We need central venous catheters (CVCs) in management of critically ill patients with severe burns, either for the administration of fluids or monitoring hemodynamic status. Central venous catheterization may cause different early or late complications, which depend on the physician's erudition, the quality of the catheters and quality of Intensive Care Unit (ICU) nursing care for insertion. 272 CVCs were inserted in 114 both adult and pediatric patients from 2004 to 2006 in the ICU of the Burn Centre in Ostrava. The average insertion length of the catheter was 10.2 days, and the average total length of catheterization was 24 days. The total number of catheter-days was 2768. All catheter tips removed were routinely cultured. The most frequent infecting pathogens were coagulase-negative Staphylococci. Peripheral blood cultures were examined in case of fever. Bacterial findings from wounds, sputa and urine were monitored in all patients. No exogenous catheter sepsis according to Maki's criteria occurred in our study group. Endogenous catheter colonization with positive peripheral blood culture and bacteraemia occurred in 4 cases, which means an incidence density of 1.44 endogenous colonizations per 1000 catheter-days. The quality of used catheters and particularly the technique of placement and maintenance of catheters are considered crucial for good results in the ICU of Burn centre in Ostrava.
- MeSH
- bakteriální infekce komplikace prevence a kontrola MeSH
- interpretace statistických dat MeSH
- jednotky intenzivní péče využití MeSH
- katetrizace centrálních vén metody škodlivé účinky využití MeSH
- katetrizace metody škodlivé účinky využití MeSH
- popáleninové jednotky využití MeSH
- sepse etiologie komplikace prevence a kontrola MeSH
- Staphylococcus cytologie izolace a purifikace patogenita MeSH
- Geografické názvy
- Česká republika MeSH
Integra® artificial skin was applied on 16% of TBSA after necrectomy on a 7-month-old girl who was scalded on 26% of TBSA by her mother when she was cooking goulash. Nutritional parameters were monitored during the period of 25 days from the 1st necrectomy and application of Integra® up to the first autotransplantation – in the period when the other burnt surfaces were almost healed. The average intake of proteins and energy to achieve normal levels of monitored nutritional parameters was lower than that recommended by calculations for similarly burnt children. Our observation is similar to that of King (1).
- Klíčová slova
- Integra,
- MeSH
- kojenec MeSH
- lidé MeSH
- metody výživy MeSH
- nutriční hodnota MeSH
- popálení klasifikace terapie MeSH
- poruchy výživy dietoterapie terapie MeSH
- umělá kůže využití MeSH
- Check Tag
- kojenec MeSH
- lidé MeSH
- Publikační typ
- kazuistiky MeSH
- srovnávací studie MeSH
The advantages of Integra have lead to an increase in its use after extensive burn injuries, in reconstructive surgery after burns, and abroad in general reconstructive surgery as well. At the Burn Center of FNsP Hospital in Ostrava Integra was used for the first time in March 2003. Since then, seven patients have undergone operations, involving the use of Integra in 14 body areas. In four of the patients scars after burns were corrected – on the neck, axilla, two on the trunk, two in the popliteal area and one between the toes. In three patients the artificial skin was applied after necronectomy. In a 7-month-old baby and in a 2-year-old child with burn injuries exceeding 25% of the body surface it was applied twice on the trunk, once on the upper extremity and once on the lower extremity. In an adult female Integra was applied on her neck and axilla after burns to a lesser extent.We have evaluated the scars one year after surgery in two patients. Cosmetic appearance was good in both of them.We have noted good functional result after the reconstruction of axilla. After reconstruction in the neck area and reconstruction of the necrectomy in the neck area and axilla, the functional results were average. The average functional results in both patients are probably due to poor compliance with the immobilization and following rehabilitation program.
Electrical burns are a serious problem within burn medicine even though they are relatively uncommon. The size of the burn is small, but the wound is often deep, and frequently the patient has systemic complications as well. In the majority of patients with such injuries immediate surgical intervention is essential, consisting of escharotomy, fasciotomy, and debridement of the devitalized tissues, necrectomy of the burn area, and closure of the defect by a direct suture, a dermo-epidermal graft, or local flap. Our report consists of three case studies. The patients underwent local flap plastic surgery after a full thickness soft tissue loss. All three patients healed primarily and did not require further correction of flaps. Final functional and aesthetic results are very good if the local flap is used appropriately.
- MeSH
- chirurgické laloky využití MeSH
- lidé MeSH
- popálení elektrickým proudem chirurgie MeSH
- transplantace kůže metody využití MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
The authors have analyzed the data files of 580 child patients up to 15 years of age who were hospitalized at the Burn Center of the FNsP Hospital in Ostrava in the years 1999 – 2003. The authors focused on mechanisms of burn injury in relation to the age of a child as well as extent, depth, localization, and local treatment of the injury. The data file was divided to four age groups: up to two years of age, 2 – 5 years of age, 5 – 10 years of age, and 10 – 15 years of age. As regards the mechanisms of injury, the authors have analyzed scalding by hot liquids, burns due to contact with a hot object, burns due to electric current, explosion, and injury caused by burning clothing. Injury by scalding prevails to a very significant degree in the youngest children. In the second age group the incidence of burn following contact with hot objects increases, as does the percentage of children injured by burning of clothing in children aged 5 – 10. The older children have increased prevalence of injuries caused by explosions. The greatest average extent of an injury is from burning of clothing. Most of the areas are burned deeply, localized in more areas of the body, and almost half of the cases required surgical intervention. Scalding comes second in terms of average extent of an injury. More than half of the injured areas are superficial, and areas of injury are different in the individual age groups.We addressed about a fifth of the cases surgically. The explosion of combustible materials caused a smaller extent of injury, on average, taking third place. The injuries were predominantly superficial, most commonly involving the head, trunk, and upper extremities. In none of the cases it was necessary for us to operate. Burn injuries caused by contact with hot objects are of a smaller extent. More than half of the burned areas are deep, localized most commonly in the upper extremities. Surgical intervention was necessary in more than half the cases. In terms of average extent of an injury, the smallest burn injuries are caused by electric current. However, these injuries are deep, and surgical intervention was necessary in all cases.
The authors present a data file of 279 children with severe and critical burn injury, hospitalized in the Intensive Care Unit or the Pediatric Resuscitation Unit of the FNsP Hospital in Ostrava in the years 1999 – 2003. The severity of the burn trauma in children is determined by age, extent, depth, localization, circumstances of the injury, its mechanism, and by other serious illnesses of a child. The authors have divided the data file into two groups, severe and critical, using classification of a burn injury in children according to the extent of injury as well as localization and other circumstances (1). Complex therapy of extensive burn injuries in children is based on adequate fluid resuscitation, treatment of burned areas, algosedation, and appropriate antibiotic therapy. The authors have unequivocally confirmed that in the group of children with diagnosis of critical burns complications occur more often, while the overall course of illness is serious and requires more therapeutical interventions than in the group of children with severe burns.
