Sepsis burn wound

The skin provides a number of protective functions. The stratum corneum acts as a barrier that prevents invasive infection, and sebum secreted by sebaceous glands has an antibacterial action. The burn wound is vulnerable to bacterial colonization and invasive bacterial contamination and sepsis. As the burn depth increases the potential reservoir for bacterial invasion increases before viable tissue and host defenses are reached. Burns dressing should have either an antibacterial barrier function or a bactericidal/bacteriastatic function or ideally both. 

MC Robson, RHM Schaerf, TJ Krizek. Evaluation of topical povidone-iodine ointment in experimental burn wound sepsis. Plast Reconstruct Surg 54 328-334, 1974. 

Vistnes, L.M., Schmitt, E.E., Ksander, G.A., Rose, E.H., Balkenhol, W.J. and Coleman, C.L. (1976) Evaluation of a prototype therapeutic svstem for prolongued, continuous topical delivery of homo-sulfanilamide in the management of Pseudomonas burn wound sepsis, Surgery, 79, 690. 

The advent of parenteral nutrition has opened new avenues for therapy and prevention of malnutrition in these children. However, the technique of parenteral nutrition in burns poses several special problems. Because of the nature of the burned wound, sepsis is a particular hazard. Placement of the catheter is difficult especially when the burns involve the upper trunk and the arms. Whirlpool debridement may compromise sterility at the site of the catheter entrance. On the other hand, infusion of calories through peripheral veins limits the caloric concentration of the infusate and require large volume to meet nutritional needs. There is also an increased incidence of venous thrombosis whenever the dextrose concentration of the infusate exceeds 10%. Some of these complications can partially be prevented by simultaneous infusion of fat emulsion which in addition to their high caloric content also appear to protect peripheral veins from thrombosis. The reported experience with parenteral nutrition in burned children is limited and critical reviews are nonexistent. We have therefore presented the experience with parenteral nutrition of both the Cincinnati and Boston Units of the Shriners Burns Institute. 

Cultures of blood, burn wound, and urine were routinely taken every three days. When signs of sepsis existed, standard cultures were taken, nutritional fluid was cultured, and the entire intravenous administration apparatus was replaced down to the catheter. 

In a randomized prospective clinical study involving 30 patients, with each group of patients having comparable bum wound size, depth and location, the wounds were treated with either a nanosilver dressing or a gauze soaked in 0.5% silver nitrate solution. The frequency of burn wound sepsis was shown to be less in wounds treated with nanosilver than in those treated with silver nitrate. Furthermore, secondary bacteremia arising from infected wounds was also less frequent [49]. As well as bum wounds, there is now increasing evidence for the use... 

Range of 20-35 kcal/kg per day Maintenance 20-25 kcal/kg per day Repletion/postoperative wound healing/critical illness/sepsis/ 25-30 kcal/kg per day Anabolic//trauma/burns 30-35 kcal/kg per day... 

Release of 4-homosulfanilamide. The usefulness of controlled delivery of 4-homosulfanilamide in the management of Pseudomonas aeruginosa bum wound sepsis has already been discussed in Sect. 4.1.4, Treatment of burns. 

---