Enzymatic debridement in critically injured burn patients — Our experience in the intensive care setting and during burn resuscitation

Bowers, Ciara; Randawa, AJ; Sloan, Brendan; Anwar, Umair; Phipps, A.; Muthayya, Preetha

doi:10.1016/j.burns.2021.07.023

Cited by 17 publications

(13 citation statements)

References 24 publications

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“…Since the market approval of NXB, several studies have been published reporting positive and satisfying results in various burn depths, manifesting the additional value of ED in context of initial handling of burn injuries [20,22,66,68,69,[84][85][86][87][88][89][90][91]. While initially intended to prevent the requirement of skin grafting, ED is now ordinarily used for general and decent debridement independently of the planned therapeutic regime.…”

Section: Results and Advantagesmentioning

confidence: 99%

Role, Development, and Value of Enzymatic Debridement as Integral Component in Initial Treatment of Burn Injuries Exemplified by NexoBrid®

Mattern

Fuchs

Schiefer

2022

EBJ

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Despite intensive research and increased knowledge over the past decades, the handling of severe burn injuries remains complex and is mainly based on clinical experience. High demands in terms of the diagnosis and choice of therapy often confront clinicians with challenging circumstances. Thus, the treatment of burn injuries has predominantly remained under the responsibility of specialised centres. As a new approach in addition to conventional surgery, enzymatically controlled debridement has come into focus for the treatment of burn injuries over the past years. The efficacy and safety of enzymatic debridement has already been implemented by numerous reputable studies. Promising results from the literature are enhanced by feedback from various conference contributions, intradisciplinary exchanges, and international collaborations. The implementation of enzymatic debridement in initial care management was found to be capable of reforming Standards of Care in numerous burn centres by facilitating treatment determinations and reducing the number of classical surgical interventions. Nevertheless, its use is also subject to certain restrictions as usage has shown limitations concerning efficacy when applied to scalds or pre-treated wounds. Enzymatic debridement shows high efficacy in terms of tissue debridement by combining this feature with the minimisation of collateral damage and a broad field of application in burn injuries. Due to their impressive performance in the treatment of burn injuries, enzyme-based techniques have also attracted attention for the treatment of other pathologies such as chronic wounds and are objects of ongoing research in this field. In this article, we illustrate the significance of enzyme-based treatment in initial burn care and shed some light on the potential value of enzymatic approaches in future burn surgery.

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Section: Results and Advantagesmentioning

confidence: 99%

Role, Development, and Value of Enzymatic Debridement as Integral Component in Initial Treatment of Burn Injuries Exemplified by NexoBrid®

Mattern

Fuchs

Schiefer

2022

EBJ

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“…Considering the safety and selectivity of this method, its use in children and severe burns seems even more justified. Recent publications addressing clinical off-label use of bromelain-based Nexobrid ® in more excessive burns also confirm the usefulness of this method in the intensive care setting and during burn resuscitation [ 32 , 33 ]. Similarly, our study did not reveal any unexpected side effects or relevant adverse events after early enzymatic debridement, irrespective of the burn area.…”

Section: Discussionmentioning

confidence: 95%

Preliminary Single-Center Experience of Bromelain-Based Eschar Removal in Children with Mixed Deep Dermal and Full Thickness Burns

Korzeniowski

Grywalska

Strużyna

et al. 2022

JCM

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Introduction: Early eschar removal is the standard management of burns. The goal is to remove all of the necrotic tissue and render the wound suitable for healing or skin grafting. The enzymatic debridement of burn wounds allows for minimally invasive removal of burn eschar. The aim of the study was to describe and compare the demographic characteristics, surgical treatment and outcomes of patients treated with Nexobrid® with patients who had standard surgical excision. Material and Methods: A retrospective review was conducted on children who underwent enzymatic debridement. The study group was compared with children treated with the standard of care (SoC). Results: Twelve children (mean age 8 years, range 3 to 15 years) with mixed deep dermal and full thickness burn wounds were treated with Nexobrid®. The mean size of the burns was 29% TBSA. The median percentage TBSA debrided using Nexobrid® was 15% (range 2–27%). In a clinical assessment, enzymatic debridement was effective in removing dead tissue in a single application. No adverse reaction to Nexobrid® and serious complications after enzymatic procedure were recorded in the study group. The estimated relative risk of the need for reconstructive procedures decreases 3.5 times for the study group (RR 3.5, 95%CI 0.9–13.5, p = 0.089). Conclusion: The bromelain-based enzymatic method offers a good and safe debridement option to improve the treatment and life quality of children with severe burns. The main outcome of interest was the number of reconstructive procedures due to scar contractures, which was reduced in the group treated enzymatically compared to the SoC-treated children.

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“…Although post‐BBD of deep burns often require more than 21 days to re‐epithelialize, long‐term cosmetic outcomes are equivalent, if not better, to surgical excision and grafting 54 . In cases of residual viable dermis that is insufficient to sustain spontaneous healing post‐BBD, prolonged pre‐ (2–24 h) and post‐ (12–24 h) NXB wet‐to‐dry soakings to ensure a moist environment, enhance graft take after a few days 39,41,43,53,55–60 . A moist wound environment is achieved with a plethora of dressings that have been used, including Suprathel®, Mepilex Ag®, Biobrane®, Medihoney® and allografts, 39,41,53 SpinCare™, an electrospun polymer nanofibrous temporary epidermal layer, 61 intact fish skin grafts (Kerecis®), 62 and Epiprotect™ (a thin film of biosynthetic cellulose polymer), 63 as well as platelet‐rich fibrin (PRF), 64 autologous cell therapy combined with PRF or fibrin glue 65 …”

Section: Discussionmentioning

confidence: 99%

Bromelain‐based enzymatic burn debridement: A systematic review of clinical studies on patient safety, efficacy and long‐term outcomes

Shoham

Gasteratos²,

Singer

et al. 2023

International Wound Journal

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In 2012 the European Medicines Agency approved a pineapple stem‐derived Bromelain‐based debridement concentrate of proteolytic enzymes (NexoBrid®, MediWound Ltd, Yavne, Israel) for adult deep burns. Over 10 000 patients have been successfully treated with NexoBrid® globally, including in the US. The aim of our study is to perform a systematic review of the current literature on Nexobrid® outcomes. We conducted a literature search in PubMed, Google Scholar, Embase, and other search engines (2013–2023). The online screening process was performed by two independent reviewers with the Covidence tool. The protocol was reported using the Preferred Reporting Items for Systematic Review and Meta‐Analyses, and it was registered at the International Prospective Register of Systematic Reviews of the National Institute for Health Research. We identified 103 relevant studies of which 34 were found eligible. The included studies report the positive effects of Nexobrid® on burn debridement, functional and cosmetic outcomes, scarring, and quality of life. Also, they validate the high patient satisfaction thanks to enhanced protocols of analgosedation and/or locoregional anaesthesia during Bromelain‐based debridement. Two studies investigate potential risks (coagulopathy, burn wound infection) which concluded there is no strong evidence of these adverse events. NexoBrid® is a safe, selective, non‐surgical eschar removal treatment modality. The benefits of Bromelain‐based debridement are faster debridement and healing times, reduced operations, length of stay, cases of sepsis, blood transfusions, and prevention of compartment syndrome. Existing evidence suggests that the indications and the role of Bromelain‐based debridement are expanding to cover “off‐label” cases with significant benefits to the global healthcare economy.

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Enzymatic debridement in critically injured burn patients — Our experience in the intensive care setting and during burn resuscitation

Cited by 17 publications

References 24 publications

Role, Development, and Value of Enzymatic Debridement as Integral Component in Initial Treatment of Burn Injuries Exemplified by NexoBrid®

Role, Development, and Value of Enzymatic Debridement as Integral Component in Initial Treatment of Burn Injuries Exemplified by NexoBrid®

Preliminary Single-Center Experience of Bromelain-Based Eschar Removal in Children with Mixed Deep Dermal and Full Thickness Burns

Bromelain‐based enzymatic burn debridement: A systematic review of clinical studies on patient safety, efficacy and long‐term outcomes

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