Shriners Hospitals for Children - Galveston

About: Shriners Hospitals for Children - Galveston is a healthcare organization based out in Galveston, Texas, United States. It is known for research contribution in the topics: Burn injury & Lean body mass. The organization has 249 authors who have published 420 publications receiving 15311 citations.

Inhalation Injury in Children: A 10 Year Experience at Shriners Hospitals for Children

Abstract: Inhalation injury remains a significant source of morbidity and mortality in children with burn injury. The purpose of this study is to analyze the incidence, demographic characteristics, and outcomes for children who have sustained burn injury at one of four regional pediatric burn centers. A retrospective review of children aged 0 to 18 years admitted to one of four pediatric burn centers from 1997 to 2007 with a diagnosis of inhalation injury was performed. Factors analyzed included demographics, injury severity, treatment duration, and outcomes. A total of 850 patients with a mean age of 7.9 +/- 0.2 years and a mean total body surface area burn of 48.6 +/- 0.9% were admitted with a diagnosis of inhalation injury. Mean interval between injury and hospital admission was 4.2 +/- 0.3 days. Inhalation injury was diagnosed by bronchoscopy in 71%, via elevated carboxyhemoglobin in 4%, and by clinical signs/history alone in 25%. Hospital length of stay averaged 44.8 +/- 1.7 days, and patients required mechanical ventilation for a mean of 15.2 +/- 0.8 days. Mortality was 16.4%. Inhalation injury in children is associated with significant morbidity and mortality, and diagnosis of inhalation injury does not follow consistent guidelines. Further studies are required to standardize diagnostic criteria for inhalation injury and to optimize the treatment of children with inhalation injury.

Cardiovascular Dysfunction Following Burn Injury: What We Have Learned from Rat and Mouse Models.

Abstract: Severe burn profoundly affects organs both proximal and distal to the actual burn site. Cardiovascular dysfunction is a well-documented phenomenon that increases morbidity and mortality following a massive thermal trauma. Beginning immediately post-burn, during the ebb phase, cardiac function is severely depressed. By 48 h post-injury, cardiac function rebounds and the post-burn myocardium becomes tachycardic and hyperinflammatory. While current clinical trials are investigating a variety of drugs targeted at reducing aspects of the post-burn hypermetabolic response such as heart rate and cardiac work, there is still a paucity of knowledge regarding the underlying mechanisms that induce cardiac dysfunction in the severely burned. There are many animal models of burn injury, from rodents, to sheep or swine, but the majority of burn related cardiovascular investigations have occurred in rat and mouse models. This literature review consolidates the data supporting the prevalent role that β-adrenergic receptors play in mediating post-burn cardiac dysfunction and the idea that pharmacological modulation of this receptor family is a viable therapeutic target for resolving burn-induced cardiac deficits.

The National Institute on Disability, Independent Living, and Rehabilitation Research Burn Model System: Twenty Years of Contributions to Clinical Service and Research.

Abstract: The National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR) established the Burn Model System (BMS) in 1993 to improve the lives of burn survivors. The BMS program includes 1) a multicenter longitudinal database describing the functional and psychosocial recovery of burn survivors; 2) site-specific burn-related research; and 3) a knowledge dissemination component directed toward patients and providers. Output from each BMS component was analyzed. Database structure, content, and access procedures are described. Publications using the database were identified and categorized to illustrate the content area of the work. Unused areas of the database were identified for future study. Publications related to site-specific projects were cataloged. The most frequently cited articles are summarized to illustrate the scope of these projects. The effectiveness of dissemination activities was measured by quantifying website hits and information downloads. There were 25 NIDILRR-supported publications that utilized the database. These articles covered topics related to psychological outcomes, functional outcomes, community reintegration, and burn demographics. There were 172 site-specific publications; highly cited articles demonstrate a wide scope of study. For information dissemination, visits to the BMS website quadrupled between 2013 and 2014, with 124,063 downloads of educational material in 2014. The NIDILRR BMS program has played a major role in defining the course of burn recovery, and making that information accessible to the general public. The accumulating information in the database serves as a rich resource to the burn community for future study. The BMS is a model for collaborative research that is multidisciplinary and outcome focused.

Influence of glucose kinetics on plasma lactate concentration and energy expenditure in severely burned patients.

Abstract: Background: In critically ill patients, elevation in the plasma lactate concentration has traditionally been interpreted as indicating a deficiency in oxygen availability and is often an impetus to increase oxygen delivery clinically. However, another possible basis for increased lactate concentrations may be simply a mass effect from increased pyruvate availability (i.e., accelerated glycolysis). Methods: In six hypermetabolic burned patients, the rates of glucose production and oxidation were quantified using a tracer infusion of 6,6 d 2 glucose combined with indirect calorimetry. Measurements were obtained after a 9-hour fast and after a 3-hour infusion of unlabeled glucose at 30 μmol/kg/min. No patient was overtly septic, hypoxic, or hypovolemic. Results: The infusion of glucose significantly increased the arterial glucose concentration and rate of glucose oxidation, with a corresponding increase in the arterial plasma concentration of lactate and pyruvate. Resting energy expenditure and oxygen consumption were not affected by the infusion of glucose. Conclusions: These findings show that elevations in plasma lactate in severely injured patients may, in part, be related to increases in glucose flux and not entirely a reflection of any deficit in oxygen availability. Such findings highlight a potential pitfall for interpreting plasma lactate concentrations as an index of tissue oxygen availability in hypermetabolic patients.