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Biomedical subjects

J R Saffle

Publications and source records attributed to J R Saffle.

At least 37 records · Page 2Linked to original sources
PubMed1991

Differences in mortality from thermal injury between pediatric and adult patients.

Children differ from adults in their responses to thermal injury, as reflected by higher reported mortality rates for equivalent major injuries. The age at which children's survival rates equal those of young adults has not been well defined, and some investigators have recently claimed that pediatric and adult burn mortality do not differ. We evaluated age-related mortality among 1,443 consecutive patients without inhalation injury treated from 1978 to 1988, inclusively. The sample consisted of 595 children aged 12 years or less, 243 children aged 13 to 20 years, and 605 young adults aged 21 to 40 years who served as a comparison group of patients with the best predicted survival. We separately examined mortality in patients with burns exceeding 30% total body surface area. There were no significant differences in mortality between age groups for the study sample as a whole, but among patients with large burns, children aged 0 to 48 months had higher mortality than comparably injured adults (31% v 12%, P less than .05 by analysis of covariance). Improvements in survival were also demonstrated between the first and second halves of the study period for children aged 25 months to 8 years. These data indicate that children 48 months of age and younger do not tolerate large thermal injuries as well as adults. Improvements in pediatric burn survival are being achieved in most age groups.

Adolescent↗
PubMed1990

Rehabilitation of burn patients with concomitant limb amputation: case reports.

Burn patients with associated limb amputations present demanding rehabilitation problems, many of which might be expected to lead to chronic difficulties. Therapeutic goals following limb amputation include oedema reduction, prevention of contracture (through positioning and range of motion), stump shaping, both pre- and post-prosthetic fitting strengthening exercises of the limb and trunk, and gait training. Some patients present problems that are associated with both the burn injury and the limb amputation that cause concern among the physical therapy staff. Some of these situations include intolerance of the stump to pressure or manipulation due to remaining open wounds or fragility of newly skin grafted areas on the residual limb or delayed gait or functional training due to wounds on other body surface areas. Delays in stump preparation or other treatment aims due to continued surgical procedures can be worrisome. A review of these patients indicates the possible difficulties that rehabilitation personnel may face when treating burn victims who required amputation. Effective rehabilitation of these patients can be achieved despite the noted concerns.

Adult↗
PubMed1990

A randomized trial of indirect calorimetry-based feedings in thermal injury.

To assess the superiority of indirect calorimetry (IC)-based enteral nutrition in burned patients, 49 adults with mean burns of 47% TBSA received feedings based either on the Curreri formula (CURR), or on IC, using enteral formulas with nonprotein calorie:nitrogen ratios of either 86:1, or 125:1. Intake in CURR patients was a mean 3,490 kcal/day, which exceeded resting energy expenditure (REE) by 43%, while IC patients received 3,530 kcal/day (1.2 x REE; p less than 0.05). Both groups maintained body weight and lymphocyte counts; survival was equal. Complications (diarrhea, nausea, hyperglycemia) were frequent in both groups, but their incidence did not differ. Patients fed the lower calorie:nitrogen ratio had greater cumulative nitrogen balance, with no increase in nitrogen excretion. It appears advisable to nourish burned patients with the minimal effective intake. While use of IC facilitates this goal, use of the Curreri formula provides acceptable approximation of caloric requirements in the early postburn period.

Adult↗
PubMed1990

The continuing challenge of burn care in the elderly.

Recent improvements in survival have stimulated interest in the care of elderly patients with burn injuries. We reviewed 278 patients aged 45 years and older treated during a 10-year period. The survival rate was 80% overall and 67% for patients over 75 years of age. Mortality rates correlated with patient age, burn size, presence of inhalation injury, number of complications of care, and fluid resuscitation requirements, but not with the number of preexisting medical problems. Burn wound excision and skin grafting were performed frequently and were well tolerated. During this period, hospital charges increased fourfold and were twice as great in nonsurvivors. Reimbursements based on diagnosis-related groups during the last 3 years of the review (75 patients) resulted in a total deficit of $1.2 million. Aggressive care for most elderly patients with burn injuries appears justified by the improved outcomes demonstrated. This has increased the difficulty of decisions regarding patient salvability and the allotment of resources. Elderly patients with burn injuries illustrate many contemporary dilemmas in patient care in this era of cost consciousness.

Aged↗
PubMed1989

The declining incidence of fatal sepsis following thermal injury.

Successful management of burned patients requires effective prevention and management of infectious complications. This study reviews the incidence of fatal sepsis in our burn center and attempts to analyze factors which may predict septic mortality. From January 1, 1978, through May 31, 1988, 1,913 patients were admitted, with a mean age of 24.8 +/- 0.5 years, a mean burn size of 17.7 +/- 0.4% total body surface area (%TBSA), and a mean 10.1 +/- 0.5% TBSA full-thickness injury. Nine per cent of patients sustained concurrent inhalation injuries. Overall mortality was 7.4%, and 1.6% of patients died from sepsis. Regression analysis showed that overall burn size, presence of inhalation injury, and the extent of full-thickness burn injury were significant independent predictors of death from sepsis, in decreasing order of relative importance. During the period 1983-1988, the incidence of septic mortality was 0.7%, which was significantly lower than the earlier half (1978-1982) of the study period (p less than 0.01). These data indicate that fatal infections are becoming increasingly uncommon after thermal injury. The reasons for this decline are probably multiple, and they include the widespread practice of early excision, and improvements in fluid resuscitation and the general medical care of burned patients.

Adolescent↗
PubMed1989

Avalanche trauma.

Medical aspects of avalanche accidents have apparently not been studied in the American literature. Records from the Utah Avalanche Forecasting Center (UAFC) for the period 1982-1987 were reviewed and compared with similar data from Europe and Canada. One hundred forty-five avalanches involving 188 individuals were reported to the UAFC. Ninety-one (48%) people were caught, of whom 21 required medical attention. Twelve of the 91 died (13%) and nine were injured (10%). Eleven of 12 nonsurvivors and four of nine survivors were completely buried. Evidence of major blunt trauma was present in nine of ten nonsurvivors and all nine survivors. Asphyxia and blunt trauma were the most common causes of death; hypothermia appeared to have played only a minor role. These findings were similar to results obtained in Europe and Canada.

Canada↗
PubMed1988

Haematopoietic progenitor cells in an infant who developed pancytopenia following an extensive burn.

We observed a 24-month-old infant who developed anaemia, thrombocytopenia and neutropenia while recuperating from an extensive burn. In order to determine the mechanism(s) responsible for the pancytopenia, we quantified marrow-derived haematopoietic progenitor cells, assessed the relative proliferative rate of haematopoietic progenitor cells, and sought the presence of progenitor cell inhibitors. The concentration and relative proliferative rate of pluripotent progenitors (CFU-GEMM) were elevated. No inhibitors of progenitor cells were observed; in fact, the patient's serum contained very high levels of stimulatory activity for CFU-GEMM as well as for granulocyte-macrophage progenitors (CFU-GM). However, the marrow concentration of erythroid progenitors (BFU-E and CFU-E) was diminished. We conclude that the anaemia in this patient was the result of either hypoproduction of differentiated erythroid progenitors or intramyeloid destruction of early erythroid cells. In contrast, the neutropenia was likely to be due to accelerated neutrophil consumption at a rate that exceeded the capacity for increasing neutrophil production.

Anemia↗
PubMed1988

Effect of exchange transfusion on cell-mediated immune function following thermal injury.

We assessed the effect of syngeneic and allogeneic exchange transfusion (XTF) on cell-mediated immunity in a murine burn model. Mice were given a 30% TBSA scald injury and lymphocyte function was monitored with the popliteal lymph node assay for host-versus-graft (HVG) or graft-versus-host (GVH) response. Nonexchanged burned animals exhibited suppression of GVH response on postburn days (PBD) 3 and 8 and suppression of HVG response on PBD 3, 8, 11, and 14. Syngeneic XTF stimulated GVH response on PBD 3, and significantly improved both GVH and HVG response to alloantigens on postburn days 3 and 8 compared to the response of burned controls. Allogeneic XTF significantly improved GVH response on PBD 3 and 8, but did not improve HVG response. Restoration of lymphocyte function in all experimental groups occurred between PBD 14 and 18 and coincided with wound healing.

Animals↗
PubMed1988

Transmission of cytomegalovirus infection in mice by skin graft.

Transmission of infectious disease, including virus, by allogeneic tissue transplants is a major clinical concern. The present study provided evidence for the transfer of murine cytomegalovirus (MCMV) by syngeneic and allogeneic skin grafts transplanted immediately after harvest from acutely infected donor mice. Transfer of MCMV also occurred following skin grafting with cryopreserved syngeneic skin. Recipients of infected skin were first positive for MCMV between 9 and 15 days post transplant, and MCMV was continually detectable through day 30. These results suggest that fresh or banked skin may serve as a source for transmission of cytomegalovirus infections.

Animals↗
PubMed1987

Increased survival after major thermal injury. A nine year review.

This study has reviewed the results of burn care in a burn center between 1978 and 1986. The total population included 1,458 patients. Mean burn size was 19 percent total body surface area, mean patient age was 24.4 years, and overall survival rate was 92 percent. We separately analyzed patients with burns of 30 percent total body surface area or greater during both halves of the study with respect to survival and length of hospital stay. Before 1982, patient survival was 59 percent and mean length of hospital stay was 28.1 days. Since that, the survival rate increased to 77 percent and mean length of hospital stay increased to 35.2 days. The early burn mortality rate remained nearly constant during the period of study (17 percent during the first half of the study and 16 percent during the second half), but the late mortality rate decreased significantly during the second half of the study (24 percent versus 8 percent, p less than 0.01). These data demonstrate increased survival rates after major thermal injury due to improvements in prevention and treatment of sepsis and other late complications of thermal injury.

Adolescent↗
PubMed1986

Fluid resuscitation in thermally injured children.

The fluid resuscitation requirements and mortality from thermal injury were reviewed in 177 children admitted to the Intermountain Burn Center over a 7 year period. Mean burn size was 27 percent of the total body surface area, whereas the mean full-thickness burn size was 13 percent of total body surface area. Twelve percent of children had associated inhalation injuries. The mean amount of fluid received during burn shock resuscitation was 5.8 +/- 0.25 ml/kg per percentage of total body surface area burned and the mean amount of sodium, 1.06 +/- 0.04 mEq/kg per percentage of total body surface area burned. There was no morbidity due to fluid overload. The presence of inhalation injury did not increase fluid or sodium requirements, but did increase mortality (29 percent versus 7 percent, p less than 0.05). The resuscitative mortality rate for all pediatric patients was 7 percent, the in-hospital mortality rate was 15 percent, and the 50 percent mortality burn correlate for these patients was 64 percent of the total body surface area. Data on children with burns were compared with an unselected, concurrent group of adult burn patients using an analysis of covariance. Fluid and sodium requirements were significantly higher for children, but there was no difference in the length of resuscitation or mortality rate. We conclude that children require much more fluid for resuscitation from burn shock than adults with similar burns. Appropriately aggressive fluid therapy for acute thermal injury in children is essential to achieve an acceptable survival rate in these patients.

Adult↗
PubMed1986

Immunologic parameters in burned patients: effect of therapeutic interventions.

Complex immunologic alterations occur following thermal injury. To further delineate the intricacies of the immune response, a longitudinal profile of immunologic parameters was investigated in burned patients with specific reference to clinical criteria (resuscitation, plasma exchange, surgical excisions, sepsis). During a 17-month period, 26 adult patients with a mean age of 32.6 years and a mean burn size of 45.6% TBSA were evaluated with serial (twice weekly) assays of immunocompetence. The immunologic variables monitored included complement components, fibronectin, immunoglobulins, acute-phase reactants, serum proteins, catecholamines, and the mixed lymphocyte reaction. Resuscitation from burn shock and clinical sepsis were associated with a wide array of serologic abnormalities and lymphocyte suppression. Plasma exchange and surgical excision and grafting procedures were also characterized by multiple serologic changes and improvement in lymphocyte function. No specific serologic parameter correlated well with cellular function; however, patterns of humoral alterations were consistently present and may represent a combined effect.

Adult↗
PubMed1985

Effect of inhalation injury on fluid resuscitation requirements after thermal injury.

The presence of inhalation injury has been reported to increase fluid requirements for resuscitation from burn shock after thermal injury. To evaluate the effect of inhalation injury on the magnitude of burn-induced shock, the characteristics of resuscitation of 171 patients with burns covering at least 25 percent of the total body surface area were reviewed. When inhalation injury was suspected, confirmation by xenon-133 scanning, bronchoscopy, or both was obtained. Initial fluid resuscitation was calculated according to the Parkland formula, and titration was initiated to maintain a urine output of 30 to 50 ml/hour. Fifty-one patients had inhalation injuries. Patients with inhalation injuries had a mean fluid requirement of 5.76 ml/kg per percentage of total body surface area burned and a mean sodium requirement of 0.94 mEq/kg per percentage of total body surface area burned to achieve successful resuscitation, compared with a fluid requirement of 3.98 ml/kg per percentage of total body surface area burned and a sodium requirement of 0.68 mEq/kg per percentage of total body surface area burned for the group without inhalation injury (p less than 0.05). These data confirm and quantitate that inhalation injury accompanying thermal trauma increases the magnitude of total body injury and requires increased volumes of fluid and sodium to achieve resuscitation from early burn shock.

Adolescent↗
PubMed1985

Use of indirect calorimetry in the nutritional management of burned patients.

The use of indirect calorimetry in assessing and monitoring nutritional support in burn patients is reported. Twenty-nine patients with a mean burn size of 35% TBSA were monitored with 228 measurements of resting energy expenditure (REE), calculations of respiratory quotient (RQ), and substrate metabolism. Daily weights, nitrogen balance determinations, and routine laboratory tests were also obtained. Oxygen consumption (VO2) was 186 +/- 39 ml/min/M2, corresponding to REE of 2,506 +/- 543 kcal/day. REE varied during the course of wound healing, demonstrating a biphasic course. Metabolic rate was also significantly increased with the performance of routine procedures such as dressings and surgery. Measurements of REE were a mean 76% of predictions based on the Curreri formula, and 1.47 times basal energy expenditure (BEE) calculated by the Harris-Benedict equation. Neither formula provided for the great variations observed in daily, and individual, measurements of REE. During the study, patients consumed 2,900 +/- 811 kcal/day, which exceeded REE by 1.14. This was associated with mean weight loss of 3.2% (range, -16 to 9%). RQ was less than 0.85 in 9% of determinations, but exceeded 1.0 24% of the time. Protein accounted for 17 +/- 3% of total metabolism, corresponding to a calorie:nitrogen ratio of 128:1. Practically, however, provision of this much protein proved difficult. Routine use of indirect calorimetry permits tailoring of nutritional support for burn patients, and is valuable in the early detection of significant under- or overnutrition.

Adolescent↗
PubMed1985

The effect of surgical excision and grafting procedures on postburn lymphocyte suppression.

Previous reports have stressed the immunosuppressive effects of major surgical procedures. In this study, 30 adult patients with a mean burn size of 42.8% TBSA and a mean age of 31.9 years underwent 78 surgical excision and grafting (E/G) procedures. The mean surface area excised was 2,373 cm2, with a mean blood transfusion requirement per E/G of 3,355 cc or 1.4 cc/cm2. The suppressive effect of burn serum was assayed in mixed lymphocyte cultures. Before E/G, burn serum caused a mean 42.2 +/- 3.3% suppression of normal lymphocyte blastogenesis; serum suppressive activity following E/G was reduced to 29.1 +/- 2.9% (p less than 0.005). The mean duration of improvement in lymphocyte function was 5.0 days. E/G procedures which achieved complete burn wound closure were more effective in restoring lymphocyte immunocompetence. E/G has a significant beneficial effect on restoring lymphocyte responsiveness in burn patients. Preliminary evidence suggests that this effect is related to blood transfusions.

Adolescent↗
PubMed1985

A prospective study of myocardial damage in electrical injuries.

A prospective study was undertaken to determine the incidence of possible myocardial damage following electrical injury. Sixteen patients with non-flash electrical injuries were assessed utilizing serial electrocardiograms (ECG), creatine kinase (CK) and MB creatinine kinase (MB-CK) determinations, technetium 99m stannous pyrophosphate scans, and 24-hour Holter monitors. Results showed that five patients (31%) had abnormal ECG, nine patients (56%) had elevations of the MB-CK isoenzyme, and one patient had a transiently abnormal Holter monitoring. No patient had an abnormal technetium pyrophosphate cardiac scan. Of the nine patients with elevated MB-CK levels, only two had abnormal ECG. None of the patients had clinical evidence of cardiac dysfunction. These results indicate a poor correlation of elevated MB-CK levels with ECG abnormalities, and demonstrate a relatively low incidence of myocardial damage in association with electrical injuries.

Adolescent↗
PubMed1985

Cataracts: a long-term complication of electrical injury.

The development of cataracts, a well-known complication of electrical injury, remains poorly understood. We reviewed 113 patients suffering major electrical injuries and identified seven patients who suffered 13 cataracts, an incidence of 6.2%. Six of the seven patients were injured with high (greater than 1,000-v) voltage current, while one man was injured by a 440-v source. All patients suffered true 'entrance and exit' wounds, but only three such injuries involved the head or neck. Cataracts first presented as decreased visual acuity 1 to 12 months postinjury. Ten of the 13 cataracts progressed to a point where surgery was required, from 3 to 27 months postinjury. Surgical therapy resulted in excellent return of vision in every case, although one patient was lost to followup and developed a late retinal detachment. Electrical cataracts remain a serious potential complication of electrical injury. Awareness by burn team members is essential in providing optimal treatment to victims of electrical injury.

Adolescent↗