Extracorporeal membrane oxygenation in the treatment of respiratory failure in pediatric patients with burns
ABSTRACT Extracorporeal membrane oxygenation (ECMO) as a treatment for pulmonary failure from postshock respiratory distress in burned children recently has been shown to salvage patients who were thought to have more than a 90% chance of dying. We describe five burned children in whom severe respiratory failure--not responsive to medical management and maximal ventilatory support--developed, and who underwent ECMO treatment. Three (60%) cases involved flame burns, with significant inhalation injury as diagnosed after a bronchoscopy; mean age was 3 years (2 to 4 years), with a mean total body surface area (TBSA) burn of 32% (15% to 53%), mean third-degree burns of 25% (5% to 53%). Two (40%) cases involved scald burns; mean age was 6 years (7 months to 11 years), with a mean TBSA burn of 56.5% (43% to 70%), mean third-degree burns of 40% (10.5% to 70%). Outcome was poor for those burned children who received ECMO therapy after prolonged ventilatory support for smoke inhalation injury. Children who experience perfusion/reperfusion shock injury to the lungs as a result of delayed resuscitation of scald burns may have an improved chance of survival with short courses of ECMO regardless of the burn size.
Article: Thermal injury[Show abstract] [Hide abstract]
ABSTRACT: This article addresses the pathophysiology of thermal burns, focusing on the complex inflammatory component, potential complications, and treatment strategies. Thermal injury is a relatively uncommon presentation in veterinary medicine. Contact with an electric heating pad, a hot muffler of a motor vehicle, or an open flame is the most common inciting cause. Severe thermal injuries, particularly full-thickness burns exceeding 30% of total body surface area, provoke a profound systemic inflammatory response characterized by leukocyte activation and plasma leakage in the microvasculature of tissues or organs remote from the wound. Burns may be caused by exposure to heat (thermal burns), electricity, chemicals, or radiation.Journal of Air Medical Transport 07/1997; 16(3):81–88. DOI:10.1016/S1067-991X(97)90021-3
Article: Thermal injury.[Show abstract] [Hide abstract]
ABSTRACT: Intensive care management of severely burned patients demands expertise in several areas. These include airway management, fluid resuscitation, support of the hypermetabolic response, infection control, and treatment of smoke inhalation injury. Surgical management of the burn wound, plastic reconstruction, and long-term rehabilitation are also essential aspects of modern burn care.Critical Care Clinics 05/1999; 15(2):333-52, ix. DOI:10.1016/S0749-0704(05)70058-0 · 2.50 Impact Factor