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      Burn injury

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          Abstract

          Burn injuries are under-appreciated injuries that are associated with substantial morbidity and mortality. Burn injuries, particularly severe burns, are accompanied by an immune and inflammatory response, metabolic changes and distributive shock that can be challenging to manage and can lead to multiple organ failure. Of great importance is that the injury affects not only the physical health, but also the mental health and quality of life of the patient. Accordingly, patients with burn injury cannot be considered recovered when the wounds have healed; instead, burn injury leads to long-term profound alterations that must be addressed to optimize quality of life. Burn care providers are, therefore, faced with a plethora of challenges including acute and critical care management, long-term care and rehabilitation. The aim of this Primer is not only to give an overview and update about burn care, but also to raise awareness of the ongoing challenges and stigmata associated with burn injuries.

          Abstract

          Burn injuries, particularly severe burns, are accompanied by a metabolic, immune and inflammatory response that can be challenging to manage, often leading to multiple organ failure or even death. This Primer discusses aspects of burn injury, from prevention to care of patients from both an acute and a long-term perspective.

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          Most cited references258

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          Burn wound healing and treatment: review and advancements

          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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            A review of tissue-engineered skin bioconstructs available for skin reconstruction.

            Situations where normal autografts cannot be used to replace damaged skin often lead to a greater risk of mortality, prolonged hospital stay and increased expenditure for the National Health Service. There is a substantial need for tissue-engineered skin bioconstructs and research is active in this field. Significant progress has been made over the years in the development and clinical use of bioengineered components of the various skin layers. Off-the-shelf availability of such constructs, or production of sufficient quantities of biological materials to aid rapid wound closure, are often the only means to help patients with major skin loss. The aim of this review is to describe those materials already commercially available for clinical use as well as to give a short insight to those under development. It seeks to provide skin scientists/tissue engineers with the information required to not only develop in vitro models of skin, but to move closer to achieving the ultimate goal of an off-the-shelf, complete full-thickness skin replacement.
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              Long-Term Persistance of the Pathophysiologic Response to Severe Burn Injury

              Background Main contributors to adverse outcomes in severely burned pediatric patients are profound and complex metabolic changes in response to the initial injury. It is currently unknown how long these conditions persist beyond the acute phase post-injury. The aim of the present study was to examine the persistence of abnormalities of various clinical parameters commonly utilized to assess the degree hypermetabolic and inflammatory alterations in severely burned children for up to three years post-burn to identify patient specific therapeutic needs and interventions. Methodology/Principal Findings Patients: Nine-hundred seventy-seven severely burned pediatric patients with burns over 30% of the total body surface admitted to our institution between 1998 and 2008 were enrolled in this study and compared to a cohort non-burned, non-injured children. Demographics and clinical outcomes, hypermetabolism, body composition, organ function, inflammatory and acute phase responses were determined at admission and subsequent regular intervals for up to 36 months post-burn. Statistical analysis was performed using One-way ANOVA, Student's t-test with Bonferroni correction where appropriate with significance accepted at p<0.05. Resting energy expenditure, body composition, metabolic markers, cardiac and organ function clearly demonstrated that burn caused profound alterations for up to three years post-burn demonstrating marked and prolonged hypermetabolism, p<0.05. Along with increased hypermetabolism, significant elevation of cortisol, catecholamines, cytokines, and acute phase proteins indicate that burn patients are in a hyperinflammatory state for up to three years post-burn p<0.05. Conclusions Severe burn injury leads to a much more profound and prolonged hypermetabolic and hyperinflammatory response than previously shown. Given the tremendous adverse events associated with the hypermetabolic and hyperinflamamtory responses, we now identified treatment needs for severely burned patients for a much more prolonged time.
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                Author and article information

                Contributors
                marc.jeschke@sunnybrook.ca
                Journal
                Nat Rev Dis Primers
                Nat Rev Dis Primers
                Nature Reviews. Disease Primers
                Nature Publishing Group UK (London )
                2056-676X
                13 February 2020
                2020
                : 6
                : 1
                : 11
                Affiliations
                [1 ]ISNI 0000 0000 9743 1587, GRID grid.413104.3, Ross Tilley Burn Center, Department of Surgery, , Sunnybrook Health Science Center, ; Toronto, Ontario Canada
                [2 ]ISNI 0000 0001 2157 2938, GRID grid.17063.33, Departments of Surgery and Immunology, , University of Toronto, ; Toronto, Ontario Canada
                [3 ]ISNI 0000 0004 0460 0556, GRID grid.416213.3, Association of Dutch Burn Centres, , Maasstad Hospital, ; Rotterdam, Netherlands
                [4 ]ISNI 000000040459992X, GRID grid.5645.2, Erasmus MC, University Medical Center Rotterdam, Department of Public Health, ; Rotterdam, Netherlands
                [5 ]ISNI 0000 0001 1089 6558, GRID grid.164971.c, Burn and Shock Trauma Research Institute, Alcohol Research Program, Stritch School of Medicine, , Loyola University Chicago Health Sciences Division, ; Maywood, IL USA
                [6 ]ISNI 0000 0001 0421 5525, GRID grid.265436.0, Department of Medicine, , Uniformed Services University of the Health Sciences, ; Bethesda, MD USA
                [7 ]ISNI 0000000122986657, GRID grid.34477.33, Department of Surgery, , University of Washington School of Medicine, ; Seattle, WA USA
                [8 ]ISNI 0000 0004 1936 9609, GRID grid.21613.37, Departments of Surgery and Psychiatry, Rady Faculty of Health Sciences, , University of Manitoba, ; Winnipeg, Manitoba Canada
                Article
                145
                10.1038/s41572-020-0145-5
                7224101
                32054846
                252705c7-f40b-4315-8786-0cad09e42cde
                © Springer Nature Limited 2020

                This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.

                History
                : 20 December 2019
                Categories
                Primer
                Custom metadata
                © Springer Nature Limited 2020

                sepsis,chemokines,microbiota,preventive medicine
                sepsis, chemokines, microbiota, preventive medicine

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