Search

Vitamin D deficiency appears to be more prevalent than previously considered in the adult critically ill population, and specifically burn-injured patients. No definitive regimen has been shown to restore vitamin D (25(OH)D) levels more effectively to therapeutic levels in the burn-injured population. The purpose of this study was to investigate the effects of either ergocalciferol (D2, 50,000 IU weekly) or cholecalciferol (D3, 6,000 IU daily) in adults with burns ≥ 10% TBSA. This retrospective, observational study (2020-2022) included patients with vitamin D deficiency (< 30 ng/mL) who received replacement and had monitoring with weekly vitamin D levels. Patients on dialysis or those with a hospital length of stay (LOS) less than 2 weeks were excluded. Forty-five patients treated with ergocalciferol and 99 patients with cholecalciferol were included in the study. Patients treated with cholecalciferol were more likely to achieve 25(OH)D levels greater than 30 ng/ml compared to ergocalciferol over a 42-day period (HR 23.56, [95% CI, 12.57-44.16, p<0.0001). A higher proportion of patients in the cholecalciferol group achieved vitamin D greater than 20 ng/ml (HR 6.37, [95% CI, 4.20-9.66, p<0.0001). The adjusted hazard ratios (D3 vs D2) for achieving 25(OH)D levels > 30 ng/ml and > 20 ng/ml were and 23.94 (95% CI 5.09-427.6, p=0.0019) and 7.32 (95% CI 3.83-15.52, p<0.0001) respectively, after controlling for TBSA and initial 25(OH)D. Cholecalciferol appears to be a more effective agent than ergocalciferol for correcting vitamin D deficiency and insufficiency in patients with burn injuries., (© The Author(s) 2024. Published by Oxford University Press on behalf of the American Burn Association. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Fluid creep occurs when resuscitation after extensive burn injury reaches volumes higher than predicted. Since this has been described in patients with high opioid requirements, continuous analgesics and sedatives, including dexmedetomidine, have been avoided during resuscitation. This study sought to describe the impact of dexmedetomidine on fluid resuscitation requirements. This retrospective cohort study included adult patients with burns greater than 20% total body surface area (TBSA) resuscitated between January 2017 and June 2022 at a regional burn center. Patients deceased within 48 hours of burn were excluded. Primary outcome was volume of fluid required in the first 24 and 48 hours post-burn. Secondary outcomes were the incidence of fluid-related adverse events within 7 days post-burn. A total of 170 patients were included: 55 in the dexmedetomidine cohort and 115 in the control cohort. After propensity matching for variables associated with fluid creep, the dexmedetomidine cohort required 4.2 ± 1.7 mL/kg/%TBSA in the first 24 hours compared to 3.6 ± 1.1 mL/kg/%TBSA in the control cohort (p=0.03). The difference was no longer significant at 48 hours (p=0.11). There were no differences in the incidence of acute respiratory distress syndrome, delayed escharotomy/fasciotomy, intraabdominal hypertension, or renal replacement therapy. Dexmedetomidine exposure during acute resuscitation resulted in increased fluid requirements in the first 24 hours, suggesting it is independently associated with fluid creep; however, this increase was not sustained at 48 hours. Clinical significance of this finding is unclear as there was no increase in adverse events related to excessive fluid resuscitation between cohorts., (© The Author(s) 2024. Published by Oxford University Press on behalf of the American Burn Association. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Lighter sedation targets over the past decade have resulted in improved outcomes for critically ill populations. Although guidelines exist for the general ICU population, these recommendations often exclude the burn population. The purpose of this study is to assess the impact of the initial continuous sedative on coma- and delirium-free days in critically ill patients with burns. This retrospective cohort study evaluated adult patients admitted to a burn intensive care unit at an academic medical center between January 2010 and September 2019. Patients were enrolled into 3 groups based on the depth of initial continuous sedation received (deep, light, or analgosedation). Intubated patients were randomly assessed for inclusion from the National V6 Burn Registry. Patients were included if they received a continuous sedative infusion for at least 48 h. A total of 107 patients were included in the study with 36, 41, and 30 patients receiving deep, light, and analgosedation, respectively. The primary outcome of coma- and delirium-free days was significantly different between sedation types with the most days free in analgosedation and the fewest in deep sedation (8 versus 3 days; P = 0.024). The composite primary outcome was divided into secondary outcomes of coma-free days and delirium-free days, with coma-free days being different (P = 0.00008). Other secondary outcomes of length of stay in the intensive care unit and hospital, time on mechanical ventilation, and survival to discharge were not statistically significant; however, a trend toward higher mortality in deep sedation was noted., (© The Author(s) 2023. Published by Oxford University Press on behalf of the American Burn Association. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Cutaneous Fusarium infections carry significant morbidity and mortality in burn-injured patients. Treatment involves surgical source control in combination of systemic and topical therapy. Given drug shortage constraints with conventional amphotericin deoxycholate, we describe the first case of successful treatment with adjunctive topical liposomal amphotericin in a critically ill burn-injured patient., (© The Author(s) 2022. Published by Oxford University Press on behalf of the American Burn Association. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Disseminated infection caused by nontuberculous mycobacteria (NTM) is very rare, with an incidence of 1.0 to 1.8 cases per 100,000 persons, and typically only occurs in severely immunocompromised hosts. Burn patients suffer a loss of the natural cutaneous barrier as well as injury-induced immune dysfunction, and as a result, commonly develop infections, especially with multidrug-resistant organisms. However, very few NTM infections in burn patients have been reported in the literature. Disseminated NTM infection, in particular, can be a challenge to diagnose in burn patients due to burn-related physiology such as hyperpyrexia and widespread skin injury. We present a case of disseminated infection leading to bacteremia caused by Mycobacterium abscessus in a critically ill burn patient with a 74% total body surface area burn. M. abscessus belongs to the subgroup of NTM known as rapidly growing mycobacteria, which are notable for their ability to form colonies in a matter of days, rather than weeks, and because they are often highly drug-resistant, which complicates antimicrobial therapy. This is the third reported case of bacteremia caused by NTM in a burn patient and the second case that was successfully transitioned from intravenous antimicrobials to an oral regimen., (© The Author(s) 2022. Published by Oxford University Press on behalf of the American Burn Association. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Opioids are the mainstay of treatment for burn pain. However, these medications may be associated with respiratory depression and dependence. Multimodal analgesia is an alternative method that utilizes both opioid and nonopioid medications with different mechanisms. This study examines the impact of multimodal therapy for postoperative pain control in a burn intensive care unit.  This was a retrospective cohort study of patients admitted to the burn unit at a tertiary medical center. Consecutively admitted patients with burns greater than or equal to 10% TBSA and intensive care unit length of stay greater than 7 days were eligible for inclusion (2012-2018). Patients were excluded if they received an opioid infusion greater than 48 hours.  Patients treated with multimodal analgesia were compared to those treated with opioids alone. Data were calculated for 5 days after surgery. There were 98 patients in the nonmultimodal group and 97 in the multimodal group. Mean cumulative opioid dose was lower in the multimodal group (1028.7 mg vs 1423.2 mg, P = .0031). Patients with greater than 20% burns had a larger reduction in mean opioid equivalents in the multimodal group (1106 vs 1594 mg, P = .009) compared to patients with burns less than 20% (940 vs 1282 mg, P = .058). There was no difference in mean pain scores on postoperative day 5 (6.2 ± 2.2 vs 5.5 ± 2.3, P = .07) or at intensive care unit discharge (4.7 ± 2.4 vs 4.7 ± 2.8, P = .99). The use of multimodal analgesia significantly reduced cumulative opioid equivalent dose without compromising pain control.    ., (© The Author(s) 2021. Published by Oxford University Press on behalf of the American Burn Association. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)