BACKGROUND: Major burn injury induces an inflammatory response that is accompanied by the release of various cytokines. We investigated the gradual changes in the levels of pro-inflammatory and anti-inflammatory cytokines following burn injury and determined the relationship between these levels and burn size in adult Korean patients with burn injury. METHODS: Blood samples from 9 healthy controls and 60 Korean burn patients were collected on days 1, 3, 7, 14, and 21 after burn injury, and concentrations of interleukin (IL)-6, IL-8, IL-10, tumor necrosis factor (TNF)-alpha, and granulocyte-colony stimulating factor (G-CSF) were measured. Burn patients were divided into 3 groups according to burn size (15-30%, 31-50%, >50% total body surface area), and the concentrations of the cytokines were compared between these groups and the control group over 3 weeks. RESULTS: Compared to their levels in controls, IL-6, IL-8, IL-10, TNF-alpha, and G-CSF levels in burn patients were significantly higher during the observation period. Median concentrations of IL-8, IL-10, and G-CSF at each time point increased with burn size, although peak levels and time to peak levels of these cytokines differed from patient to patient. CONCLUSIONS: These findings indicate that IL-6, IL-8, IL-10, TNF-alpha, and G-CSF are important mediators in inflammatory changes after burn injury; however, various factors, including burn size, may influence the concentrations of these cytokines.
Adolescent ; Adult ; Aged ; Asian Continental Ancestry Group ; Burns/blood/*pathology ; Granulocyte Colony-Stimulating Factor/*blood ; Humans ; Interleukin-10/*blood ; Interleukin-6/*blood ; Interleukin-8/*blood ; Male ; Middle Aged ; Republic of Korea ; Time Factors ; Tumor Necrosis Factor-alpha/*blood ; Young Adult

BACKGROUND: Major burn injury induces an inflammatory response that is accompanied by the release of various cytokines. We investigated the gradual changes in the levels of pro-inflammatory and anti-inflammatory cytokines following burn injury and determined the relationship between these levels and burn size in adult Korean patients with burn injury. METHODS: Blood samples from 9 healthy controls and 60 Korean burn patients were collected on days 1, 3, 7, 14, and 21 after burn injury, and concentrations of interleukin (IL)-6, IL-8, IL-10, tumor necrosis factor (TNF)-alpha, and granulocyte-colony stimulating factor (G-CSF) were measured. Burn patients were divided into 3 groups according to burn size (15-30%, 31-50%, >50% total body surface area), and the concentrations of the cytokines were compared between these groups and the control group over 3 weeks. RESULTS: Compared to their levels in controls, IL-6, IL-8, IL-10, TNF-alpha, and G-CSF levels in burn patients were significantly higher during the observation period. Median concentrations of IL-8, IL-10, and G-CSF at each time point increased with burn size, although peak levels and time to peak levels of these cytokines differed from patient to patient. CONCLUSIONS: These findings indicate that IL-6, IL-8, IL-10, TNF-alpha, and G-CSF are important mediators in inflammatory changes after burn injury; however, various factors, including burn size, may influence the concentrations of these cytokines.
Adolescent ; Adult ; Aged ; Asian Continental Ancestry Group ; Burns/blood/*pathology ; Granulocyte Colony-Stimulating Factor/*blood ; Humans ; Interleukin-10/*blood ; Interleukin-6/*blood ; Interleukin-8/*blood ; Male ; Middle Aged ; Republic of Korea ; Time Factors ; Tumor Necrosis Factor-alpha/*blood ; Young Adult

PURPOSE: Inhalation injury is one of the most severe morbidity and mortality factors in burn patients. The purpose of this study is to analyze the impact of inhalation injury to the prognosis of burn patients and to investigate the relationship between the inhalation injury assessment and the prognosis of patients. METHODS: Bronchoscopy was performed in 170 patients who had the suspicion of inhalation injury and the patients were reviewed retrospectively from January 2008 to December 2009. Mortality was compared between the factors of brochoscopic findings, age, total body surface area (TBSA) burned, carboxyhemoglobin (COHb) level, PaO2/FiO2 (P/F) ratio. RESULTS: Of 170 patients, 28 patients had no inhalation bronchoscopic finding. 109 patients had mild inhalation, 31 patients had moderate inhalation, only 2 patients had severe inhalation findings. The patients of moderate and severe inhalation findings had higher mortality (48.5%) than mild inhalation patients (31.1%). The larger total burnsurface area in inhalation patients, the greater the mortality. When compared to total admitted burn patients during the same period, inhalation patients showed higher mortality in the patients between 10 to 40% total burn surface area. Inhalation patients whose P/F ratio was below 300 showed higher mortality than above 300. But inhalation patients whose COHb level was below 1.5 had no difference in mortality with patients above 1.5. The COHb level and P/F ratio was the statistically different factors between inhalation patients and non-inhalation group in the mortality. CONCLUSION: Bronchoscopic findings, age, TBSA burned, P/F ratio were related with mortality in inhalation patients. When the international standardization of bronchoscopic classification developed, it can be possible to assess the inhalation patients more objectively and that will lead to the advancement in inhalation treatment and research.
Body Surface Area ; Bronchoscopy ; Burns ; Carboxyhemoglobin ; Humans ; Inhalation ; Prognosis ; Retrospective Studies

PURPOSE: Severe burns induce multiple derangements in normal homeostasis. In this conditions, the value of proper nutritional supports can not be overemphasized. The purpose of this study was to evaluate the nutritional, immunological, catabolic and clinical effects of early enteral support in major burn patients. METHODS: The subjects were 49 major burned adults admitted to the Hangang Sacred Heart Hospital between June 1, 2003 and August 31, 2003. The patients qualified for study participation if they were over 20 years of age, sustained burns in excess of a 35% total body surface area or a 25% full-thickness burn. The early feeding (EF) group started enteral feeding within 48 hours of injury, and the delayed feeding (DF) group started after 48 hours. Each patients received entreral feeing through a nasogastric tube. The calorifice requirements were calculated by a modified Long's formula. Enteral feeding was discontinued when the patients could voluntarily orally take at least 60~70 percent of their estimated calorific or protein needs. The serum prealbumin, transferrin and immunoglobulin (IgG, IgA and IgM) concentrations, total lymphocyte counts and cortisol were monitored as a nutritional, immunological and catabolic marker. The clinical outcomes of the two groups were compared. RESULTS: Several of the markers were in an arithmtically high state for the EF group, but these were not statistical significance. There were no significant differences in the clinical outcomes between the two groups. CONCLUSION: More active trials and many-sided studies will be needed to maximize the effect of early enteral nutritional support as a method to improve treatment for major burned patients.
Adult ; Body Surface Area ; Burns* ; Enteral Nutrition* ; Fees and Charges ; Heart ; Homeostasis ; Humans ; Hydrocortisone ; Immunoglobulin A ; Immunoglobulins ; Lymphocyte Count ; Nutritional Support ; Prealbumin ; Transferrin

PURPOSE: The aim of this study was to elucidate whether plasma lactate (PL) and base deficit (BD) are useful early parameters to predict the prognosis of burn patients with inhalation injury. In addition, one of the main objectives was to evaluate if PL and its change, BD and its change due to fluid resuscitation, adds additional information. METHODS: A retrospective review was performed on 151 patients admitted to our burn intensive care unit who were suspected to have inhalation burn injury, and then were confirmed by fibreoptic bronchoscopy between 1 Jan 2008 and 31 Dec 2008. All patients received proper fluid and electrolyte resuscitation, pain management, nutritional support, wound care and surgical debridement of dead tissue by burn surgeon. RESULTS: Initial PL, PL1 (24 hours later) and initial BD show statistical differences between survivors group and non-survivors group. A better chance of survival occurs when resuscitation results in normal PL values within 24 h. Moreover, an outcome predictor of shock and effective resuscitation could be defined by evaluating the changes of BD on Day 1. Normalization of the BD within 24 h is associated with a better chance of survival. CONCLUSION: Measuring PL, BD and their changes may help to identify burn patients either for adequacy of treatment, or selection of other therapeutic options. Therefore titration of burn resuscitation to normalize PL and BD levels may be a reasonable method to improve burn mortality.
Bronchoscopy ; Burns ; Burns, Inhalation ; Debridement ; Humans ; Inhalation ; Intensive Care Units ; Lactic Acid ; Nutritional Support ; Pain Management ; Plasma ; Prognosis ; Resuscitation ; Retrospective Studies ; Shock ; Survivors

PURPOSE: Acute kidney injury (AKI) in major burn patients is a common complication with high morbidity and mortality. The mainstream treatment is early diagnosis and rapid termination and prevention of the underlying insult. Therefore, it's essential to identify early biomarkers predicting AKI. METHODS: A total of 85 patients who were admitted to the burn intensive care unit from June 2012 to July 2013 were included in this prospective cohort study. Ten biomarkers (blood urea nitrogen, serum creatinine, urine creatinine, cystatin C, cystatin C glomerular filtration rate, AST, lacate dehydrogenase [LD], creatine kinase, lactic acid, and myoglobin) were obtained at time of admission and evaluated as diagnostic biomarkers to predicting AKI and early AKI. RESULTS: Out of 85 patients, 35 patients were dead and overall mortality was 41.2%. The mean age was 49.4 years and mean percentage of total body surface area was 53.2%. Area under the curve (AUC) of receiver operating characteristic curve of biomarkers on predicting AKI were 0.746, 0.718, and 0.717 in LD, lactic acid, and serum creatinine, respectively. AUC of cystatin C predicting AKI was much lower at 0.555. AUC of biomarkers on predicting early AKI were 0.833, 0.816, 0.790, and 0.759 in LD, serum creatinine, AST, and serum myoglobin. CONCLUSION: LD, lactic acid and serum creatinine were acceptable as diagnostic biomarkers of AKI and LD, serum creatinine, AST, and serum myoglobin were reasonable as diagnostic biomarkers of early AKI. However, cystatin C was an unfavorable biomarker in major burn patients.
Acute Kidney Injury* ; Area Under Curve ; Biomarkers* ; Body Surface Area ; Burns* ; Cohort Studies ; Creatine Kinase ; Creatinine ; Cystatin C ; Early Diagnosis ; Glomerular Filtration Rate ; Humans ; Intensive Care Units ; L-Lactate Dehydrogenase ; Lactic Acid ; Mortality ; Myoglobin ; Nitrogen ; Oxidoreductases ; Prospective Studies ; ROC Curve ; Urea

Necrotizing fasciitis (NF) is a life-threatening soft tissue infection that manifests with a rapid course of inflammation and necrosis of the skin, subcutaneous fat, and fascia. NF commonly follows trauma to the skin, such as a laceration, scratch or insect bite. NF is a surgical emergency and requires both a high index of suspicion for diagnosis and prompt operative intervention. Early aggressive surgical intervention is important for improving survival rates. Mortality and morbidity can be decreased with early diagnosis, adequate and urgent surgical debridement, intensive supportive care, and wound resurfacing. Recently, we experienced a case of NF secondary to a third-degree contact burn on the dorsum of the right foot (1% body area). We report our therapeutic experience in this case, with a review of the literature.
Burns ; Debridement ; Early Diagnosis ; Emergencies ; Fascia ; Fasciitis, Necrotizing ; Foot ; Inflammation ; Insect Bites and Stings ; Lacerations ; Necrosis ; Skin ; Soft Tissue Infections ; Subcutaneous Fat ; Survival Rate

PURPOSE: This study was planned to evaluate the effect of plant extracts contained dressing material which is rich in procyanidins for treatment of deep second degree burn. METHODS: This study conducted from September 1, 2013 to February 28, 2014. Patients with the deep dermal burn wound which is larger than 200 cm2 were enrolled in this study. The test material was applied total 3 times every 2 days when the wounds were relatively clean, with thin eschar and scab removed and the dermal layer exposed. The test and control sites were treated with hydro-foam equally. The effectiveness was evaluated by comparing the re-epithelialization rates between the test and control sites. Two burn surgeons blindly evaluated for re-epithelialization. Evaluation of adverse reaction was also performed during study period. RESULTS: Total of 40 patients were enrolled. Mean total body surface area burned% was 12.3+/-5.5% and the test material was first applied at mean post burn day # 7.2+/-2.0.The re-epithelialization period was 9.0+/-1.7 days in the test site and 11.1+/-2.0 days in the control site. In the test site, re-epithelialization was 2.1+/-1.0 days faster than in the control site (P<0.0001). There was no significant adverse reaction during study period. CONCLUSION: The plant extracts contained dressing material which is rich in procyanidins accelerates wound healing time and shows the safety.
Bandages* ; Body Surface Area ; Burns* ; Humans ; Plant Extracts* ; Proanthocyanidins* ; Re-Epithelialization ; Wound Healing ; Wounds and Injuries

PURPOSE: To find progression and prognosis of pancreatitis developed in massive burn patients through retrospective analysis. METHODS: A retrospective study was conducted on 32 patients with abnormal increase of serum lipase level among 2523 acute burn patients admitted to our burn center from January 1, 2017 to June 30, 2018. Pancreatitis in this study was defined as a serum lipase concentration level that is higher than 180 IU/L which is three times more than the normal level (less than 60 IU/L). In this study, a retrospective analysis was performed on patients with serum lipase level higher than 300 IU/L to better understand causality of burns and pancreatitis. RESULTS: 32 patients (1.27%) had serum lipase level higher than 180 IU/L among 2523 acute burn subjects. And 13 patients (0.52%) of these 32 patients had serum lipase level elevated more than 300 IU/L. The study indicated serum lipase level was increased around 7 days after the injury. It returned to normal level early as after 1 to 2 weeks and late as after 4 to 6 weeks of injury. The serum amylase level was increased as similar modality as to the serum lipase level increase. The serum bilirubin, AST, ALT, LD, and GGT were also observed to be elevated when serum lipase was more than 1000 IU/L. CONCLUSION: The pancreatitis developed in burn patients are mostly as mild symptom. It could due to the ischemic injury and can easily be treated by a temporary fasting, TPN, and Gabexate intravenous injection.
Amylases ; Bilirubin ; Burn Units ; Burns ; Fasting ; Gabexate ; Humans ; Injections, Intravenous ; Lipase ; Pancreatitis ; Prognosis ; Retrospective Studies

PURPOSE: The aim of this study was to investigate the characteristics of Acute Kidney Injury Network (AKIN)-defined nephrotoxicity in patients undergoing intravenous colistimethate sodium (CMS) therapy for major burns. METHODS: This retrospective study included burn patients who received more than 48 h of intravenous CMS between September 2009 and December 2015. Data collection was performed using the institution's electronic medical record system. Patients assigned to the developed nephrotoxic group experienced aggravation of current AKIN stage during CMS treatment; those assigned to the non-nephrotoxic group experienced no change in current or exhibited improved AKIN stage during CMS therapy. RESULTS: A total of 306 patients were included in this study. All patients were grouped according to AKIN stage: AKIN 0 (n=152); AKIN 1 (n=6); AKIN 2 (n=9); AKIN 3 (n=139). The baseline creatinine (Cr) level was 0.73 mg/dL. The incidence of nephrotoxicity was 50.3% according to AKIN stage; overall mortality was 45.8%. The non-nephrotoxic group consisted of 127 (74.7%) patients and 43 (25.3%) were in the developed nephrotoxic group. In patients requiring continuous renal replacement therapy (CRRT), baseline Cr level was 0.83 mg/dL, pre-CMS Cr level was 1.17 mg/dL, and post-CMS Cr level was 1.34 mg/dL. CONCLUSION: CMS can be administered without signs of nephrotoxicity for a certain period (approximately 1 week), it can be used relatively safely for 2 weeks. Application of CMS is a reasonable option for treating infections caused by multi-drug resistant gram-negative bacteria in patients with major burns. The caution should be exercised nevertheless.
Acute Kidney Injury ; Burns ; Colistin ; Creatinine ; Data Collection ; Electronic Health Records ; Gram-Negative Bacteria ; Gram-Negative Bacterial Infections ; Humans ; Incidence ; Mortality ; Renal Replacement Therapy ; Retrospective Studies ; Sodium