bluuebunny/crossref_metadata_2025_split huggingface dataset:
703 Evaluation of a Stress Ulcer Prophylaxis Protocol in an Burn Intensive Care Unit
Authors: Drabick Zachary , Driscoll Ian , Nguyen Duong 
Published: March 2022

Abstract

Introduction
Patients suffering from large burn injuries have an increased risk of gastrointestinal mucosal damage from stress ulcers. Proton pump inhibitors (PPIs) and histamine H2-receptor antagonists (H2RAs) are routinely used for stress ulcer prophylaxis in burn patients, however there are few comparative trials evaluating the efficacy of these therapies in the burn population. Our burn center uses a stress ulcer prophylaxis protocol that incorporates both classes in a step-wise manner. The objective of this study was to evaluate the protocol by comparing the incidence of uncontrolled gastric pH, positive gastric occult blood, and gastrointestinal bleed (GIB) while on famotidine or pantoprazole prophylaxis.

Methods
This was a single-center retrospective observational study conducted at an academic medical center and was approved by the hospital’s Institutional Review Board. Patients were included if they were at least 18 years of age, admitted to the burn intensive care unit (BICU) from June 2017 to August 2020 with burns involving at least 1% TBSA, and had at least one documented gastric pH and/or occult blood test while receiving famotidine or pantoprazole. The primary endpoint was a composite of gastric pH less than 5, a positive occult blood test, or occurrence of GIB.

Results
In total, 107 patients with a mean age of 55 yo were included in the study. The median TBSA burn was 16% and length of stay was 23 days. Seventy seven (72%) patients received famotidine and 93 (87%) of patients received pantoprazole. The incidence of the primary endpoint in all patients receiving famotidine and pantoprazole were 69 (90%) and 86 (92%), respectively (p = 0.513). During famotidine prophylaxis, 256 (43%) gastric pH tests were less than 5 and 397 (47%) gastric occult blood tests were positive, with no reports of GI bleeding. During pantoprazole prophylaxis, 751 (33%) gastric pH tests were less than 5 and 1220 (47%) gastric occult blood tests were positive, and 4 (4%) were diagnosed with a GI bleed. A total of 91 (85%) patients had deviations from the protocol, which included 42 (46%) patients who did not receive the recommended dose or agent, 27 (30%) patients who were not initiated on the recommended initial agent, and 22 (24%) patients who did not receive a recommended increase in dose or switch agents when recommended.

Conclusions
In the setting of burn injuries of at least 1% TBSA, no difference was detected in uncontrolled gastric pH, positive occult blood tests, or GIB when using famotidine or pantoprazole in our stress ulcer prophylaxis protocol. The overall incidence of gastric pH less than 5 and positive gastric occult blood was high for both agents, while the incidence of GIB was low in both groups.
705 Reduction in Central Line Associated Blood Stream Infection Rate with a Central Line Change-Over Protocol
Authors: Hollowell Jamie L , Williams Felicia , Blandon-Hendrix Daniel , King Booker , Nizamani Rabia , Chrisco Lori , Gebe Patricia , Hoke Emily 
Published: March 2022

Abstract

Introduction
Burn Intensive Care Units (BICU)s traditionally have changed central lines over a wire (COWs) as a method to reduce infection. To date, there is not a standard timeline for this process and every center has their own timeline for this process. We aimed to create a standardized process for this practice to then have a baseline for future study.

Methods
The Change-Over-Wire (COW) process was evaluated with the BICU Infection Control Nurse and Performance Improvement Manager. A protocol was developed that includes step-by-step detail that was modified until it was deemed practical and acceptable to all involved parties as the best practice for maintaining the most sterility as possible. The protocol was provided to the Central Line team, the ICU Advisory Board, and the UNC CLABSI committee for review

Results
While the hospital as a whole does not standardly endorse routine COWs, the protocol was reviewed and accepted as best practice by both the ICU Advisory Board and the UNC CLABSI committee. Additionally, the BICU had an 80% reduction in CLABSI’s from FY 2017 to 2020 with implementation of this protocol (p value = 0091).

Conclusions
Having a standardized method for COWs both allows for best practice and a starting point for study. Endorsement by both hospital committees allows this practice to be the published standard by which future studies can be measured.
715 The incidence of refeeding syndrome in burn patients receiving enteral nutrition
Authors: Hendren-Santiago Bryce K , Vrouwe Sebastian Q , Pakvasa Mikhail , Reynolds Valerie , Micic Dejan , Gottlieb Lawrence J 
Published: March 2022

Abstract

Introduction
A major burn injury result in a hypermetabolic response which leads to increased nutritional requirements. Previous studies have shown that burn patients experience severe electrolyte abnormalities that are likely the result of multiple factors, but share similarities to refeeding syndrome (RS). Recently, the American Society for Parenteral and Enteral Nutrition (ASPEN) published consensus recommendations on RS, including clinical definitions and a grading system. Our aim was to evaluate this definition in a cohort of burn patients.

Methods
A retrospective analysis was performed of adults admitted to an American Burn Association-verified center from 2015-2020 with a burn injury who received enteral feeding for at least 72 hours. Patients with a length of stay &lt; 7 days were excluded. Patients were categorized as having mild, moderate, or severe RS based on the newly established ASPEN criteria, defined by a decrease in any one, two, or three of serum phosphorus, potassium, and/or magnesium levels from baseline by 10%–20% (mild RS), 20%–30% (moderate RS), or &gt;30% and/or organ dysfunction resulting from a decrease in any of these and/or due to thiamin deficiency (severe RS).

Results
A total of 350 patients were reviewed, from which 72 met the inclusion criteria. The mean patient age was 52 ± 18 years, and the average BMI was 28.3 ± 7.4. The average burn size was 21.7 ±17.0% TBSA and the average length of stay was 36 ± 32 days. A total of 57 (89%) patients had severe RS while five (8%) exhibited moderate and two (3%) developed mild refeeding syndrome. Of the 57 patients with severe RS, hypophosphatemia was the most prevalent (89%) followed by hypokalemia (19%) and hypomagnesemia (13%). Regression analysis comparing those with severe RS to those with mild or moderate RS revealed that number of surgeries performed was positively associated with the development of severe RS (p=0.0006). %TBSA trended but was not statistically significant (p=0.063). All other variables evaluated were not significant on univariate analysis.

Conclusions
The presence of severe electrolyte abnormalities as a result of burn injuries is significantly more common than originally anticipated. Further investigations are needed to determine if these abnormalities truly reflect RS or are primarily a result of the hypermetabolic response characteristic of burn patients.
716 Safety and benefits of intraoperative enteral nutrition in critically ill pediatric burn patients
Authors: Morzycki Alexander , Hudson Alexandra , Wong Joshua N 
Published: March 2022

Abstract

Introduction
Burn injuries significantly increase a patient’s metabolic demand. Adequate nutrition is essential to aid in recovery and reduce morbidity and mortality. This is important for pediatric patients, who have limited reserves and are in a period of growth, in contrast to adults. Burn patients often need multiple surgeries, with standard perioperative fasting periods leading to multiple nutritional interruptions. Continuous intraoperative feeding has been a proposed solution, but there is no current consensus on its role and safety, particularly in the pediatric population. The goal of our study was therefore to examine the safety and benefits of intraoperative nutrition in critically ill pediatric burn injury patients.

Methods
A systematic review of MEDLINE, PubMed, Scopus, and Google Scholar was conducted using the following terms: Feeding or enteral or nutrition or fasting and adolescent or youth or pediatric or child or teen and burn or thermal injury or fire. The primary outcome was incidence of aspiration. Secondary outcomes included patient nutritional status (caloric deficit, weight), wound healing, days spent in the intensive care unit, ventilator days, pneumonia, number of surgeries, length of hospital stay, and mortality. Pooled analyses of binary outcomes were computed.

Results
Four studies consisting of 496 patients, met inclusion criteria. All studies were level IV evidence, but had high methodological quality. The median burn total body surface area (TBSA) was 43.8% (IQR 33.4-58.8%), with a median of one-third of patients having an inhalational injury. Patients underwent a median of 4.2 surgeries (IQR 1.8-7.4). Intraoperative feeding was conducted through nasoduodenal tubes. There were no aspiration events. Pooled analysis demonstrated that there were no differences in rates of aspiration, pneumonia, or wound infection (p &gt;0.05) between patients who were intraoperatively fed and those who were not. Those fed intraoperatively had significantly more surgeries, ventilator days, longer hospital stays, but lower mortality (p&lt; 0.05). There was large heterogeneity in nutritional assessment methods. Intraoperatively fed patients had an average gain of 144.4 kcal/kg and 1.7 days of exclusive enteral nutrition (vs. loss of -119.1 kcal/kg and -1.4 days) and cumulative positive caloric balance of +2673kcal ±2147 (vs. loss of -7899kcal ±3123), compared to those with interrupted feeding.

Conclusions
Continuous intraoperative duodenal feeding during burn surgery appears to be safe in the Pediatric burn population, with no reported episodes of aspiration. Uninterrupted feeding was also associated with weight maintenance and reduced caloric deficit. It may also have survival benefit, as continuously fed patients needed more surgeries and intensive/hospital care, but had decreased mortality.
725 Case Series: New Porcine Placental ECM for Burn Injuries
Authors: G'sell David , Carter Jeffrey E , Kopari Nicole M , Hickerson William L 
Published: March 2022

Abstract

Introduction
Human amniotic membrane (HAM) has been used as a biologic dressing for burn wounds since 1955 but limited due to availability, size, and processing costs. In 2021 a new porcine placental product was FDA-approved overcoming challenges with human-sourced products. Our study is the first case series to report outcomes using porcine placental extracellular matrix (PPECM) in the use of adult burn patients.

Methods
Adults with thermal burns resulting in partial-thickness burn wounds (PTBW) were consented and included in the study from 03/2021 to 09/2021. Patients with full-thickness injures, concomitant trauma, or adverse beliefs to porcine products were not included in the study. Serial still images and initial wound measurements were obtained intraoperatively and post-operatively. PPECM trial product processed with a proprietary decellularization method to produce single sheets up to 15x20cm was approved by the facility value assessment committee. Adverse events were defined a priori as infection, increased pain or itching relative to adjacent autografts, or failure to heal. Infection was defined as a PPECM treatment site requiring any change from standard of care or initiation of local or systemic antibiotics. Pain was assessed using a visual analogue scale. Itching was assessed at discharge and follow-up. Healing was assessed using the FDA guidance for wound closure with 2 consecutive visits 2 weeks apart demonstrating 100% epithelialization without drainage or dressing requirements.

Results
Four patients were treated during the study period with wounds involving the torso and major joints such as the hands/wrists and knees. None of the PPECM wounds demonstrated failure to heal or required revision excision, or autograft. None of the PPECM wounds had evidence of infection. PPECM wounds had decreased pain/itching relative to adjacent burn wounds which were treated with split-thickness autograft, autologous skin cell suspension, or allogeneic cultured skin substitute (VAS mean 1 vs 3.1). Healing was noted in all wounds at 1-week primary dressing removal with confirmation at 2-week interval follow-up.

Conclusions
PPECM treatment of PTBW was not associated with adverse events and resulted in favorable outcomes clinically. The large size, ease of use, and lower costs relative to HAM is an intriguing alternative for PTBW. Comparative studies are needed in the field to determine best practices and overall value.
740 Cyclosporine in Stevens Johnson Syndrome & Toxic Epidermal Necrolysis: Experience from a Tertiary Care Center
Authors: Hassan Manal , Ho Bao Vincent , Bhavsar Dhaval , Korentager Richard 
Published: March 2022

Abstract

Introduction
Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN) are rare severe cutaneous adverse reactions associated with high morbidity and mortality, however, there lacks an established treatment protocol. Treatment with intravenous immunoglobulin (IVIg) has demonstrated mixed success rates in improving mortality. More recently, cyclosporine (CsA) has been found to have a promising role in management of SJS/TEN owing to its potent anti-apoptotic activity. We present 3 patients with SJS/TEN treated in our burn unit with CsA; all of them demonstrated clinical improvement.

Methods
We conducted a retrospective analysis of patients who were hospitalized with the diagnosis of SJS/TEN in a specialized burn center in the year 2020. Data regarding clinical factors, causative agent(s), disease severity, treatment received, and outcome were collected on chart review. SCORTEN and ABCD-10 prognostic scores were calculated for each patient at the time of admission. All patients were evaluated by a dermatologist and started on CsA at a dosage of 5 mg/kg daily given in 2 divided doses. Predicted mortality rate was compared with observed mortality rate to assess treatment outcomes.

Results
A total of 3 patients were identified with a mean age of 48.33 ± 16.50. All patients had TEN with an average initial BSA involvement of 56.67 ± 20.21 and peak BSA involvement of 63.33 ± 25.17. Lamotrigine was the presumptive causative drug in each case with an average duration of time from starting the medication to symptom onset of 19.3 days. Patients received CsA on average 7 days after symptom onset. Most of our patients had oral (100%), ocular (100%), genital (100%), and esophageal (33.3%) involvement during hospitalization. The observed mortality rate of 0% was lower than that predicted by SCORTEN (12.2% to 32.4%) and ABCD-10 (5.4% to 12.3%). No patients developed complications during admission. All patients had minimal wound care needs on discharge as most of the involved areas were healed by then.

Conclusions
Our study sheds light on a possible beneficial role of cyclosporine for the treatment of SJS/TEN and reinforces the necessity of further prospective studies to solidify treatment guidelines.
756 Self-Inflicted Frostbite with Dry Ice: A Case Report
Authors: Shingleton Sarah K , Chambers Michael G , Rowland Michael R , Britton Garrett W , Basel Anthony P 
Published: March 2022

Abstract

Introduction
Frostbite (FB) is a severe form of cold injury that may result in significant morbidity. Freezing causes formation of ice crystals and protein denaturation leading to cellular damage and tissue necrosis. Although commonly affecting populations who live and work or become stranded in cold environments, the true prevalence is unknown due to lack of standardized reporting. Dry ice is a solid form of carbon dioxide commonly found in the food industry, that can reach temperatures as cold as -110 degrees Fahrenheit and can be purchased at local department stores. Exposure to dry ice is an unusual cause of FB injury that could occur anywhere, especially in warmer climates. Healthcare professionals practicing in warmer climates may be unprepared to assess and treat patients with such injuries.

Methods
We describe a case of self-inflicted FB injury to the bilateral lower extremities (BLE) following intentional submersion in dry ice who presented to a Southern U.S. Burn Unit.

Results
A 20-year-old man with self-diagnosed Body Integrity Identity Disorder (BIID) sustained a 12% TBSA FB injury to his BLE following intentional submersion in dry ice for an estimated 4 hours (Figure 1). He presented to the Burn Center from an outside facility approximately 12 hours post injury with initial rewarming having already occurred. He immediately underwent catheter directed intra-arterial thrombolysis with tissue plasminogen activator (TPA) for leg length preservation. TPA infusion was initiated at 16 hours post-injury for a total infusion time of 24 hours. Wound care consisted of gentle twice daily cleansing with silver sulfadiazine and mafenide acetate creams. The patient ultimately required bilateral below the knee amputations which successfully healed with minimal autografting to the distal limbs. He was formally diagnosed with schizophrenia by our behavioral health team and initiated on risperidone. He underwent aggressive physical therapy and was discharged home with his parents after 21 days. He underwent weekly mental health follow up appointments and has been seen regularly in our burn and rehabilitation clinic.

Conclusions
This unusual case is one of few to describe Grade 4 FB after exposure to dry ice and highlights that severe FB may occur in any climate and can cause severe morbidity. Severe cold injury management is important for burn care professionals to maximize tissue and limb preservation.
757 A Patient Inclusion Criteria Algorithm for New Burn Centers Seeking to Implement a Burn Registry
Authors: Guilford Amanda , Garland Jeneva , Wyse Ransom , Harbour Lori , Smith Rebecca , Bregman Monica , Jones Samuel W 
Published: March 2022

Abstract

Introduction
Data submissions to the NBR are based upon the standardized medical definitions and generalized guidance on patient inclusion criteria found in the ABA Burn Care Quality Data Dictionary. The guidance is complex, often leading to confusion in determining proper patient identification. This is most problematic for new burn centers seeking to implement a burn registry. Therefore, at our burn center, we designed and implemented an algorithm based on a thorough literature review and ABA guidance to improve the accuracy and efficiency of patient identification.

Methods
A review of the literature was conducted using the PubMed database. In addition, utilizing the ABA’s multitude of resources including, the Burn Care & Quality Platform (BCQP) Data Dictionary 2020 version 1.1 patient inclusion criteria statements, a BCQP Q&A session on admission information, and Quality & Registry Community discussion boards, the following algorithm was developed by the compilation and simplification of the definitions provided for burn and non-burn injury patient inclusion criteria.

Results
A thorough literature review produced no articles that address NBR inclusion criteria. According to these documents, all patients admitted to the hospital for treatment of an acute burn or soft tissue wound should be included in the burn registry; however, a BCQP Q&A session expressed the Burn Service must provide medical care in order for a patient to be included in the registry. Furthermore, the BCQP Data Dictionary outlines patient inclusion based on a hospital length of stay &gt;24 hours, a surgical operation, or expire at a hospital facility for registry inclusion. Observation patients and non-burn patient consults are excluded from the NBR. The ABA community discussion board revealed many centers only count and track non-burn injury admissions to the burn center service line. The compilation of information resulted in the development of a standardized algorithm defining a patient for registry inclusion.

Conclusions
A comprehensive review of the ABA resource documents was compiled to clarify the patient inclusion criteria for data submission to the NBR. The BCQP Data Dictionary 2020 version 1.1 patient inclusion criteria statements, the collaborative Ameriburn communities, and the BCQP Q&A session influenced the design of the clarification algorithm for patient identification to assist burn centers seeking to accurately and most efficiently implement a burn registry. Further research should be conducted on the utilization of the algorithm in comparison to other burn centers.
758 Constant evolution: Early experiences treating COVID-19 in a burn center
Authors: Basel Anthony P , Britton Garrett W , Yugawa Craig , Cancio Leopoldo C 
Published: March 2022

Abstract

Introduction
The COVID-19 pandemic came as an unexpected challenge to many healthcare systems around the world. Many centers struggled to provide COVID-19 ICU-level care while also maintaining adequate care for non-COVID-19-related conditions, especially in critical care specialty units like trauma and burn. We present a case series of our early experiences treating COVID-19 in a burn center.

Methods
We present a case.

Results
See Table 1. Though one case was admitted prior to initiation of universal testing, routine infection-control protocols limited exposure to personnel and prevented transmission to staff. In May 2020, we implemented the use of N95 mask and eye protection during all aerosolizing procedures, N95 mask use in all ORs, and universal surgical mask use in all rooms regardless of COVID-19 status. An in-house risk-stratification system was used to screen patients based on symptoms and exposure. Burn-center admissions were screened at a lower threshold than throughout the institution given the unique nature of burn injury. Eventually, because of increasing community spread, all admissions to the hospital were universally screened with RT-PCR prior to admission. To minimize exposure to non-COVID patients and Burn Center staff, COVID-19 positive burn admissions were assessed on a case-by-case basis. High acuity patients were admitted to the Burn Center and followed by the COVID consult team. Lower acuity patients were admitted to the Burn Center but were treated on the medical COVID unit and followed by the burn consult service.

Conclusions
The COVID 19 pandemic has strained healthcare systems worldwide. Development and implementation of universal screening, testing, infection-control precautions, and triage strategies are critical elements of burn care during the COVID-19 pandemic. As we prepare for future surges due to more transmissible variants, implementation of standard protocols enables continued provision of quality care, preservation of the healthcare workforce, and efficient use of resources.