Manu H. Desai

The University of Texas Medical Branch at Galveston

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David N. Herndon

Joseph M. Still Research Foundation

Randi L. Rutan

Mallinckrodt (United States)

Sally Abston

Shriners Hospitals for Children

David N. Herndon

Shriners Hospitals for Children - Galveston

Marsha A. Hildreth

Shriners Hospitals for Children - Galveston

Thomas C. Rutan

University Hospital, Newark

David N. Herndon

Joseph M. Still Research Foundation

Lyle D. Broemeling

Medical Lake School District

Robert E. Barrow

The University of Texas Medical Branch at Galveston

Robert R. Wolfe

University of Arkansas for Medical Sciences

Cooperative Institutions

The University of Texas Medical Branch at Galveston

Shriners Hospitals for Children - Galveston

Shriners Hospitals for Children - Erie

Shriners Hospitals for Children

Galveston College

Burn Institute

The University of Texas Southwestern Medical Center

The University of Texas Health Science Center at Houston

The University of Texas MD Anderson Cancer Center

University of South Florida

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NEBULIZATION TREATMENT OF SMOKE INHALATION INJURY IN SHEEP MODEL WITH DIMETHYLSULFOXIDE, HEPARIN, COMBINATION AND N ACETYLCYSTEINE

Critical Care Medicine (1986)

Manu H. Desai Mark Brown Ron Mlcak James A. Richardson Lillian D. Traber

Desai, Manu H.; Brown, Mark; Mlcak, Ron; Richardson, James; Traber, Lillian; Herndon, David N.; Traber, Daniel Author Information

Smoke Inhalation Injury

10.1097/00003246-198604000-00029

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Citations (7)

Biosynthetic Skin Substitute versus Frozen Human Cadaver Allograft for Temporary Coverage of Excised Burn Wounds

Journal of Trauma and Acute Care Surgery (1987)

William Dominic John L. Hunt Robert W. Gillespie John F. Hansbrough David J. Smith

During the past 2 years a multicenter study was performed comparing Biobrane (Woodroof) and frozen cadaver allograft as temporary dressings on freshly excised full-thickness burns before the application of autograft. Each biologic dressing was evaluated with respect to the other on the same patient. Seventy-one patients were evaluated. The mean burn size was 35 ± 20% with a mean full-thickness burn of 28 ± 20%. Mean patient age was 34 ± 21 years. Overall survival was 82%. The mean time of wound coverage was 10.2 ± 6.7 days. There was no significant difference in the number of dressing changes, area changed, purulence, autograft take, and final results between allograft- and Biobrane-covered sites. There were no complications following use of either Biobrane or allograft. We conclude that Biobrane is as effective as frozen human cadaver allograft for the temporary coverage of freshly excised fullthickness burn wounds before autografting.

10.1097/00005373-198702000-00010

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Adaptation of Self-Image in Burn-Disfigured Children

Journal of Burn Care & Rehabilitation (1989)

Sylvia A. Beard David N. Herndon Manu H. Desai

Massive burn injury alters both the physical appearance and the functional ability of the child. The changed body necessitates concomitant alteration of the internal self-image, including feelings about the internal self or self-esteem. Six children of primary school age are being followed up in a prospective, longitudinal study to track their adaptation to burn disfigurement. Results of the first 5 1/2 years reveal that, initially, all children displayed pervasive developmental regression, accompanied by phobias, nightmares, and various other symptoms. Two years later, one half of the children had returned to the average range of development attainment. By the fifth year, five of the six children had returned to an average level of progressive personality development. The sixth child was progressing well considering cognitive and emotional deficits before the burn injury. A primary factor influencing adaptation appeared to be the role of the parent or parents in facilitating the acquisition of a positive self-image and in launching and maintaining active mastery in their children.

Disfigurement

10.1097/00004630-198911000-00019

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Citations (33)

Scald Injury of the Respiratory Tract: An Unusual Occurrence

Journal of Burn Care & Rehabilitation (1987)

Manu H. Desai Myron M. Nichols David N. Herndon

An unusual case of tracheobronchial scald associated with head and neck scald is reported. A five-month-old infant, lying on his back with his face under the hot water tap, not only sustained head and neck scalds, but also swallowed and aspirated hot water. Burns of the mouth, pharynx, trachea, major bronchi, and bronchides ensued.

Respiratory tract

10.1097/00004630-198705000-00007

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Regulation of Lipolysis in Severely Burned Children

Annals of Surgery (1987)

Robert R. Wolfe David N. Herndon Edward J. Peters Farook Jahoor Manu H. Desai

In this study, the rates of lipid mobilization and of lipolysis have been quantified in severely burned children. In all 12 patients studied, the basal rates were determined. In seven patients, the lipolytic responsiveness to an infusion of epinephrine (0.015 micrograms/kg/min) was tested, and in the other five patients, the response to beta-adrenergic blockade (propranolol, 1 mg/kg) was tested. The rate of appearance (Ra) of free fatty acids (FFA) was quantified by means of the infusion of 1-13C-palmitate to determine the rate of lipid mobilization, and Ra glycerol was determined using d5-glycerol to assess the rate of lipolysis more directly. In five patients, body composition was determined after recovery by means of H2(18)O dilution. The basal rate of lipolysis was higher than normal in the burned children. In four of the seven patients infused with epinephrine, there was a pronounced increase in Ra glycerol. In all patients given beta-blockade, Ra glycerol decreased greatly. Changes in Ra FFA corresponded with the changes in Ra glycerol in each case. Total body fat was very low (approximately 2% body weight), reflecting the surgical removal of fat in the process of burn wound excision. From these data it is concluded that lipolytic responsiveness to catecholamines in severely burned children is variable, but not absent, despite chronically elevated levels of catecholamines. The total extent of lipolysis may be limited by the available fat mass in children treated with fascial excision. In such patients, the limitation in the ability to mobilize an adequate amount of FFA to fully meet energy requirements provides an important rationale for the clinical practice of providing nutritional support in hourly boluses, as opposed to infrequent meals, since any period of even a few hours in which nutrients are not being absorbed will result in an energy substrate deficiency and consequent increase in amino acid oxidation.

Basal (medicine)

10.1097/00000658-198708000-00016

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Citations (131)

Comparison of Resting Energy Expenditures and Caloric Intake in Children with Severe Burns

Journal of Burn Care & Rehabilitation (1990)

Dennis C. Gore Randi L. Rutan Marsha A. Hildreth Manu H. Desai David N. Herndon

Nutritional support is provided to children after severe burn injuries in amounts derived from empirical formulas or measurements of resting energy expenditure. To scrutinize these methods, indirect calorimetry measurements were performed on 74 survivors of burns (greater than or equal to 40% total body surface area) and compared to their actual caloric intake, percent weight change, and optimal caloric requirements formulated from the Curreri and Shriners' equations. These parameters showed that in spite of an initial deficit in actual caloric intake as compared to formulated goals, weight was maintained, whereas resting energy expenditures ranged from 30% to 40% below the actual caloric intake. Furthermore, a subgroup of patients (n = 42) who met +/- 20% of their formulated needs were stratified by extent of burn; this illustrated a significant weight gain in the more severely burned children. In conclusion, nutritional formulas in popular use overestimate caloric requirements in severe burns, whereas resting energy expenditure measurements require an additional factor of 30% to maintain body weight.

Caloric theory

Resting energy expenditure

Caloric intake

Kilogram

10.1097/00004630-199009000-00005

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An Unusual Donor Site, A Lifesaver in Extensive Burns

Journal of Burn Care & Rehabilitation (1988)

Manu H. Desai David N. Herndon Randi L. Rutan Jayne Parker

The availability of donor sites is a limiting factor in autologous skin grafting and, therefore, the survival of patients with large total body surface area (TBSA) burns. Of 19 males admitted to our facilities with burns greater than 80% TBSA, eight had the scrotum spared injury. The remaining 11 patients served as a control population to study the efficacy of scrotal donor harvests. The scrotal skin was expanded using the Pitkin syringe and harvested at a depth of 5/1000 to 8/1000 in, with a mean yield of 73 +/- 8 sq cm. Expanded 4:1, this tissue covered an area of 280 +/- 33 sq cm. The scrotum was harvested 2 +/- 0.4 times, compared to 4 +/- 1 harvests of the other donor group. There were no statistical differences in the number of surgical procedures or the length of hospitalization between the two groups. The scrotal donor sites healed within the same length of time as other donor sites and were harvestable as frequently. Due to the natural expandability of scrotal skin, a large surface area of usable donor site is available and their harvest may be lifesaving in male patients with large TBSA burns.

Limiting

Skin grafting

10.1097/00004630-198811000-00014

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The Quality of Life after Major Thermal Injury in Children

Journal of Trauma and Acute Care Surgery (1986)

David N. Herndon Jean E. LeMaster SYLVIA BEARD Norman R. Bernstein S. R. Lewis

Twenty-one children admitted between December 1981 and May 1985, with greater than 80% total body surface area burn (TBSAB), underwent total excision and grafting of all of their wounds within 72 hours of injury. Twelve survivors (with an average TBSAB of 89%, 82% third degree) were studied in detail describing the length of hospital stay (77 ± 10 days), number of operative procedures (7.8 ± 0.8), total blood loss (12 ± 2 blood volumes), the number of patients who experienced septic episodes (three), the number of patients who required amputation (four), range of motion, degree of scarring, ability to perform daily activities, and psychological adjustment. Physical impairment, according to standard scales, was approximately 60%; however, 50% of the children old enough to be tested were completely independent in activities of daily living. One third of the children had excessive fear, regression, and neurotic and somatic complaints, but all of them showed remarkable energy in adapting to their disabilities. We conclude that the final outcome, for these patients, can only be assessed as they achieve late adolescence and young adulthood.

Skin grafting

10.1097/00005373-198607000-00004

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Citations (88)

Determinants of Mortality in Pediatric Patients with Greater than 70% Full-thickness Total Body Surface Area Thermal Injury Treated by Early Total Excision and Grafting

Journal of Trauma and Acute Care Surgery (1987)

David N. Herndon DENNIS GORE MELVIN COLE Manu H. Desai Hugo A. Linares

Recent advancements in burn care have improved the survival rates of victims with severe burn injuries. The total mortality rate in a series of 1,057 pediatric patients admitted to Shriners Burns Institute Galveston Unit between 1982 and 1986 was 2.7%. The burn size resulting in a 50% death rate was 95% of the total body surface area (TBSA). In this study 19 survivors and 13 nonsurvivors with greater than 70% full-thickness TBSA burn injuries were compared. All survivors were adequately resuscitated upon arrival 11 % sustained an inhalation injury. Forty-six per cent of the nonsurvivors sustained an inhalation injury; 31% were not initially adequately resuscitated. The presence of preadmission shock and inhalation injury were early determinants of mortality with secondary renal, pulmonary, or cardiovascular collapse being the later predictors of mortality in these massively burned pediatric patients.

Body surface area

Skin grafting

10.1097/00005373-198702000-00020

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Citations (125)

Caloric Requirements of Patients With Burns Under One Year of Age

Journal of Burn Care & Rehabilitation (1993)

Marsha A. Hildreth David N. Herndon Manu H. Desai Lyle D. Broemeling

Formulas for estimating the caloric requirements of pediatric patients with burns have been suggested. However, the needs of infant patients with burns have not been specifically addressed. This study was undertaken to determine the caloric intake required to maintain weight in patients under 1 year of age who had burns covering more than 25% total body surface area. Thirty patients were studied, and a comparison was made between the actual intake required for weight maintenance and the suggested calorie levels provided by published pediatric caloric formulas. The results indicated that a new formula was needed. Multivariate regression analysis indicated that body surface area and burn surface area were significant predictors of caloric requirements, but body surface area was the more important predictor in this infant population. The equation resulting from the regression provides 2100 kcal/m2 body surface area/day plus 1000 kcal/m2 body surface area burned/day.

Body surface area

Caloric theory

Caloric intake

Calorie

10.1097/00004630-199301000-00023

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Citations (44)