Longitudinal assessment of Integra in primary burn management: a randomized pediatric clinical trial.


BACKGROUND:Early excision with autograft-allograft closure is standard in severe burn management. Cadaver skin is associated with risks such as antigenicity, infection, and limited availability and shelf life. Previous studies have shown that Integra is safe to use in burns of <20% total body surface area. However, the suitability of its use in large burns (>50% total body surface area), its effects on postburn hypermetabolism, and the long-term cosmetic and functional results have not yet been evaluated. MATERIALS AND METHODS:Twenty children with an average burn size of 73 +/- 15% total body surface area (71 +/- 15% full-thickness burn) were randomized to be treated with either Integra or with autograft-allograft technique. Outcome measures such as length of hospital stay, mortality, incidence of infection and sepsis, acute phase protein levels, and muscle fractional synthetic rate were compared between and within groups during the acute stay (admission to discharge). Outcome measures such as resting energy expenditure, body composition data (measured by dual-energy radiograph absorptiometry), cardiac function indexes, and number of reconstructive procedures were compared during acute hospital stay and at long-term follow-up (up to 2 yrs postinjury). Scar evaluation was performed at long-term follow-up. RESULTS:There were no significant differences between Integra and controls in burn size (70 +/- 5% vs. 74 +/- 4% total body surface area), mortality (40% vs. 30%), and length of stay (41 +/- 4 vs. 39 +/- 4 days). In the short term, resting energy expenditure significantly decreased (p < .01), and serum levels of constitutive proteins significantly increased (p < .03) in the Integra group compared with controls. Long-term follow-up revealed a significant increase in bone mineral content and density (24 months postburn, p < .05), as well as improved scarring in terms of height, thickness, vascularity, and pigmentation (12 months and 18-24 months, p < .01) in the Integra group. CONCLUSION:Integra can be used for immediate wound coverage in children with severe burns without the associated risks of cadaver skin.


Crit Care Med


Critical care medicine


Branski LK,Herndon DN,Pereira C,Mlcak RP,Celis MM,Lee JO,Sanford AP,Norbury WB,Zhang XJ,Jeschke MG




Has Abstract


2007-11-01 00:00:00












  • Rivastigmine for the prevention of postoperative delirium in elderly patients undergoing elective cardiac surgery--a randomized controlled trial.

    abstract:OBJECTIVE:Cardiac surgery is frequently followed by postoperative delirium, which is associated with increased 1-year mortality, late cognitive deficits, and higher costs. Currently, there are no recommendations for pharmacologic prevention of postoperative delirium. Impaired cholinergic transmission is believed to pla...

    journal_title:Critical care medicine

    pub_type: 杂志文章,随机对照试验


    authors: Gamberini M,Bolliger D,Lurati Buse GA,Burkhart CS,Grapow M,Gagneux A,Filipovic M,Seeberger MD,Pargger H,Siegemund M,Carrel T,Seiler WO,Berres M,Strebel SP,Monsch AU,Steiner LA

    更新日期:2009-05-01 00:00:00

  • Pathophysiology of the upper gastrointestinal tract in the critically ill patient: rationale for the therapeutic benefits of acid suppression.

    abstract::Gastric mucosal damage occurs in critically ill patients in intensive care units and develops in the setting of severe physiologic stress. Within 24 hrs of admission to the intensive care unit, 75% to 100% of critically ill patients demonstrate evidence of stress-related mucosal disease. Stress ulcers present a risk o...

    journal_title:Critical care medicine

    pub_type: 杂志文章,评审


    authors: Fennerty MB

    更新日期:2002-06-01 00:00:00

  • Intestinal nitric oxide output during reduced mucosal blood flow in healthy volunteers.

    abstract:OBJECTIVE:Nitric oxide regulates epithelial permeability and other properties of the intestinal mucosal barrier. It previously has been shown in animals that intestinal mucosal nitric oxide production is impaired during gut hypoperfusion. The study was performed to confirm the presence of intestinal mucosal nitric oxid...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Snygg J,Aneman A,Pettersson A,Fändriks L

    更新日期:2003-08-01 00:00:00

  • Increased resistance of hygroscopic condenser humidifiers when using a closed circuit suction system.

    abstract:OBJECTIVES:To examine a hygroscopic condenser after clinical use and to describe the interaction of a hygroscopic condenser and a closed circuit suction system used simultaneously. DESIGN:Prospective evaluation of hygroscopic condensers used clinically, and laboratory investigation of a hygroscopic condenser used with...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Martinez FJ,Pietchel S,Wise C,Walek J,Beamis JF

    更新日期:1994-10-01 00:00:00

  • Microvascular and systemic effects following top load administration of saturated carbon monoxide-saline solution.

    abstract:OBJECTIVE:To determine how top loads with different doses of carbon monoxide (CO)-saturated saline solutions (CO-saline) affect microvascular and systemic hemodynamics and to delineate the corresponding biochemical mechanisms. DESIGN:Prospective study. SETTING:University research laboratory. SUBJECTS:Male Golden Syr...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Hangai-Hoger N,Tsai AG,Cabrales P,Suematsu M,Intaglietta M

    更新日期:2007-04-01 00:00:00

  • Diffusive vs. convective therapy: effects on mediators of inflammation in patient with severe systemic inflammatory response syndrome.

    abstract:OBJECTIVE:To compare two forms of continuous renal replacement therapy, continuous venovenous hemofiltration (CVVH) vs. continuous venovenous hemodialysis (CVVHD), in terms of the removal of inflammatory mediators from the blood of patients with systemic inflammatory response syndrome and acute renal failure. DESIGN:R...

    journal_title:Critical care medicine

    pub_type: 临床试验,杂志文章,随机对照试验


    authors: Kellum JA,Johnson JP,Kramer D,Palevsky P,Brady JJ,Pinsky MR

    更新日期:1998-12-01 00:00:00

  • The impact of adding 1 month of intensive care unit training in a categorical internal medicine residency program.

    abstract:OBJECTIVE:To determine the impact of adding a month of critical care training in the postgraduate year (PGY)-2 on the critical care skills of PGY-3 residents. DESIGN:Prospective, nonrandomized. SETTING:The internal medicine (IM) residency program of a tertiary care medical center. STUDY SUBJECTS:The study subjects i...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Mullon JJ,Gajic O,Gali B,Ficalora RD,Kolars JC,Afessa B

    更新日期:2009-04-01 00:00:00

  • Ultra-Protective Ventilation Reduces Biotrauma in Patients on Venovenous Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome.

    abstract:INTRODUCTION:Ventilator settings for patients with severe acute respiratory distress syndrome supported by venovenous extracorporeal membrane oxygenation are currently set arbitrarily. The impact on serum and pulmonary biotrauma markers of the transition to ultra-protective ventilation settings following extracorporeal...

    journal_title:Critical care medicine

    pub_type: 杂志文章,随机对照试验


    authors: Rozencwajg S,Guihot A,Franchineau G,Lescroat M,Bréchot N,Hékimian G,Lebreton G,Autran B,Luyt CE,Combes A,Schmidt M

    更新日期:2019-11-01 00:00:00

  • Metallothionein alleviates glutathione depletion-induced oxidative cardiomyopathy in murine hearts.

    abstract:OBJECTIVE:Antioxidant therapy has shown some promise in critical care medicine in which glutathione depletion and heart failure are often seen in critically ill patients. This study was designed to examine the impact of glutathione depletion and the free radical scavenger, metallothionein (MT), on cardiac function. DE...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Ren J,Privratsky JR,Yang X,Dong F,Carlson EC

    更新日期:2008-07-01 00:00:00

  • Role of exogenous surfactant in acute lung injury.

    abstract:OBJECTIVES:To outline both the preclinical and clinical data demonstrating surfactant alterations in acute lung injury, which provide the rationale for testing exogenous surfactant administration in this setting. We also review the results of the randomized, controlled clinical trials conducted to date that have evalua...

    journal_title:Critical care medicine

    pub_type: 杂志文章,评审


    authors: Lewis JF,Brackenbury A

    更新日期:2003-04-01 00:00:00

  • Simultaneous monitoring of transcutaneous blood gases and heart-rate variability in neonates.

    abstract::Instantaneous heart rate, indices of long-term and short-term heart-rate variability (HRV), and transcutaneous O2 (PtcO2) and CO2 (PtcCO2) tensions were recorded simultaneously on 164 occasions in 16 neonates. There was significant inverse correlation between PtcCO2 and both HRV indices, while no linear correlation wa...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Aärimaa T,Kero P,Välimäki I

    更新日期:1985-01-01 00:00:00

  • Comparative scintigraphy in oleic acid pulmonary microvascular injury.

    abstract::Computerized gamma scintigraphy revealed a significant (p less than 0.001) rising lung:heart radioactivity ratio, which has been called "slope of injury" or "slope index", with both 99mTechnetium-tagged human serum albumin (99mTc-HSA) and 99mTechnetium-tagged red blood cells (99Tc-RBC) after 0.05 or 0.2 ml/kg iv oleic...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Sugerman HJ,Hirsch JI,Tatum JL,Strash AM,Sharp DE,Greenfield LJ

    更新日期:1982-01-01 00:00:00

  • Use of the anterior cricoid split operation in infants with acquired subglottic stenosis.

    abstract::Ten infants with acquired subglottic stenosis were treated successfully using the anterior cricoid split operation. Eight had been preterm infants who required endotracheal intubation and assisted ventilation for the respiratory distress syndrome. Two had been born at term; 1 required mechanical ventilation for aspira...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Frankel LR,Anas NG,Perkin RM,Seid AB,Peterson B,Park SM

    更新日期:1984-04-01 00:00:00

  • Randomized, double-blind, placebo-controlled trial of granulocyte colony-stimulating factor in patients with septic shock.

    abstract:OBJECTIVE:To investigate the effect of early administration of granulocyte colony-stimulating factor (G-CSF) on hospital mortality in nonneutropenic patients with septic shock, excluding patients with melioidosis. DESIGN:A randomized, placebo-controlled, double-blinded clinical trial. SETTING AND PATIENTS:Adult patie...

    journal_title:Critical care medicine

    pub_type: 杂志文章,随机对照试验


    authors: Stephens DP,Thomas JH,Higgins A,Bailey M,Anstey NM,Currie BJ,Cheng AC

    更新日期:2008-02-01 00:00:00

  • Resuscitation with 7.5% NaCl in 6% dextran-70 during hemorrhagic shock in swine: effects on organ blood flow.

    abstract::We previously reported that small volume infusions of 7.5% NaCl in 6% dextran-70 (HSD) are superior to equal volumes of normal saline (NS) or 7.5% NaCl in the ability to resuscitate animals from an otherwise lethal hemorrhage. In the present experiment, we evaluated organ blood flow in unanesthetized swine bled 46 ml/...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Maningas PA

    更新日期:1987-12-01 00:00:00

  • Effects of propofol on hemodynamic and inflammatory responses to endotoxemia in rats.

    abstract:OBJECTIVE:To document the effects of propofol on the hemodynamic and inflammatory responses to endotoxemia in an animal model. DESIGN:Randomized, prospective laboratory study. SETTING:University experimental laboratory. SUBJECTS:Thirty-two male rats. INTERVENTIONS:The animals were randomly assigned to one of four g...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Taniguchi T,Yamamoto K,Ohmoto N,Ohta K,Kobayashi T

    更新日期:2000-04-01 00:00:00

  • Medical, legal and ethical issues in critical care.

    abstract::This report is intended to familiarize the reader with the current legislation concerning state definitions of death, the pertinent judicial decisions concerning termination of life support and the current status of medical/ethical committees. However, it is of paramount importance to all health care personnel to beco...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Wallace-Barnhill G,Roth MD,Briggs BA,Bastron DR,Barrocas A

    更新日期:1982-01-01 00:00:00

  • Impaired cerebral blood flow autoregulation during posttraumatic arterial hypotension after fluid percussion brain injury is prevented by phenylephrine in female but exacerbated in male piglets by extracellular signal-related kinase mitogen-activated prot

    abstract:OBJECTIVE:Traumatic brain injury contributes to morbidity and mortality in children and boys are disproportionately represented. Hypotension is common and worsens outcome after traumatic brain injury. Extracellular signal-related kinase mitogen-activated protein kinase is upregulated and reduces cerebral blood flow aft...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Armstead WM,Kiessling JW,Kofke WA,Vavilala MS

    更新日期:2010-09-01 00:00:00

  • Effects of temperature on bleeding time and clotting time in normal male and female volunteers.

    abstract:OBJECTIVE:This study was done to assess the effects of temperature on bleeding time and clotting time in normal male and female volunteers. DESIGN:Open study utilizing normal volunteers. SETTING:University research laboratory. SUBJECTS:Fifty-four healthy male and female volunteers, ranging in age from 19 to 35 yrs, ...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Valeri CR,MacGregor H,Cassidy G,Tinney R,Pompei F

    更新日期:1995-04-01 00:00:00

  • Esophageal and transpulmonary pressures in acute respiratory failure.

    abstract:OBJECTIVE:Pressure inflating the lung during mechanical ventilation is the difference between pressure applied at the airway opening (Pao) and pleural pressure (Ppl). Depending on the chest wall's contribution to respiratory mechanics, a given positive end-expiratory and/or end-inspiratory plateau pressure may be appro...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Talmor D,Sarge T,O'Donnell CR,Ritz R,Malhotra A,Lisbon A,Loring SH

    更新日期:2006-05-01 00:00:00

  • A National Emergency Airway Registry for children: landscape of tracheal intubation in 15 PICUs.

    abstract:OBJECTIVES:To characterize the landscape of process of care and safety outcomes for tracheal intubation across pediatric intensive care units BACKGROUND:Procedural process of care and safety outcomes of tracheal intubation across pediatric intensive care units has not been described. We hypothesize that the novel Nati...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Nishisaki A,Turner DA,Brown CA 3rd,Walls RM,Nadkarni VM,National Emergency Airway Registry for Children (NEAR4KIDS).,Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network.

    更新日期:2013-03-01 00:00:00

  • Pretransport Pediatric Risk of Mortality (PRISM) score underestimates the requirement for intensive care or major interventions during interhospital transport.

    abstract:OBJECTIVE:To test the hypothesis that a pretransport Pediatric Risk of Mortality (PRISM) score underestimates the requirement for both intensive care and interventions during pediatric interhospital transport. DESIGN:Prospective, descriptive study. SETTING:All children were treated in a regional hospital and then tra...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Orr RA,Venkataraman ST,Cinoman MI,Hogue BL,Singleton CA,McCloskey KA

    更新日期:1994-01-01 00:00:00

  • Effects of N-acetylcysteine plus deferoxamine in lipopolysaccharide-induced acute lung injury in the rat.

    abstract:OBJECTIVES:Interventions that reduce the generation or the effects of reactive oxygen species exert controversial effects in animal models of lung injury, and these could be secondary to the pro-oxidant effects of antioxidants generally by their interaction with iron. We here describe the effects of N-acetylcysteine, d...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Ritter C,da Cunha AA,Echer IC,Andrades M,Reinke A,Lucchiari N,Rocha J,Streck EL,Menna-Barreto S,Moreira JC,Dal-Pizzol F

    更新日期:2006-02-01 00:00:00

  • The effect of daily bathing with chlorhexidine on the acquisition of methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus, and healthcare-associated bloodstream infections: results of a quasi-experimental multicenter trial.

    abstract:OBJECTIVE:Spread of multidrug-resistant organisms within the intensive care unit (ICU) results in substantial morbidity and mortality. Novel strategies are needed to reduce transmission. This study sought to determine if the use of daily chlorhexidine bathing would decrease the incidence of colonization and bloodstream...

    journal_title:Critical care medicine

    pub_type: 杂志文章,多中心研究


    authors: Climo MW,Sepkowitz KA,Zuccotti G,Fraser VJ,Warren DK,Perl TM,Speck K,Jernigan JA,Robles JR,Wong ES

    更新日期:2009-06-01 00:00:00

  • Incidence and Mortality of Acute Respiratory Distress Syndrome in Children: A Systematic Review and Meta-Analysis.

    abstract:OBJECTIVES:Our understanding of the acute respiratory distress syndrome in children is limited, and literature is dominated by investigations in adult patients. Recent preclinical studies suggest that the susceptibility to and severity of acute respiratory distress syndrome in children could differ from that in adults....

    journal_title:Critical care medicine

    pub_type: 杂志文章,meta分析,评审


    authors: Schouten LR,Veltkamp F,Bos AP,van Woensel JB,Serpa Neto A,Schultz MJ,Wösten-van Asperen RM

    更新日期:2016-04-01 00:00:00

  • Ethical decision-making in critical care in Hong Kong.

    abstract:OBJECTIVES:Biomedical ethics has assumed an increasingly important role in medicine over the past 30 yrs, and its development has served the important goal of protecting patients' rights and interests. However, medical ethics has evolved within a Western tradition, and conflict often arises when trying to apply Western...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Ip M,Gilligan T,Koenig B,Raffin TA

    更新日期:1998-03-01 00:00:00

  • Patient and hospital characteristics associated with inpatient severe sepsis mortality in California, 2005-2010.

    abstract:OBJECTIVES:The primary objective of this study was to identify which patient demographic, patient health, and hospital characteristics were associated with in-hospital mortality. A secondary objective was to determine the relative influence of these characteristics on mortality. DESIGN AND SETTING:Public-use data for ...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Banta JE,Joshi KP,Beeson L,Nguyen HB

    更新日期:2012-11-01 00:00:00

  • Urgent coronary angiography and percutaneous coronary intervention as a part of postresuscitation management.

    abstract::Because an acute coronary thrombotic event may be viewed as the main trigger of sudden cardiac arrest, urgent coronary angiography followed by percutaneous coronary intervention appeared as a promising tool in the early postresuscitation phase. Unfortunately, large randomized trials, which have unequivocally demonstra...

    journal_title:Critical care medicine

    pub_type: 杂志文章,评审


    authors: Noc M

    更新日期:2008-11-01 00:00:00

  • Randomized Feasibility Trial of a Low Tidal Volume-Airway Pressure Release Ventilation Protocol Compared With Traditional Airway Pressure Release Ventilation and Volume Control Ventilation Protocols.

    abstract:OBJECTIVES:Low tidal volume (= tidal volume ≤ 6 mL/kg, predicted body weight) ventilation using volume control benefits patients with acute respiratory distress syndrome. Airway pressure release ventilation is an alternative to low tidal volume-volume control ventilation, but the release breaths generated are variable ...

    journal_title:Critical care medicine

    pub_type: 杂志文章,多中心研究,随机对照试验


    authors: Hirshberg EL,Lanspa MJ,Peterson J,Carpenter L,Wilson EL,Brown SM,Dean NC,Orme J,Grissom CK

    更新日期:2018-12-01 00:00:00

  • Perioperative diabetic and hyperglycemic management issues.

    abstract:OBJECTIVE AND DESIGN:To review and discuss selected literature, expert opinion, and conventional care of the hyperglycemic perioperative or critically ill patient. MAIN POINTS:Diabetes mellitus, the most commonly encountered perioperative endocrinopathy, continues to increase dramatically in prevalence. Diabetes is th...

    journal_title:Critical care medicine

    pub_type: 杂志文章,评审


    authors: Coursin DB,Connery LE,Ketzler JT

    更新日期:2004-04-01 00:00:00