Factors involved in burn wound healing – short review

Burns represent one of the worldwide leading causes of injury. Burn wounds are associated with increased mortality and morbidity, especially the impaired quality of life due to hypertrophic scarring, scar pain and itching, paresthesia, and contractures. To properly influence the burn wound healing, it is important to establish a correct classification of the acute injury and to understand the main phase of burn wound healing process. There are various local and systemic factors that can be influenced to obtain proper healing. The most important factors include local necrosis and infection, increased local pressure and edema, anemia, hypoxia, hypotension, the presence of important chronic disease and medication, immunosuppression, nutritional status, age, and body constitution. After adequate fluid resuscitation and patient stabilization, the main step is represented by the detachment of the devitalized tissues and rapid coverage of the lesion. There are various methods to be used, like autologous or allogenic skin grafting, the use of skin substitutes, or tissue bioengineering. Knowing all these aspects, allows clinicians to properly define a therapeutic management for patients presenting severe burns

Burns of the head and neck – from physiological to psychological impact

Burn injuries have a long-term negative impact on patients, families, and healthcare systems, and prevention remains the primary goal. Head and neck lesions have a reported prevalence between 6-65.6%, sometimes even 95.1%. There are various risk factors and predictors of facial burns, like younger age, male sex, flame or flash burns, and work-related injuries. Surgical and non-surgical management is chosen depending on the burn type and extension, and the patients’ previous health status. Tangential necrosectomy is the gold standard of third-degree burn care. In the last years, enzymatic debridement showed promising results. Long-term complications, from altered sensibility, and face motor dysfunction, to hypertrophic scarring and mutilating aspects, frequently lead to depression, post-traumatic stress disorders, and social exclusion. To improve patients’ quality of life, various programs targeting reconstructive surgeries with cosmetic purposes, social skill training, and cognitive behavioural therapies should be implemented

Hydrotherapy in burn care: Pros, cons and suggestions

Hydrotherapy represents the use of water for medical purpose, being involved in burn wound care since the 17th century. Burn wound cleansing, performed daily, twice a day, or as needed, as part of standard care, should be scheduled by a burn surgeon and supervised by proper specialists. It can be performed by various methods, like shower, immersion, bedside irrigation or wiping. Due to the high risk of cross-contamination, immersion is no longer recommended. Tap water seems to be superior to saline solution in burn wound care, and adjuvants can be added, especially chlorhexidine, povidone-iodine, or special detergents. Disposable plastic sheets use during showering and the following of cleaning protocols for washing areas have decreased the risk of infection. Apart from the wound-cleansing role, hydrotherapy reduces itching and pain, improves wound healing, favours early mobilization and increases patients’ comfort. Controversy persists around the optimal method and appropriate solutions for cleaning burn injuries and clinical studies are further required to solve this matter. In the absence of standardized recommendations, most burn centers are guided by experience

Nebulized heparin for burned patients with inhalation injury: a review

The presence of inhalation injury has a negative impact on the evolution of burned patients, being associated with increased mortality. It occurs as a direct consequence of thermal action, or secondary to the presence of respiratory irritants or absorption of toxins, and actual therapeutic management is mainly supportive. Several clinical findings are relevant to raising suspicion and guiding further examinations, fiberoptic bronchoscopy being the gold standard of diagnosis and staging. In burned patients with inhalation injuries, various reports showed that nebulized heparin (5,000 or 10,000 units) with a 4-hour administration regimen leads to improved outcome, reduces the days of mechanical ventilation and consequently the length of hospital stay, reduces pulmonary complications and improves lung function, having a safe profile, with fewer side effects

Bromelain-based enzymatic debridement in hand burns – an easier way to manage a difficult patient: case report

Introduction. Bromelain-based enzymatic debridement may be considered the standard in patients with upper extremity burns management, regarding the low risk of bleeding, wound infections, reduction of surgical timing, and the decreased risk of compartment syndrome development. Case presentation. We present the case of hand and face burns in a patient presenting deep venous thrombosis of the lower limb extended to the level of the vena cava, and bilateral pulmonary embolism. The enzymatic debridement reduced periprocedural bleeding and allowed a faster recovery and therefore the resumption of oral anticoagulation and antiplatelet medication in a patient with important cardiac, arterial, and renal comorbidities. Conclusion. Bromelain-based enzymatic debridement use is recommended in patients presenting upper limb deep burns, especially in anatomically challenging areas, like hand fingers, and especially in those with a previous medical history that predisposes them to periprocedural bleeding and increased risk of poor healing

Immunosupression in IgA Nephropathy

IgA Nephropathy (IgAN) is one of the most frequent types of glomerulonephritis encountered in adults from Western countries and Asia. IgAN is responsible for approximately 40% of end-stage renal disease (ESRD) mediated by glomerular impairment. The majority of adult IgAN patients present a slowly progressive pattern towards ESRD. Current types of treatment are based mainly on supportive care: i.e., life style risk factors, measures that lower blood pressure and reduce proteinuria, weight loss, smoking cessation or glycaemia control. Because IgAN is an immune complex-mediated disease, immunosuppression therapy gains more and more attention as a modality of treatment. Despite the beneficial effects, the value of immunosuppression remains controversial due to high rates of adverse reactions. The aim of this review is to highlight the benefits and limitations of promoting immunosuppression in IgAN with mild to moderate proteinuria despite supportive antiproteinuric therapy up titrated to maximum tolerated doses

The etiology and pathophysiology of COVID-19 associated acute kidney injury

Hospitalized COVID-19 patients often develop acute kidney injury (AKI), leading to increased mortality. In order to improve patients’ survival rate, it is important to understand the pathophysiology mechanism of AKI. In this brief review, we highlight the most important elements of the etiology and pathophysiology of COVID-19 associated AKI. Acute tubular injury seems to be more frequent than prerenal azotemia in COVID-19 patients and collapsing glomerulopathy is the most encountered form of glomerular disease. Another important role in acute kidney injury seems to play immune cell infiltration, inflammation, endothelial injury and microvascular thrombi. Renin-angiotensin-aldosterone system is also important in the pathophysiology of COVID-19 associated AKI

The importance of high flow nasal cannula (HFNC) oxygen therapy

High flow nasal cannula (HFNC) oxygen therapy devices are used on a daily-basis in many intensive care units and postoperative wards. Such a device deliver a mixture of air and oxygen, warmed, humidifi ed, with gas flow between 20-60 L/min, and inspired oxygen fraction between 0.21-1. Therefore, it improves oxygenation, decreases dead space, washes out the carbon dioxide (CO2) from patients’ airways, improves thoraco-abdominal synchrony and decreases the work of breathing. Studies have shown effi cacy of HFNC oxygen therapy use for acute hypoxemic respiratory failure, for patients with exacerbations of chronic pulmonary diseases, after extubation in order reduce the need for mechanical ventilation, in perioperative period to prevent atelectasis and in palliative care, in order to reduce breathlessness. It isn`t feasible for patients with severe altered neurological status, facial trauma, basal skull fracture, complete airway obstruction or epistaxis. There are no standardized recommendation for the use or contraindication of HFCN oxygen therapy. The weaning is realised according with patients’ tolerance, oxygen saturation, respiratory and heart rates

Abdominal Compartment Syndrome – a Surgical Emergency

Over the past six decades, abdominal compartment syndrome (ACS) remained a very controversial subject, both in surgical and non-surgical specialties. Doctors failed to understand why critically ill patients died in the ICU with distended abdomens without fi nding any cause or why postoperative patients with wound defects such as dehiscence died after suturing the wound again „very tightly”. After the concept of intra-abdominal pressure (IAP) was established and methods for measuring it and diagnosing intra-abdominal hypertension (IAH) were available for clinicians to use it, it became clearer that ACS was a very serious and life threating pathology and the need for a correct treatment is essential. In this article we will try to make a literature review of the past decade and see when and how to diagnose correctly a patient with ACS and also how the diagnostic and treatments methods changed over the years

The Labyrinth Behind an Acute Respiratory Failure

Introduction: Acute hypoxemic respiratory failure may have different causes. Case presentation: We present the case of a 42-year-old woman, with history of recent thyroidectomy and a late history of sleeve gastrectomy, who presented for acute dyspnoea. The chest X-ray revealed hydropneumothorax, and, therefore, an intercostals chest tube drainage was inserted. The evolution was unfavourable, with further respiratory status deterioration. A computed tomography of the thorax and abdomen was performed, that revealed a dilated thoracic oesophagus and stenosis of the esophagogastric junction, with lack of substance in the oesophageal wall and extravasation of oesophageal content in the posterior mediastinum, due to an oesophageal pleural fi stula. An oesophageal stent was inserted under endoscopic guidance and the patient underwent minim-invasive surgical interventions for evacuation of the mediastinal and pleural collections, with a favourable evolution. Conclusions: Acute respiratory failure can be the face of multiple conditions, some of these can be life threatening and in need for rapid detection and treatment