A novel rapid and selective enzymatic debridement agent for burn wound management: A multi-center RCT

Rosenberg, Lior; Krieger, Yuval; Bogdanov-Berezovski, Alex; Silberstein, Eldad; Shoham, Yaron; Singer, Adam J.

doi:10.1016/j.burns.2013.08.013

Cited by 179 publications

(162 citation statements)

References 24 publications

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“…Improvements in care, including early excision and autografting, caused a significant decrease of morbidity and mortality rates [2]. Nevertheless, excessive scarring leading to functional restrictions and disfigurement are issues that need to be solved in burn care currently [3].…”

Section: Bromelain As Debriding Agent In Burnsmentioning

confidence: 99%

“…This eschar makes accurate diagnosis of burn depth challenging, which may put the patient at risk for local and systemic complications [3,4]. Furthermore, non-excised eschar contributes to burn wound progression, which is associated with a conversion from deep-partial thickness burns into full-thickness burns [4].…”

Section: Bromelain As Debriding Agent In Burnsmentioning

confidence: 99%

“…However, this surgical technique has its drawbacks: excisional debridement is traumatic and associated with vast amounts of blood loss, especially if hemostasis is not performed properly. In addition, surgical wound debridement requires trained surgical personnel and adequate tools [3]. Viable tissue is prone to damage during tangential excision.…”

Section: Bromelain As Debriding Agent In Burnsmentioning

confidence: 99%

“…Initial approaches toward enzymatic debridement used a combination of papain, sodium salicylate and cysteine hydrochloride. Earlier enzymatic debriding agents were slow, and thereby useless for early burn wound debridement [4], and even increased the risk of infections via maceration of the eschar [3].…”

Section: Bromelain As Debriding Agent In Burnsmentioning

confidence: 99%

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Low exposure levels of respirable particles during the preparation of NexoBrid® bromelain powder

et al. 2015

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Background: Burns are common injuries that are usually covered with a layer of necrotic tissue called the eschar. Early removal of the eschar is the current standard of care, however, debridement using tangential excision is usually traumatic and may increase wound surface. In recent years a bromelain-based debriding agent called NexoBrid® that can remove the eschar selectively and thus causes less additional trauma was developed. Bromelain is a pineapple-stem derived mix of proteases. In its raw form bromelain is a yellowish powder. Cases are known where frequent inhalation of bromelain dust led to respiratory sensitization and subsequently to severe allergic reactions. In order to activate bromelain for debridement it has to be mixed with a hydrating gel. We aimed to assess the risk of sensitization by measuring the particle concentration in the air during the mixing process in order to determine the safety of the product for patients as well as practitioners. Methods: The mixing process was repeated five times in a row. Samples of the particle concentration in the workers breathing area were taken with an air particle counting device during continuous performance. The worker wore a lab coat and gloves but no face mask. Results: Particle concentrations ranged from 0.010 mg/m 3 to 0.012 mg/m 3 (mean 0.010 mg/m

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Section: Bromelain As Debriding Agent In Burnsmentioning

confidence: 99%

Section: Bromelain As Debriding Agent In Burnsmentioning

confidence: 99%

Section: Bromelain As Debriding Agent In Burnsmentioning

confidence: 99%

Section: Bromelain As Debriding Agent In Burnsmentioning

confidence: 99%

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Low exposure levels of respirable particles during the preparation of NexoBrid® bromelain powder

et al. 2015

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“…pacijenata bez obzira na vrstu tretmana koji su dobijali (23). dobijeni rezultati su u skladu s prethodno objavljenim podacima iste grupe autora, koji su dobijeni iz retrospektivne studije u kojoj je 69 pacijenata s dubokim opekotinama ruke tretirano debrase® (formulacija bromelaina).…”

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Current experience and future perspectives of bromelain application in medicine

Milić¹,

Milanović²,

Goločorbin-Kon³

et al. 2014

Medicinski casopis

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Bromelain je sirov, vodeni ekstrakt stabljike i ploda ananasa (Ananas cosmus fam. Bromeliaceae) i predstavlja kompleksnu mešavinu različitih tiol endopeptidaza, raznovrsnih glikoliziranih enzimskih vrsta papainske superfamilije enzima koji imaju različitu proteolitičku aktivnost (1, 2). dobija se iz hladnog soka ananasa centrifugiranjem, ultrafiltracijom, liofilizacijom i drugim postupcima. Smatra se da je bromelain glikoprotein sastavljen od jednog polipeptidnog i jednog bočnog oligosaharidnog lanca koji je vezan za asparagin. Oligosaharidni lanac sadrži monosaharide: d-glukozamin, d-manozu, d-ksilozu i l-fukozu u odnosu 2 : 2 : 1 : 1. Polipeptidni lanac je sastavljen od 211 (2) rezidua i sadrži 15 lizinskih ostataka (3, 4). Bromelain ima izuzetnu termičku stabilnost i zadržava svoju proteolitičku aktivnost na temperaturi između 40 °C i 60 °C na kojoj većina enzima postaje neaktivna ili se denaturiše, a stabilan je pri pH vrednosti u rasponu od 5 do 10 (5). američka agencija za hranu i lekove (Fda) svrstava ga na listu bezbednih supstanci koje se koriste u prehrambenoj industiji kao aditiv za omekšavanje mesa. Komercijalno dostupni proizvodi uglavnom sadrže bromelain iz stabljike u obliku praška, krema, tableta ili kapsula. danas se na tržištu nalaze preparati koji kombinuju bromelain s drugim prirodnim sastojcima, kao što su Phlogenzym ® , Wobenzym ® , BCQ ® , a postoje i preparati u kojima se bromelain nalazi samostalno npr. ananase ® , Bromelain-POS ® i slično (6).Doziranje. Bromelain je bezbedan za primenu u terapijskim dozama 200-2000 mg (500-5000 FiP) dnevno tokom dužeg perioda. utvrđena je terapijska efikasnost i u dozama 120-160 mg/dnevno. Najbolji rezultati postižu se

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