Cooling of burns: Mechanisms and models

被引:42
作者
Wright, E. H. [1 ,2 ]
Harris, A. L. [3 ]
Furniss, D. [4 ,5 ]
机构
[1] Univ Oxford, Green Templeton Coll, Stoke Mandeville Hosp, Dept Plast Surg, Oxford OX2 6HG, England
[2] Univ Oxford, Green Templeton Coll, Stoke Mandeville Hosp, Dept Oncol, Oxford OX2 6HG, England
[3] Univ Oxford, Green Templeton Coll, Dept Oncol, Med Oncol, Oxford OX2 6HG, England
[4] Univ Oxford, Green Templeton Coll, Oxford Univ Hosp, Dept Plast Surg, Oxford OX2 6HG, England
[5] Univ Oxford, Green Templeton Coll, Botnar Res Ctr, Oxford OX2 6HG, England
关键词
Burn; Cooling; Model; Animal; Human; Mechanism; COLD-WATER TREATMENT; HAIRLESS MOUSE EAR; OF-STASIS BURNS; THERMAL-INJURY; MICRO-CIRCULATION; EDEMA FORMATION; PORCINE MODEL; OPTIMAL DURATION; AID TREATMENT; SCALD INJURY;
D O I
10.1016/j.burns.2015.01.004
中图分类号
R4 [临床医学];
学科分类号
100218 [急诊医学];
摘要
The role of cooling in the acute management of burn is widely accepted in clinical practice, and is a cornerstone of basic first aid in burns. This has been underlined in a number of animal models. The mechanism by which it delivers its benefit is poorly understood, but there is a reduction in burns progression over the first 48 h, reduced healing time, and some subjective improvements in scarring when cooling is administered after burning. Intradermal temperature normalises within a matter of seconds to a few minutes, yet the benefits of even delayed cooling persist, implying it is not simply the removal of thermal energy from the damaged tissues. Animal models have used oedema formation, preservation of dermal perfusion, healing time and hair retention as indicators of burns severity, and have shown cooling to improve these indices, but pharmacological or immunological blockade of humoural and cellular mediators of inflammation did not reproduce the benefit of cooling. More recently, some studies of tissue from human and animal burns have shown consistent, reproducible, temporal changes in gene expression in burned tissues. Here, we review the experimental evidence of the role and mechanism of cooling in burns management, and suggest future research directions that may eventually lead to improved treatment outcomes. (C) 2015 Published by Elsevier Ltd and ISBI.
引用
收藏
页码:882 / 889
页数:8
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