It is well known that shock is one of the main complications occurring during early stage of severe burn, and presently, ischemic/hypoxic damage of tissues and organs is still hard to be prevented by various fluid resuscitation regimens. Findings in recent years demonstrated that postburn cardiac damage occurs promptly and much earlier than any other organs. Application of measures to ameliorate cardiac damage may improve organ blood flow in liver, kidney, and intestines, and mitigate organ damage concomitant with fluid resuscitation according to Parkland formula. These facts suggest that cardiac damage occurring promptly at early stage of severe burn is one of the important factors leading to ischemia/hypoxia of tissues and organs, therefore,new resuscitation regimen including "volume replacement" plus "dynamic support" may conduct to more effective burn shock resuscitation, and reduce organ complications as a result of either insufficient or over fluid infusion.
Burns ; therapy ; Fluid Therapy ; Humans ; Resuscitation ; methods ; Shock, Traumatic ; therapy

To retrospect the development of fluid resuscitation for burn shock and to look to the future. The main achievements in burn care in the past fifty years and existing problems are summarized, and the appropriate regime of fluid resuscitation for burn shock is suggested. Numerous achievements in burn care have been made, including the estimation of burn area, fluid replenishment formula, delayed resuscitation, fluid resuscitation for burn shock complicated by inhalation injury, covert compensatory shock and research on mechanism of burn shock etc. We had established and improved fluid resuscitation formula, and we had made clear how to properly resuscitate burn shock. However how to tide over the patient form burn shock smoothly had not yet reached a consensus. Effective treatment to alleviate hypoxic injuries as a result of severe shock had not been properly defined. Although significant achievements in fluid resuscitation for burn shock have been made, there is still a long way to go to attain a perfect regime. Therefore it is still utterly necessary to carry on in-depth research on this problem both in the laboratory and bedside.
Burns ; therapy ; Fluid Therapy ; Humans ; Shock, Traumatic ; therapy

OBJECTIVETo investigate the influence of escharectomy during shock stage on plasma lipid and free fatty acid levels in scalded rats.

METHODSThirty-two adult Wistar rats inflicted with 30% TBSA III degree scalding were employed as the model and were divided into normal control (NC), scalding control (SC) and treatment groups (T), and the latter was further divided into three sub groups according to the time of escharectomy, i.e. 8 postburn hour (PBHs) (T8), 24 PBHs (T24) and 96 PBHs (T96) groups. The rats were sacrificed at 168 PBHs. The postburn changes in the rat plasma lipid and free fatty acid levels were determined.

RESULTS1) There was significant increase in serum triglyceride (TG), cholesterol (CHO), high density lipoprotein (HDL), low density lipoprotein (LDL), very low density lipoprotein (VLDL), apolipoprotein A (ApoA), apolipoprotein B (ApoB) and all the free fatty acids (FFAs) in the total serum FFAs excluding myristic acid (P < 0.05) at 168 PBHs in rats of all the T groups. 2) The serum levels of TG, CHO, ApoB, total FFA, lauric acid, palmitic acid, zoomaric acid, oleic acid and linoleic acid in T8 and T24 groups were evidently lower than those in SC group (P < 0.05). The plasma levels of VLDL, stearic acid and arachidonic acid in T8 were obviously lower than those in SC group (P < 0.05); 3) In T96 group, the serum levels of ApoB and lauric acid were significantly lower than those in SC group (P < 0.05), but all the other indices remained higher than those before injury.

CONCLUSIONThere was enhanced fat mobilization after severe burn injury. Escharectomy during shock stage might decrease fat mobilization, which was beneficial to the restoration of normal lipid metabolism.

Animals ; Burns ; blood ; surgery ; Fatty Acids ; blood ; Lipids ; blood ; Male ; Rats ; Rats, Wistar ; Shock, Traumatic ; blood ; surgery

BACKGROUND: The Sewol ferry disaster caused national shock and grief in Korea. The present study examined the prevalence and associated factors of post-traumatic stress disorder (PTSD) symptoms among the surviving students 20 months after that disaster. METHODS: This study was conducted using a cross-sectional design and a sample of 57 students (29 boys and 28 girls) who survived the Sewol ferry disaster. Data were collected using a questionnaire, including instruments that assessed psychological status. A generalized linear model using a log link and Poisson distribution was performed to identify factors associated with PTSD symptoms. RESULTS: The results showed that 26.3% of participants were classified in the clinical group by the Child Report of Post-traumatic Symptoms score. Based on a generalized linear model, Poisson distribution, and log link analyses, PTSD symptoms were positively correlated with the number of exposed traumatic events, peers and social support, peri-traumatic dissociation and post-traumatic negative beliefs, and emotional difficulties. On the other hand, PTSD symptoms were negatively correlated with psychological well-being, family cohesion, post-traumatic social support, receiving care at a psychiatry clinic, and female gender. CONCLUSION: This study uncovered risk and protective factors of PTSD in disaster-exposed adolescents. The implications of these findings are considered in relation to determining assessment and interventional strategies aimed at helping survivors following similar traumatic experiences.
Adolescent ; Child ; Disasters* ; Female ; Grief ; Hand ; Humans ; Korea* ; Linear Models ; Prevalence ; Protective Factors ; Shock ; Stress Disorders, Post-Traumatic ; Survivors

PURPOSE: A new unmatched type-O packed red blood cell (UORBC) storage system was established in Ajou University Hospital Trauma Center. This system was expected to deliver faster and more efficient transfusion. METHODS: On March 2016, a new blood storage bank was installed in the trauma bay. Sixty patients who received UORBC from March 2016 to August 2016 were compared with 50 traumatic shock patients who received transfusions at the trauma bay in 2015. Time of transfusion, mortality, adverse transfusion reaction and change of systolic blood pressure were reviewed. RESULTS: Transfusion time from arrival at the hospital was significantly shorter in 2016 (14.07±11.14 min vs. 34.72±15.17 min, p < 0.001), but 24-hour mortality was not significantly different (13.3% vs. 20.8%, p=0.292). Systolic blood pressure significantly increased after UORBC transfusion (92.49 mmHg to 107.15 mmHg, p=0.002). Of the 60 patients who received UORBC in trauma bay, 47 (78.3%) patients had an incompatible ABO type, but no adverse transfusion reaction was notated. CONCLUSION: UORBC allows early blood transfusion and improved systolic blood pressure without significant adverse reactions.
ABO Blood-Group System ; Bays ; Blood Pressure ; Blood Transfusion ; Erythrocyte Transfusion* ; Erythrocytes* ; Humans ; Mortality ; Shock* ; Shock, Traumatic ; Transfusion Reaction ; Trauma Centers

OBJECTIVETo explore fluid management and cause of death during shock period in severe burns or burns with inhalation injury.

METHODSOne hundred and twelve patients with severe burns or burn complicated by inhalation injury admitted to our hospital from 1991 to 2000 were analyzed. The fluid management and death conditions during shock period were discussed.

RESULTSThe fluid volume for resuscitation could be described as follows: the total fluid volume was 2.2 ml/(%TBSA.kg) including colloid fluid 0.5 ml/(%TBSA.kg), crystalloid fluid 1 ml/(%TBSA.kg)and water 0.7 ml/(%TBSA.kg) during first 24 hours. The total fluid volume was 1.8 ml/(%TBSA.kg) including colloid fluid 0.4 ml/(%TBSA.kg), crystalloid fluid 0.7 ml/(%TBSA.kg) and water 0.7 ml/(%TBSA.kg) during second 24 hours. There were no difference in fluid management between burns and burns with inhalation injury. Seven patients died due to respiratory failure during shock period.

CONCLUSIONSMany fluid formula can provide guidance for resuscitation and it is very important that early fluid therapy should accord with concrete clinical conditions of patients in order to pass smoothly through shock period. Early fluid management is not different between burns and burns with inhalation injury.

Adolescent ; Adult ; Burns ; mortality ; therapy ; Cause of Death ; Child ; Female ; Fluid Therapy ; Humans ; Male ; Middle Aged ; Shock, Traumatic ; mortality ; therapy ; Smoke Inhalation Injury ; mortality ; therapy

OBJECTIVETo explore new methods for the management of extensive deep partial thickness burn wounds.

METHODSFifty burn patients with extensive deep partial thickness burn wounds were randomly divided into two groups: A and B groups. The patients in A group (n = 30) were treated with dermabrasion while those in B (n = 25) with conventional tangential excision. The first operation time in A and B groups was 12.3 +/- 10.7 hours and 47.2 +/- 11.5 hours, respectively. The patients' urine output, heart rate and arterial oxygen saturation (SaO2) were monitored.

RESULTSThe mean one setting operation area in A and B groups were (65.5 +/- 19.4)% and (64.8 +/- 18.7)%, respectively. All the indices remained stable in both groups during and after the operation. Nevertheless, the burn wound healing time (20 days averagely) in A group was 10 days shorter than that in B group. The incidences of internal organ injury and bacteremia in A group were much lower than those in B group. Furthermore, the hospitalization cost in A group was decreased compared with that in B group. And the scar after wound healing was much less obvious in A group than that in B group.

CONCLUSIONDermabrasion during early postburn shock stage for the management of deep partial thickness burn wound had many advantages such as: easy manipulation, less injury to patients, lower infection rate, less complications and quicker burn wound healing.

Adolescent ; Adult ; Burns ; surgery ; Dermabrasion ; methods ; Female ; Humans ; Male ; Middle Aged ; Minimally Invasive Surgical Procedures ; Shock, Traumatic ; surgery ; Time Factors ; Treatment Outcome ; Young Adult

OBJECTIVETo investigate the postburn dynamic changes in the hypothalamus-pituitary-adrenal hormones in severely burned patients.

METHODSFifty burn patients were enrolled in the study. The plasma contents of total GC (cortisol), ACTH and aldosterone (ALDO) and urinary contents of 17-OHO and 17-KS were determined with radio-immunological assay (RIA) method after burn injury to compare with the normal values which were well established clinically.

RESULTSThe postburn plasma and urinary contents of the above indices were increased evidently with two peak values in shock and infectious stages, whilst the majority of he indices were lower than the normal values after 6 postburn weeks (PBWs). The values of these hormones were the lowest in dying patients. On the other hand, the values approached normal levels in those patients whose burn wounds were healing.

CONCLUSIONIncreases of the plasma and urinary levels of hypothalamus-pituitary -adrenal hormones in severely burned patients were constantly seen. Burn shock and infection seemed to be the two major factors in inducing postburn stress reaction in burn victims. Abrupt decrease of the hormone levels in plasma and or urine indicated adrenal failure predicting a poor prognosis of the burn patients.

Adrenal Cortex Hormones ; metabolism ; Adult ; Burns ; metabolism ; surgery ; Female ; Humans ; Hypothalamic Hormones ; metabolism ; Male ; Pituitary Hormones ; metabolism ; Shock, Traumatic ; metabolism ; surgery ; Time Factors ; Young Adult

OBJECTIVETo investigate the relationship between blood concentration of lactic acid (LA) and tissue oxygenation in severely burned patients with shock.

METHODSThirty-four severely burned patients admitted during early postburn stage were included in this study and were randomly divided into A (n = 18) and B (n = 16) groups. The patients in A group were resuscitated with modified anti-shock programme by which the patients' urine output was maintained roughly around 100ml per hour, while the patients in B group were treated by our traditional resuscitation formula by which the patients urine was kept at 40 ml per hour. The blood concentration of LA and usual indices (urine output, blood pressure, heart rate, and mental status) were simultaneously monitored before and 1, 8, 16, 24, 48 and 72 hours after resuscitation in patients of both groups.

RESULTS(1) The average blood LA level in patients of A group was (3.2 +/- 0.4) mmol/L within 24 hours of resuscitation, while the monitored indices remained within normal range. Nevertheless the LA level in B group was (7.4 +/- 1.6) mmol/L (P < 0.01, compared with that of A group), and hyperlactacidemia lasted for more than 72 hours while other indices were normal. (2) The mortality in B group was high (31.2%), whilst that in A-group was only 5.5% (P < 0.01). (3) There was negative correlation between blood LA and urine output and positive correlation between blood LA and heart rate.

CONCLUSION(1) Blood LA concentration might be taken as an immediate, sensitive, simple and useful index of tissue oxygenation of the whole body during burn shock stage. (2) It was suggested by our results that fluid resuscitation should be extended to 72 PBHs (postburn hours) with urine output over 100 ml/h, so as to ensure the quality and effects of the resuscitation of burn shock.

Adult ; Burns ; metabolism ; physiopathology ; therapy ; Female ; Fluid Therapy ; Humans ; Lactic Acid ; blood ; Male ; Middle Aged ; Oxygen Consumption ; physiology ; Shock, Traumatic ; metabolism ; physiopathology ; therapy ; Young Adult

OBJECTIVETo explore the dynamic postburn changes in rat hepatic function and the effects of hyperoxic Ringer's solution resuscitation on the function.

METHODSOne hundred and ninety Wistar rats of both sexes with body weight of 250 - 300 g were employed as the model and were divided into 6 groups as A, B, C, D, E and F groups as follows: normal control (A, n = 10), early resuscitation with Ringer's solution (B, n = 40), delayed resuscitation with Ringer's solution (C, n = 30), early resuscitation with hyperoxic Ringer's solution (D, n = 40), delayed hyperoxic Ringer's solution resuscitation (E, n = 30) and burn control (F, n = 40). Blood samples were drawn from the injured rats under anesthesia at 6, 12, 24 and 48 postburn hours (PBHs), and the serum contents of ALT, AST and MDA in these blood samples were determined. Hepatic tissue samples were also harvested at the same time and served histologically.

RESULTSThe plasma ALT level at 6 PBH in all groups was higher than that in A group (P < 0.05). There was significant difference of plasma ALT levels between hyperoxic Ringer's solution treatment group an other treatment groups (P < 0.05). And there was evident difference of plasma ALT levels between hyperoxic Ringer's solution treatment groups and other treatment groups (P < 0.05). The dynamic change in plasma AST was almost similar to that of ALT. The plasma MDA level was increased obviously after injury, especially in F group (highest level). Furthermore, the MDA level in C group was higher than that in B group. The plasma MDA levels in D and E groups were evidently lower than that in all other groups (P < 0.05). It was revealed by histological examination that there were different degrees of degeneration an necrosis of hepatocytes during early postburn stage, but less so in D group.

CONCLUSIONFluid resuscitation during early postburn stage with hyperoxic Ringer's solution could inhibit the production of oxygen free radicals and blunt lipid peroxidation, and it could also enhance the host tolerance to hypoxia and prevent hepatocytes from injury, thus hepatic function was protected.

Animals ; Burns ; metabolism ; therapy ; Fluid Therapy ; Hepatocytes ; drug effects ; pathology ; Isotonic Solutions ; therapeutic use ; Liver ; metabolism ; pathology ; Oxygen ; administration & dosage ; Rats ; Rats, Wistar ; Shock, Traumatic ; metabolism ; therapy