Modulation of inflammatory and catabolic responses in severely burned children by early burn wound excision in the first 24 hours

Juan P. Barret, David Herndon

Research output: Contribution to journalArticle

70 Citations (Scopus)

Abstract

Hypothesis: Early burn wound excision modulates the hypermetabolic response in severe pediatric burn injuries. Design: Before-after trial. Setting: A 30-bed burn referral center in a private, university-affiliated hospital. Methods: We studied 35 severely burned children who were divided into 2 groups. One group (n = 20) was treated with early burn wound excision within 24 hours after the injury. The second group (n = 15) was treated conservatively with silver sulfadiazine in other burn facilities for 5 days, and burn wounds were surgically excised when patients were admitted to our burn center on day 6 after the injury. Data compiled included oxygen consumption and acute-phase protein, interleukin 1β; interleukin 6, interleukin 10, tumor necrosis factor α, and anabolic hormone (growth hormone, insulinlike growth factor type 1) levels preoperatively and 24 hours and 5 days postoperatively. Main Outcome Measures: Acute-phase and hypermetabolic responses. Results: Early burn wound excision abrogated the hypermetabolic response in pediatric burn patients. Patients who underwent conservative treatment had a significantly more severe inflammatory and hypermetabolic response at the same time interval and significantly lower levels of anabolic hormones. Conclusions: Early burn wound excision is a safe therapeutic approach that modulates the hypermetabolic response after burn injury. It was superior to the conservative treatment of silver sulfadiazine and delayed excision, and it should be considered when treating all severe full-thickness burns.

Original languageEnglish
Pages (from-to)127-132
Number of pages6
JournalArchives of Surgery
Volume138
Issue number2
DOIs
StatePublished - Feb 1 2003

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Wounds and Injuries
Silver Sulfadiazine
Burn Units
Hormones
Pediatrics
Acute-Phase Reaction
Acute-Phase Proteins
Interleukin-1
Burns
Oxygen Consumption
Interleukin-10
Growth Hormone
Interleukin-6
Intercellular Signaling Peptides and Proteins
Referral and Consultation
Tumor Necrosis Factor-alpha
Outcome Assessment (Health Care)
Conservative Treatment
Therapeutics

ASJC Scopus subject areas

  • Surgery

Cite this

Modulation of inflammatory and catabolic responses in severely burned children by early burn wound excision in the first 24 hours. / Barret, Juan P.; Herndon, David.

In: Archives of Surgery, Vol. 138, No. 2, 01.02.2003, p. 127-132.

Research output: Contribution to journalArticle

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