Coletta Francesco, Sala Crescenzo, De Marco Giovanna Paola, Mataro Ilaria, Petroccione Carlo, Bonagura Pietro, Pirolli Rossella, Foreste Giuseppe, Tomasello Antonio, Villani Romolo
Emergency and Acceptance Department, Anesthesia, Emergency and Burn Intensive Care Unit, "A.O.R.N. A. Cardarelli", Naples, Italy.
Covid 19 Intensive Care Unit, "A.O.R.N. A. Cardarelli", Naples, Italy.
Plast Reconstr Surg Glob Open. 2023 Jan 25;11(1):e4808. doi: 10.1097/GOX.0000000000004808. eCollection 2023 Jan.
The presence of a high number of positive SARS-CoV-2 patients is found daily in the emergency room database, finding evidence of infection also in trauma and burns. Surgical debridement remains the gold standard for eschar removal, but it does not come without complications such as bleeding and high heat loss. In recent years, there has been an increase in the use of enzymatic debridement techniques, replacing surgical escharotomy. Early eschar removal is proven to be important; it has been proved that an early and effective burn treatment in COVID-19 patients can reduce other infection. Five clinical cases of patients arrived at our COVID-19 Major Burns Intensive Care Unit. On admission, burns extension and depth were assessed by an expert burn surgeon. We evaluated eschar removal modality, adverse events, and potential side effects. Enzymatic debridement was efficient in all patients treated with complete eschar removal, and no serious adverse events. All patients were treated within 24 hours of arrival at our facility with Nexobrid by specialized personnel in deep sedation and with O support using a face mask or nasal goggles. The use of enzymatic debridement in COVID-19-positive burn patients within dedicated pathways through nonsurgical treatment optimizes the treatment time. We believe that the use of enzymatic debridement could be a valid therapeutic option in burn patients, even with SARS-CoV-2 infection, and its use, when indicated, is safe and effective for the patient and optimizes the use of instrumental and human resources in a pandemic emergency.
急诊室数据库中每天都能发现大量新冠病毒检测呈阳性的患者，在创伤和烧伤患者中也发现了感染证据。手术清创术仍然是去除焦痂的金标准，但它并非没有并发症，如出血和大量热量流失。近年来，酶促清创技术的使用有所增加，取代了手术切开焦痂术。事实证明，早期去除焦痂很重要；已经证明，对新冠肺炎患者进行早期有效的烧伤治疗可以减少其他感染。有5例患者抵达我们的新冠肺炎重症烧伤监护病房。入院时，由一名专业烧伤外科医生评估烧伤范围和深度。我们评估了焦痂去除方式、不良事件和潜在副作用。酶促清创术对所有接受完全焦痂去除治疗的患者均有效，且无严重不良事件。所有患者在抵达我们的机构后24小时内，由专业人员使用Nexobrid进行深度镇静治疗，并通过面罩或鼻罩给予氧气支持。在专门的治疗途径中，对新冠肺炎阳性烧伤患者使用酶促清创术进行非手术治疗可优化治疗时间。我们认为，酶促清创术可能是烧伤患者的一种有效治疗选择，即使是感染了新冠病毒的患者，在有指征时使用对患者来说是安全有效的，并且在大流行紧急情况下优化了仪器和人力资源的使用。
