Relationships Between heat Production, Heat Loss, and Body Temperature for Rats With Burn Injuries Between 26% and 63% of the Body Surface Area
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Abstract:
Burn injury in man is characterized by increased body temperature proportional to burn wound size and may represent fever and/or hyperthermia. A nonseptic animal model used to study this phenomena has not been described. To test the hypothesis that large burn injuries in rats would produce increased body temperature, the rectal, skin, and body temperatures were sequentially measured and were calculated for rats in the control group and rats with burn injuries covering 26% to 63% of the body surface area [< or = 35%, 36% to 45%, and > or = 46% body surface area]. The group with burns covering > or = 46% of the body surface area had significantly higher rectal temperatures than did at least one other group on postburn days 7, 9, 11, 13, 18, and 20. On postburn days 7 and 11 this increase was significantly higher than that of all burn and control groups. Animals did not demonstrate any overt evidence of wound infection. These data do not establish a cause for increased body temperature after burn injury but suggest that a reproducible animal model may be possible for the study of the cause of increased body temperature after burn injury.Keywords:
Body surface area
Rectal temperature
Body surface
Human body temperature
Lower body
Animal model
Skin Temperature
The treatment of the patients with extensive burns has advanced dramatically in the past 10 years, and the mortality rate has also been reduced. The establishment of the skin-bank network as well as the development of emergency and critical care medicine can be cited as reasons Moreover, immediate burn wound excision and grafting for patients with extensive burns may be beneficial. Meticulous management is required perioperatively to perform these procedures safely during burn shock. Patients with extensive burns are susceptible to hypothermia while receiving massive fluid resuscitation. We use a warmer device (Level 1) to keep burn patients warm. From 1991 to 2003, we performed immediate burn wound excision and grafting in 26 extensively burned patients within 24 hours after burn injury. We completed the surgery within 2 hours and excised burn wounds covering 40% of the total body surface area (TBSA). The mean age was 57 +/- 22 (mean +/- SD years), the mean burn surface area (% of TBSA) was 47 +/- 20, the mean burn index was 45 +/- 19, and the mean prognostic burn index was 94 +/- 36. There were 15 survivors and 11 deaths, for an overall mortality rate of 43%.
Skin grafting
Body surface area
Severe burn
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Objective To determine the effect of early excision and closure of burns on postburn hypermetabolism, measured as oxygen consumption (Vo2). Methods Twelve patients with deep burns of 30% to 50% of total body surface underwent sequential excisions and wound coverage, beginning 1 to 3 days after burn. The majority of the deep burn was removed by day 7, but with the addition of a donor site area of 20% to 25% of total body surface. Results No decrease in Vo2 was noted in relation to the percent removal of burn tissue. In addition, a transient further increase in Vo2 was noted early after excision, especially with surgical procedures performed after 5 days. This response could not be attributed to wound manipulation-induced bacteremias. Conclusion We conclude that early surgical excision and closure of burns in excess of 30% to 50% of total body surface do not decrease postburn hypermetabolism in proportion to the area closed. It is possible that remaining open wounds in the form of donor sites and nonexcised burn are sufficient to perpetuate the hypermetabolic process, once established. (Crit Care Med 1991; 19:861)
Hypermetabolism
Wound Closure
Body surface area
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Body surface area
Body surface
Body height
Body water
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The decade of the 1980s saw a tremendous diminution of mortality in major thermal burn injuries. Early massive excision and grafting of burns has increased the LD50 to 98% total body surface area (TBSA) burn in referral pediatric burn centers such as the Shriners Burns Institute-Galveston Unit. We believe that early excision of the burn wound, within 72h of the time of injury, is absolutely essential in the very largest of 3rd degree burns, and we advocate, as a standard of care, the use of fresh cadaver skin as a temporary cover. We initially thought that excising and grafting the acute burn wound would return the patients' immunologic and hypermetabolic responses to normal. Surprisingly, this has not been the case; the physiologic and metabolic alterations following thermal injury continue despite these measures. Essentially, a burn patient is one whose outer defense, the skin, is breached and whose inner defense mechanism is deranged.
Hypermetabolism
Thermal burn
Skin grafting
Severe burn
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Body surface area
Blood Culture
Skin biopsy
Microbiological culture
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Objective: To study the relationship of resting energy expenditure(REE) with wound depth in burn patients and offer some guidance for the nutrition treatment of burn.Methods: Twenty-three burn patients with a similar total burn surface were randomly divided in accordance with the Ⅲ° wound area into Goups A,B,C and D,their total burn surface and Ⅲ°wound area were(66±18)% and(12±9)%,(59±18)% and(20±5)%,(62±6)% and(39±5)%,and(65±16)% and(54±4)%,respectively.Their REE was determined on PBD(postburn day) 1,2,3,7,14,21 and 28 with the indirect measuring method.The measured values of 13 normal adults were used for comparison.Results: The mean value of REE of each burn group was higher than the normal control.REE enhanced significantly with the increase of the Ⅲ° wound area.Conclusion: REE obviously increases in burn patients,and,with a similar total burn surface,the larger the Ⅲ° wound area,the higher REE.Therefore,increased calories should be furnished in the nutrition treatment of burn patients with a larger Ⅲ° wound area.
Resting energy expenditure
Body surface area
Calorie
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Accurate assessments of the surface areas of burn injuries are important for the prognosis and initial fluid resuscitation of burn victims. The area of the surface of the hand is often used to estimate the area of a burn. In our previous study, the volar hand surface area is equal to 0.75% of body surface area in Taiwanese adult. But none discusses about variations in individual body weight. In this study, we used two-dimensional projection to estimate hand surface areas of Taiwanese adults in variant of body mass index. The areas of the volar hand, including that of the thumb and fingers, in healthy, overweight and obese Taiwanese were 0.82%, 0.74%, and 0.70% of body surface area, respectively. We conclude that the ratio between hand and body surface area of Taiwanese adults differ from that of individual body weight and suggest an adjustment of the ratio for use with overweight and obese people.
Body surface area
Body surface
Body shape
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Skin grafting
Severe burn
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Debridement (dental)
Skin grafting
Body surface area
Wound care
Burn center
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Objective To summarize the experiences in the treatment of severely burned patients with third degree burn area over 90% TBSA.Methods Forty-eight patients with third degree burn area over 90% TBSA during 1966 to 2002 were enrolled in this study.The primary treatment included immediate and optimal fluid resuscitation.Early tracheotomy was applied to those patients with moderate or severe inhalation injury,so as to keep smooth airway.To support the systematic defense power and to deal with the wounds correctly.Antibiotics were employed reasonably.Disinfection and isolation rules were obeyed strictly.Burn infection and internal organ complications were prevented and treated.The principle of the management of third degree burn wounds:debridement of necrotic tissue as early as possible and coverage of the burn wound in time and completely.The coverage of the burn wound could be accomplished by the intermingled grafting of autoskin and alloskin,by that small pieces of autoskin were inlayed in the open holes in the large sheet of alloskin and by microskin grafting,by skin plasma grafting with large sheet alloskin coverage.In addition, enteral nutrition support and physical therapy were also adopted.Results Sixteen patients out of the 48 were rescued with 7 of them minding their own life.Conclusions Correct and in time fluid resuscitation were the basis of rescuing.Faithful wound coverage was key point of the rescuing.Infection control and in- ternal organ complication management were carried out throughout the whole process.
Third-Degree Burn
Debridement (dental)
Burn center
Skin grafting
Severe burn
Tracheotomy
Second-Degree Burn
Enteral administration
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