Extracorporeal Blood Purification in Burns: For Whom, Why, and How?

Abstract

Patients with serious thermal burn injuries require immediate and specialized care in order to minimize morbidity and mortality. Optimal fluid resuscitation, nutritional support, pulmonary care, burn wound care, and infection control practices represent key aspects of patient care in burn centers. When severely burned, the patient usually presents a systemic inflammatory response syndrome, soon balanced by a counter anti-inflammatory response syndrome. These may lead to immune dysregulation/exhaustion favoring infectious complications that dramatically impair the prognosis of burn patients. This narrative review provides an overview of the main concepts, current understanding, and potential applications of extracorporeal blood purification techniques for burn patient management. Current understanding of burn patients’ immune responses is reported. Hypotheses and data on the potential value of immunoregulation are reviewed. Finally, how extracorporeal blood purification may be of interest in this specific population is discussed.

Analysis of perioperative corticosteroid therapy in children undergoing cardiac surgery: A systematic review and meta‐analysis

“…Children were thought to be more at risk for this kind of SIRS because they experience more severe haemodilution, have a reduced circulation volume, and experience more challenging surgical procedures than adults 35–38 . Factually, corticosteroids have been both the most effective and most controversial therapeutic medications for preventing the SIRS associated with CPB.…”

“…Children were thought to be more at risk for this kind of SIRS because they experience more severe haemodilution, have a reduced circulation volume, and experience more challenging surgical procedures than adults. 35 , 36 , 37 , 38 Factually, corticosteroids have been both the most effective and most controversial therapeutic medications for preventing the SIRS associated with CPB. The above‐mentioned pathophysiologic processes as a result of CPB were, however, substantially relieved by the development of perfusion and postoperative treatment regimens, leading to a decrease in mortality and morbidity.…”

The Effects of Tissue Healing Factors in Wound Repair Involving Absorbable Meshes: A Narrative Review

“…On wounding, elevated levels of IL-6 were detected within 24 h of bacterial infection during the initial inflammatory phase, which gradually diminished by the eighth day [65]. IL-6 was the only pro-inflammatory cytokine, the levels of which were persistently elevated post-burn injury; IL-6 levels in the serum peaked during the first few hours after injury and correlated directly with the area of the burn injury, the magnitude of the trauma, the duration of surgery, and the risk of postoperative complications [66]. IL-6 activity in human wound fluids was observed to peak within eight hours of surgery and return to baseline by the third day, a temporal pattern that may suppress the proliferation of fibroblasts in later stages [67].…”