria (p = 0.001, compared with early admission). Three patients in the late excision group experienced infection and graft loss (p < 0.05, compared with the early excision group). Burn Wound excision significantly decreased bacterial colonization for all patients (p < 0.001). Greater bacterial colonization and higher rates of infection were correlated with topical treatment and late excision (p < 0.001). It is concluded that Burn Wound excision significantly reduces bacterial colonization. Patients who undergo topical treatment and delayed Burn Wound excision exhibit greater bacterial colonization and increased rates of infection. Acute Burn Wound excision should be considered for all full-thickness Burns.
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modulation of inflammatory and catabolic responses in severely Burned children by early Burn Wound excision in the first 24 hours
Archives of Surgery, 2003Co-Authors: Juan P. Barret, David N. HerndonAbstract:Hypothesis: Early Burn Wound excision modulates the hypermetabolic response in severe pediatric Burn injuries. Design: Before-after trial. Setting: A 30-bed Burn referral center in a private, university-affiliated hospital. Methods: We studied 35 severely Burned children who were divided into 2 groups. One group (n = 20) was treated with early Burn Wound excision within 24 hours after the injury. The second group (n = 15) was treated conservatively with silver sulfadiazine in other Burn facilities for 5 days, and Burn Wounds were surgically excised when patients were admitted to our Burn center on day 6 after the injury. Data compiled included oxygen consumption and acute-phase protein, interleukin 1beta; interleukin 6, interleukin 10, tumor necrosis factor alpha, and anabolic hormone (growth hormone, insulinlike growth factor type 1) levels preoperatively and 24 hours and 5 days postoperatively. Main Outcome Measures: Acute-phase and hypermetabolic responses. Results: Early Burn Wound excision abrogated the hypermetabolic response in pediatric Burn patients. Patients who underwent conservative treatment had a significantly more severe inflammatory and hypermetabolic response at the same time interval and significantly lower levels of anabolic hormones. Conclusions: Early Burn Wound excision is a safe therapeutic approach that modulates the hypermetabolic response after Burn injury. It was superior to the conservative treatment of silver sulfadiazine and delayed excision, and it should be considered when treating all severe full-thickness Burns.
Yaojun Wang - One of the best experts on this subject based on the ideXlab platform.
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Negative pressure Wound therapy decreases mortality in a murine model of Burn-Wound sepsis involving Pseudomonas aeruginosa infection. PloS One
2016Co-Authors: Yang Liu, Qin Zhou, Yunchuan Wang, Zhengcai Liu, Maolong Dong, Yaojun WangAbstract:Background: The colonization of Burn Wounds by Pseudomonas aeruginosa can lead to septic shock, organ injuries, and high mortality rates. We hypothesized that negative pressure Wound therapy (NPWT) would decrease invasion and proliferation of P. aeruginosa within the Burn Wound and reduce mortality. Methods: Thermal injuries were induced in anesthetized mice, and P. aeruginosa was applied to the Wound surface for 24 h. After removing the Burn eschar and debridement, the animals were subjected to either NPWT or wet-to-dry (WTD) treatment protocols. The bacterial loads on the Wound surface were assessed during 7 d of treatment, as were the concentrations of inflammatory cytokines in the peripheral blood samples. Survival was monitored daily for 14 d after Burn induction. Finally, samples of Wounded skin, lung, liver, and kidney were collected and subjected to histopathological examination. Results: Applying P. aeruginosa to the Burn Wound surface led to sepsis. During early stages of treatment, NPWT reduced the mortality of the septic animals and levels of P. aeruginosa within the Burn Wound compared with WTD-treated animals. Circulating levels of cytokines and cytoarchitectural abnormalities were also significantly reduced via NPWT. Conclusions: Our data indicate that NPWT inhibits the invasion and proliferation of P. aeruginosa in Burn-Wounded tissue and decreases early mortality in a murine model of Burn-Wound sepsis. These therapeutic benefits likely result from th
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negative pressure Wound therapy decreases mortality in a murine model of Burn Wound sepsis involving pseudomonas aeruginosa infection
PLOS ONE, 2014Co-Authors: Yang Liu, Qin Zhou, Yunchuan Wang, Zhengcai Liu, Maolong Dong, Yaojun WangAbstract:Background The colonization of Burn Wounds by Pseudomonas aeruginosa can lead to septic shock, organ injuries, and high mortality rates. We hypothesized that negative pressure Wound therapy (NPWT) would decrease invasion and proliferation of P. aeruginosa within the Burn Wound and reduce mortality. Methods Thermal injuries were induced in anesthetized mice, and P. aeruginosa was applied to the Wound surface for 24 h. After removing the Burn eschar and debridement, the animals were subjected to either NPWT or wet-to-dry (WTD) treatment protocols. The bacterial loads on the Wound surface were assessed during 7 d of treatment, as were the concentrations of inflammatory cytokines in the peripheral blood samples. Survival was monitored daily for 14 d after Burn induction. Finally, samples of Wounded skin, lung, liver, and kidney were collected and subjected to histopathological examination. Results Applying P. aeruginosa to the Burn Wound surface led to sepsis. During early stages of treatment, NPWT reduced the mortality of the septic animals and levels of P. aeruginosa within the Burn Wound compared with WTD-treated animals. Circulating levels of cytokines and cytoarchitectural abnormalities were also significantly reduced via NPWT. Conclusions Our data indicate that NPWT inhibits the invasion and proliferation of P. aeruginosa in Burn-Wounded tissue and decreases early mortality in a murine model of Burn-Wound sepsis. These therapeutic benefits likely result from the ability of NPWT to decrease bacterial proliferation on the Wound surface, reduce cytokine serum concentrations, and prevent damage to internal organs.
Peter K M Maitz - One of the best experts on this subject based on the ideXlab platform.
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Burn injury challenges and advances in Burn Wound healing infection pain and scarring
Advanced Drug Delivery Reviews, 2018Co-Authors: Yiwei Wang, Joanneke Beekman, Stuart D Jackson, Andrea C Isslerfisher, Roxanne Parungao, Sepher S Lajevardi, Zhe Li, Peter K M MaitzAbstract:Severe Burn injuries are the most traumatic and physically debilitating injuries affecting nearly every organ system and leading to significant morbidity and mortality. Early Burn Wound excision and skin grafting are common clinical practices that have significantly improved the outcomes for severe Burn injured patients by reducing mortality rate and days of hospital stay. However, slow Wound healing, infection, pain, and hypertrophic scarring continue to remain a major challenge in Burn research and management. In the present article, we review and discuss issues in the current treatment of Burn injuries; the advances and novel strategies developed in the past decade that have improved Burn management; and also, pioneer ideas and studies in Burn research which aims to enhance Burn Wound care with a focus on Burn Wound infection, pain management, treatments for scarring and skin tissue engineering.
Leopoldo C Cancio - One of the best experts on this subject based on the ideXlab platform.
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Burn Wound healing and treatment: review and advancements
Critical Care, 2015Co-Authors: Matthew P. Rowan, Leopoldo C Cancio, Eric A. Elster, David M. Burmeister, Lloyd F. Rose, Shanmugasundaram Natesan, Rodney K. Chan, Robert J. Christy, Kevin K. ChungAbstract:Burns are a prevalent and burdensome critical care problem. The priorities of specialized facilities focus on stabilizing the patient, preventing infection, and optimizing functional recovery. Research on Burns has generated sustained interest over the past few decades, and several important advancements have resulted in more effective patient stabilization and decreased mortality, especially among young patients and those with Burns of intermediate extent. However, for the intensivist, challenges often exist that complicate patient support and stabilization. Furthermore, Burn Wounds are complex and can present unique difficulties that require late intervention or life-long rehabilitation. In addition to improvements in patient stabilization and care, research in Burn Wound care has yielded advancements that will continue to improve functional recovery. This article reviews recent advancements in the care of Burn patients with a focus on the pathophysiology and treatment of Burn Wounds.
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correlation of culture with histopathology in fungal Burn Wound colonization and infection
Burns, 2007Co-Authors: Christina Schofield, Seung H. Kim, Clinton K Murray, Edward E Horvath, Leopoldo C Cancio, Steven E Wolf, Duane R HospenthalAbstract:An increasing number of Burn Wound infections are now due to fungi. Historically, therapy of fungal Burn Wound infections (FWI) consisted of debridement, topical antifungals and/or IV amphotericin B, negating the need to categorize disease further than fungal Burn Wound colonization (FWC) versus FWI. Newer antifungal agents have varying spectrums of activity, increasing the importance of identifying fungi, often to species. The records of patients admitted to our Burn center from April 2000 to March 2005 were reviewed for fungi identified by histopathology. Wound specimens with fungi were classified as FWC or FWI and culture results were compared. The 1515 surgical Wound tissue specimens were obtained from 2036 patients. Fungi were detected in the histopathology of 68 patients, 19 with FWI (3.8FWI/year); 9 had corresponding growth on culture. Forty nine patients were identified with FWC, 16 with fungi recovered in corresponding cultures. FWI was associated with increased mortality (OR 25.3, CI 3.12-204.8). Correlation between histopathologic and culture identification of fungi was inconsistent. The etiology of FWI was diverse; fungi with known resistance to each of the three major classes of antifungals were isolated, suggesting empirical use of one class may be inadequate to treat FWI. Future Burn Wound management must seek to identify fungal pathogens to species.
