Journal Article Clinical Safety and Efficacy of Probiotic Administration Following Burn Injury Get access Theresa Mayes, RD, CSP, CCRC, Theresa Mayes, RD, CSP, CCRC *Department of Nutrition, Shriners Hospitals for Children, Cincinnati, Ohio†Divison of Nutrition Therapy, Cincinnati Children's Hospital Medical Center, Ohio **Address correspondence to Theresa Mayes, RD, CSP, CCRC, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, Ohio 45229. Search for other works by this author on: Oxford Academic Google Scholar Michele M. Gottschlich, PhD, RD, CSP, Michele M. Gottschlich, PhD, RD, CSP ‡Department of Research, Shriners Hospitals for Children, Cincinnati, Ohio§Department of Surgery, University of Cincinnati College of Medicine, Ohio Search for other works by this author on: Oxford Academic Google Scholar Laura E. James, MS, Laura E. James, MS ‡Department of Research, Shriners Hospitals for Children, Cincinnati, Ohio Search for other works by this author on: Oxford Academic Google Scholar Chris Allgeier, DTR, Chris Allgeier, DTR *Department of Nutrition, Shriners Hospitals for Children, Cincinnati, Ohio Search for other works by this author on: Oxford Academic Google Scholar Julie Weitz, RN, BSN, Julie Weitz, RN, BSN ‖Department of Nursing, Shriners Hospitals for Children, Cincinnati, Ohio Search for other works by this author on: Oxford Academic Google Scholar Richard J. Kagan, MD Richard J. Kagan, MD §Department of Surgery, University of Cincinnati College of Medicine, Ohio¶Department of Surgery, Shriners Hospitals for Children, Cincinnati, Ohio Search for other works by this author on: Oxford Academic Google Scholar Journal of Burn Care & Research, Volume 36, Issue 1, January-February 2015, Pages 92–99, https://doi.org/10.1097/BCR.0000000000000139 Published: 01 January 2015
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Thrombocytopenia is initially seen in patients with burn injury as a transient occurrence during the first week after injury. Subsequent decreases occur later in the course of treatment and are commonly due to sepsis, dilutional effects, and medication exposure. Although studies have demonstrated that thrombocytopenia in the critically ill patients is associated with a worse prognosis, there is limited literature as to the significance of thrombocytopenia in the pediatric burn patients. In this study, the authors evaluate the prognostic implications of thrombocytopenia in the pediatric burn patients. They performed a 5-year retrospective chart of patients aged 18 years or younger with burns >20% TBSA admitted to their institution. Data collected included patient demographics, burn etiology and %TBSA involvement, length of stay, pertinent laboratory values, and in-hospital morbidity and mortality. Of the 187 patients studied, thrombocytopenia occurred in 112 patients. Eighty-two percent demonstrated thrombocytopenia within the first week of injury and 18% demonstrated additional episodes of thrombocytopenia after this time. A reactive thrombocytosis occurred in 130 (70%) patients. The incidence of thrombocytopenia could not be attributed to age, gender, or burn etiology. However, patients with thrombocytopenia were more likely to have inhalation injury and extensive TBSA involvement than those without (P < .05). Sepsis was the cause of significant thrombocytopenia after the first week of hospitalization. Of the 187 patients, 14 died (7%). The incidence of thrombocytopenia in survivors and nonsurvivors was statistically significant in that nonsurvivors demonstrated a more profound drop in platelet count during the first week after injury and had a more depressed platelet recovery curve than survivors. The authors conclude that the early development of thrombocytopenia with depressed thrombocytosis in the pediatric burn patient is associated with increased mortality risk and is influenced by the extent of burn, inhalation injury, and the development of sepsis.
Inhalation injury, a major contributor to burn-related mortality, has been difficult to quantify. A scoring system paralleling current adult respiratory distress syndrome systems has the potential to distinguish survivors from nonsurvivors. The utility of the PaO2/FiO2 (P/F) ratio in predicting injury severity was first examined. In a review of 120 patients with inhalation injury, those with P/F ratios greater than or equal to 300 after resuscitation were more likely to survive than those with ratios less than 300. The P/F ratio had no value when obtained before resuscitation. Next, a scoring system was developed to assist in comparing the severity of injury in ventilator-dependent patients with burns. Measurements were recorded prospectively in four categories: chest x-ray evaluation, P/F ratio, peak inspiratory pressure, and bronchoscopy. When comparing survivors (20) versus nonsurvivors (6), significant differences were found early (day 0, day 1, and week 1) for P/F ratio and overall severity score. Differences were seen later (week 1 and week 2) for chest x-ray evaluation and peak inspiratory pressure values. Because of low numbers the value of bronchoscopy could not be evaluated. The role of an inhalation injury severity scoring system for predicting survival should be examined in larger prospective trials.
