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Biomedical subjects

Juan P Barret

Publications and source records attributed to Juan P Barret.

8 recordsLinked to original sources
PubMed2006

Complications of the hypercoagulable status in burn injury.

Burn patients commonly exhibit signs of thrombogenicity, theoretically, puts them at risk for thromboembolic complications. However, the literature is controversial, and the real impact of these complications is yet unknown. We reviewed a series of 3331 burned patients to study the incidence of arterial thrombosis, deep venous thrombosis, and pulmonary thromboembolism. Ten patients presented with thrombotic complications, which accounted to a raw incidence of 0.3%. One complication occurred in the paediatric population (incidence of 0.1%) and nine in the adult population (incidence of 0.37%). There were three arterial thromboses (AT) of the common femoral artery, one in an 8 years old boy and two in two adult male patients. The other seven patients had deep venous thrombosis (DVT) of the inferior extremities and three of them presented with pulmonary thromboembolism (PTE). Thrombotic complications represented 3.38% of all deaths in our burn population. Despite the hypercoagulable status of burn patients, thrombotic complication and related mortality continue to have a low impact in this population.

Adult↗
PubMed2005

Disseminated intravascular coagulation: a rare entity in burn injury.

Severe burns are traditionally quoted as causes for acute disseminated intravascular coagulopathy (DIC). However, literature is scarce, and the real incidence of DIC is still unknown. In order to determine the incidence and the clinical implications of DIC in the burned population, 3331 consecutive burned patients were review. There were three episodes of DIC (0.09%) and six patients had abnormal levels of fibrin degradation products. All DIC episodes resolved with aggressive supportive therapy and replacement therapy, although two of the patients died from the underlying pathology. There were no deaths attributed to DIC and there were no signs of DIC on autopsy. In conclusion, disseminated intravascular coagulopathy is a rare complication following severe burn trauma. It complicates the course of the critically ill burn patient, although appropriate therapy prevents its fulminant course. However, a prospective multicenter study with close monitoring of all coagulation parameters may be necessary to elucidate the real incidence of DIC in burn patients.

Adult↗
PubMed2004

Plantar burns in children: epidemiology and sequelae.

Pediatric plantar burns present with significant and unique characteristics. The treatment of choice remains controversial, and any alteration of the anatomy will lead to alteration in gait. To study the outcome of conservative treatment of plantar burns and determine risk factors, 40 pediatric patients affected with isolated plantar burns were studied. All burns were treated with silver sulfadiazine and early ambulation, and those that did not heal within 3 weeks were autografted. Twenty-eight patients (70%) had partial-thickness burns and 12 patients (30%) full-thickness burns. Complications during the acute period included 1 episode of cellulitis and 1 patient with prolonged difficulties with ambulation. Three patients required excision and autografting, and none of them developed late sequelae. Five patients presented with late sequelae, and all had in common complete healing with conservative treatment, young age, and a longer healing time (24.4 days). We conclude that conservative treatment of pediatric plantar burns has a negligible complication rate. Burns that do not heal within 3 weeks are best managed with excision and autografting, which had a 0% incidence of complication rate in this series.

Burns↗
PubMed2003

Modulation of inflammatory and catabolic responses in severely burned children by early burn wound excision in the first 24 hours.

HYPOTHESIS: Early burn wound excision modulates the hypermetabolic response in severe pediatric burn injuries. DESIGN: Before-after trial. SETTING: A 30-bed burn referral center in a private, university-affiliated hospital. METHODS: We studied 35 severely burned children who were divided into 2 groups. One group (n = 20) was treated with early burn wound excision within 24 hours after the injury. The second group (n = 15) was treated conservatively with silver sulfadiazine in other burn facilities for 5 days, and burn wounds were surgically excised when patients were admitted to our burn center on day 6 after the injury. Data compiled included oxygen consumption and acute-phase protein, interleukin 1beta; interleukin 6, interleukin 10, tumor necrosis factor alpha, and anabolic hormone (growth hormone, insulinlike growth factor type 1) levels preoperatively and 24 hours and 5 days postoperatively. MAIN OUTCOME MEASURES: Acute-phase and hypermetabolic responses. RESULTS: Early burn wound excision abrogated the hypermetabolic response in pediatric burn patients. Patients who underwent conservative treatment had a significantly more severe inflammatory and hypermetabolic response at the same time interval and significantly lower levels of anabolic hormones. CONCLUSIONS: Early burn wound excision is a safe therapeutic approach that modulates the hypermetabolic response after burn injury. It was superior to the conservative treatment of silver sulfadiazine and delayed excision, and it should be considered when treating all severe full-thickness burns.

Acute-Phase Reaction↗
PubMed2003

[Timing of bacterial colonization in severe burns: is strict isolation necessary?].

INTRODUCTION: Infection is still one of the main causes of mortality in severe burn patients. Strict isolation has been used for the prevention of infection, but the efficacy of this measure is debatable. The aim of this study was to determine the timing of bacterial colonization in these patients and to ascertain whether strict isolation is indicated. METHODS: Thirty consecutive children with severe burns were studied. Patients were only barrier-nursed during dressing changes. On admission and twice weekly over the entire hospital stay, burn, sputum, gastric aspirates, feces, and blood samples were obtained for culture. All isolates were tested for specific biotypes. Results were studied with linear regression and repeated measures ANOVA to determine the timing of colonization and cross-colonization between patients. RESULTS: On admission, normal cutaneous flora were isolated from burn cultures of all patients. The remaining cultures were negative. After one week, gastric aspirates were found to be colonized by gram-negative bacteria and fungi. This was followed by colonization of feces, burn, and sputum cultures. Biotype identification showed unidirectional colonization from the gastrointestinal tract to burns and upper airway. There were no cross infections between patients. CONCLUSIONS: Microbial colonization in severe burn patients was endogenous in nature and there were no cross infections. Thus, strict isolation is not necessary in burn centers, except during outbreaks of multi-resistant microorganisms.

Bacteria↗
PubMed2003

Effects of burn wound excision on bacterial colonization and invasion.

Rates of survival after thermal injury have improved in the past two decades, and rates of wound infections and sepsis have decreased during the same period. Early excision has been advocated as one of the major factors, but its safety and efficacy and the exact timing of burn excision are still under debate. It was hypothesized that acute burn wound excision (in the first 24 hours after burning) would be superior to conservative treatment and delayed excision in preventing bacterial colonization and invasion. Twenty consecutive patients with thermal injuries were studied. Twelve patients underwent acute burn wound excision, and eight patients underwent conservative treatment and delayed excision. The second group of patients received topical treatments in another facility and underwent delayed excision after transfer to our service, on postburn day 6. Quantitative bacteriological assessments of the excised wound and biopsy samples of the wound bed, obtained before autografting and/or homografting, were performed. The effects of time on bacterial counts, differences between superficial and deep biopsy samples, and the effects of early versus late debridement were studied. Patients admitted early exhibited bacterial counts of less than 10 bacteria per gram of tissue. Patients in this group did not experience infection or graft loss. Patients admitted late exhibited counts of more than 10 bacteria (p = 0.001, compared with early admission). Three patients in the late excision group experienced infection and graft loss (p < 0.05, compared with the early excision group). Burn wound excision significantly decreased bacterial colonization for all patients (p < 0.001). Greater bacterial colonization and higher rates of infection were correlated with topical treatment and late excision (p < 0.001). It is concluded that burn wound excision significantly reduces bacterial colonization. Patients who undergo topical treatment and delayed burn wound excision exhibit greater bacterial colonization and increased rates of infection. Acute burn wound excision should be considered for all full-thickness burns.

Bacteriological Techniques↗