Comment

By contrast to TEN, many RCTs on burn care have been published. Several recent trials are potentially useful for TEN/SJS.

Enteral feeding

Twenty-two patients were randomly assigned into two groups (early enteral feeding versus delayed enteral feeding). Early enteral feeding had a beneficial effect on the reduction of enterogenic infection, by decreasing intestinal permeability.30

Supplementation

Oxandrolone is an anabolic agent. Compared with placebo, it is effective for decreasing weight loss and net nitrogenous loss and increasing donor site wound healing.31 Compared with human growth hormone, oxandrolone was equally effective but induced fewer complications (hyperglycaemia and hypermetabolism).32 The effectiveness of ornithine alpha-ketoglutarate supplementation of enteral feeding was assessed against an isonitrogenous control. Wound healing time was reduced by 33% with ornithine supplementation.33 High-dose ascorbic acid (66 mg/kg/hour) for the first 24 hours for >30% burns reduces volume of rehydration fluid required.34

Topical treatment

A controlled right-left comparative and randomised study showed that frozen cultured human allogeneic epidermal sheets reduced healing time of partial-thickness burns by 44%.35 A living skin equivalent, Apligraf, was applied over meshed split-thickness autografts in 38 patients while a control site in each patient was treated with split-thickness autograft alone.

There was no difference in the per cent and delay of graft take, but Apligraf-treated sites were rated superior to control sites in 58% and worse in 16%. Pigmentation and vascularity were significantly better.36 In 89 children with <25% burns, Biobrane decreased healing time without increasing the risk of infection.37 In a trial of 20 children, Biobrane was superior to topical 1% silver sulfadiazine in pain, requirements for analgesics, wound healing time and length of hospital stay.38 TransCyte is composed of human newborn fibroblasts cultured on the nylon mesh of Biobrane. Sites treated with TransCyte healed more rapidly (11 versus 18 days) and with less hypertrophic scarring than sites treated with silver sulfadiazine in 14 patients.39 In an RCT of 600 patients with second-degree burns, topical recombinant bovine basic fibroblast growth factor allowed faster granulation tissue formation and epidermal regeneration than with placebo.40 The effect of systemic growth hormone is still debated.

0 0

Post a comment