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Factors affecting mortality probability
300
Printed
Burns, 9,300-301
in Great Britain
Abstracts CLINICAL
STUDIES
Burns
Pregnancy
and
An analysis of 50 patients with bums in pregnancy has shown that patients in the second or third trimester of pregnancy with bums covering 50 per cent or more of the body surface should be delivered as soon as possible since maternal death is likely and foetal survival rate is not improved by waiting. Vaginal delivery has always proved possible even in the presence of perineal burns but Caesarean section should be considered and may be preferred. Patients in the first trimester may survive with more extensive burns. Pregnancy testing on admission should be mandatory in burned women of reproductive age. In patients with burns of less than 40 per cent of the body surface area in the second and third trimesters, spasmolytics should be used to suppress spontaneous labour and to cover operations, thus allowing greater foetal maturity without worsening maternal prognosis. Matthews R. N. (1982) Obstetric implications of burns in pregnancy. Br. J. Obst. Gynec. 89,603. lodinated
PVP
and Thyroid
Function
Topical treatment of the burn wound with iodinated PVP did not induce hyperthyroidism in 12 patients with burns covering between 10 and 70 per cent of the body surface area. Early loss of plasma proteins accounted for the initial decrease of thyroxine binding globulin (TBG). There was the usual decrease in T, to TBG ratio and increase in rT, to TBG ratio. The decrease in T, to TBG ratio was attributed to inhibition of thyroid hormone release. The PVP iodine treatment induced a minor but significant increase in the basal TSH level showing an intact regulation of thyroid function by the pituitary gland. Habermann J., Pickardt C. R., Scriba P. C. et al (1982) Thyroid function during treatment of burn injuries with polyvinylpyrrolidone iodine complex. Unfallheilkunde, 85,253. Changes
in Oxygen
Metabolism
Changes in oxygen metabolism were measured in 23 patients with burns covering between 13 and 87 per cent of the body surface area. Only IO of the patients survived. Daily measurements were made of the partial pressure of haemoglobin at 50 per cent oxygen saturation (P,,), 2-3 diphosphoglycerate (DPG), inorganic phosphorus (Pi), ATP and blood gases. On
admission P,, values were high. In non-survivors P,, started to decline one week after burning. Values of P,, Corrected to pH 7.4 were correlated with values of DPG, In survivors P,, tended to correlate with the values of inorganic phosphorus but in nonsurvivors at the septic or terminal stage, the values of P,, did not correlate with Pi or ATP, Low values of P,, predicted the poor outcome of severely burned patients. During convalescence P,, and DPG values were higher than normal and often remained elevated for weeks. Nishimura N and Fukuda M (1982) P,, in burn injury. Crit. Care. Med. 10, 384. Factors Affecting
Mortality
Probability
Data from 854 burned patients have been analysed for the effect of factors other than age and extent of bum on mortality probability using multiple logistic regression analysis. The following variables also had a significant effect on mortality probability when incorporated into a predictive model with age, size of partial skin thickness burn and size ofa full thickness skin loss burn; the admission white blood cell count, admission serum osmolality, the involvement of inflammable liquids in the injury, the presence of pre-existing mental disorders and circulatory and digestive diseases. Berry C. C., Wachtel T. L. and Frank H. A. (1982) An analysis of factors which predict mortality in hospitalized burn patients. Burns 9, 38 Polyethylene
Glycol Poisoning
Three patients with burns covering between 20 and 56 per cent of the body surface were treated with Furacin soluble dressing and died with unexplained increases in the anion gap and serum osmolality. Ethylene glycol was found in the circulation. ALI 3 patients were acidotic and died with acute renal failure. There was an increase in serum bound calcium and a corresponding decrease in the ionized calcium. The cause of the high ‘calcium gap’ appeared to be binding of calcium by dicarboxylic acid metabolites of polyethylene glycol. Bruns D. E., Herold D. A., Rodeheaver G. T. et al (1982) Polyethylene glycol intoxication in burn patients. Burns 9, 49. ANIMAL STUDIES Cardiac muscle function
studies
Atria1 muscle was isolated 16-18 hours after guineapigs received either a sham burn or scalds covering 16
Printed
Burns, 9,300-301
in Great Britain
Abstracts CLINICAL
STUDIES
Burns
Pregnancy
and
An analysis of 50 patients with bums in pregnancy has shown that patients in the second or third trimester of pregnancy with bums covering 50 per cent or more of the body surface should be delivered as soon as possible since maternal death is likely and foetal survival rate is not improved by waiting. Vaginal delivery has always proved possible even in the presence of perineal burns but Caesarean section should be considered and may be preferred. Patients in the first trimester may survive with more extensive burns. Pregnancy testing on admission should be mandatory in burned women of reproductive age. In patients with burns of less than 40 per cent of the body surface area in the second and third trimesters, spasmolytics should be used to suppress spontaneous labour and to cover operations, thus allowing greater foetal maturity without worsening maternal prognosis. Matthews R. N. (1982) Obstetric implications of burns in pregnancy. Br. J. Obst. Gynec. 89,603. lodinated
PVP
and Thyroid
Function
Topical treatment of the burn wound with iodinated PVP did not induce hyperthyroidism in 12 patients with burns covering between 10 and 70 per cent of the body surface area. Early loss of plasma proteins accounted for the initial decrease of thyroxine binding globulin (TBG). There was the usual decrease in T, to TBG ratio and increase in rT, to TBG ratio. The decrease in T, to TBG ratio was attributed to inhibition of thyroid hormone release. The PVP iodine treatment induced a minor but significant increase in the basal TSH level showing an intact regulation of thyroid function by the pituitary gland. Habermann J., Pickardt C. R., Scriba P. C. et al (1982) Thyroid function during treatment of burn injuries with polyvinylpyrrolidone iodine complex. Unfallheilkunde, 85,253. Changes
in Oxygen
Metabolism
Changes in oxygen metabolism were measured in 23 patients with burns covering between 13 and 87 per cent of the body surface area. Only IO of the patients survived. Daily measurements were made of the partial pressure of haemoglobin at 50 per cent oxygen saturation (P,,), 2-3 diphosphoglycerate (DPG), inorganic phosphorus (Pi), ATP and blood gases. On
admission P,, values were high. In non-survivors P,, started to decline one week after burning. Values of P,, Corrected to pH 7.4 were correlated with values of DPG, In survivors P,, tended to correlate with the values of inorganic phosphorus but in nonsurvivors at the septic or terminal stage, the values of P,, did not correlate with Pi or ATP, Low values of P,, predicted the poor outcome of severely burned patients. During convalescence P,, and DPG values were higher than normal and often remained elevated for weeks. Nishimura N and Fukuda M (1982) P,, in burn injury. Crit. Care. Med. 10, 384. Factors Affecting
Mortality
Probability
Data from 854 burned patients have been analysed for the effect of factors other than age and extent of bum on mortality probability using multiple logistic regression analysis. The following variables also had a significant effect on mortality probability when incorporated into a predictive model with age, size of partial skin thickness burn and size ofa full thickness skin loss burn; the admission white blood cell count, admission serum osmolality, the involvement of inflammable liquids in the injury, the presence of pre-existing mental disorders and circulatory and digestive diseases. Berry C. C., Wachtel T. L. and Frank H. A. (1982) An analysis of factors which predict mortality in hospitalized burn patients. Burns 9, 38 Polyethylene
Glycol Poisoning
Three patients with burns covering between 20 and 56 per cent of the body surface were treated with Furacin soluble dressing and died with unexplained increases in the anion gap and serum osmolality. Ethylene glycol was found in the circulation. ALI 3 patients were acidotic and died with acute renal failure. There was an increase in serum bound calcium and a corresponding decrease in the ionized calcium. The cause of the high ‘calcium gap’ appeared to be binding of calcium by dicarboxylic acid metabolites of polyethylene glycol. Bruns D. E., Herold D. A., Rodeheaver G. T. et al (1982) Polyethylene glycol intoxication in burn patients. Burns 9, 49. ANIMAL STUDIES Cardiac muscle function
studies
Atria1 muscle was isolated 16-18 hours after guineapigs received either a sham burn or scalds covering 16