Background: Severe burn injuries are a major health problem globally. A profound and prolonged hypermetabolic response develops in severe burn injuries and it is crucial to monitor the patients’ energy requirements in order to meet them adequately. The aim of the present study was to examine the energy changes during the acute phase using the indirect calorimetry (IC) method in severe burn patients. Methods: The study included 15 severe burn patients. Patients with FiO2 >60%, tube thoracostomy, closed underwater drain (CUWD) and air leakage were excluded from the study. Patients’ demographic data, burn percentages, burn types, duration of stay in intensive care, mortality and Acute Physiology and Chronic Health Evaluation II (APACHE II) scores were recorded. Indirect calorimeter measurements were taken once from the patients upon their first arrival and during the following four weeks. Resting energy expenditure (REE), basal metabolic rate (BMR), oxygen consumption (VO₂), carbon dioxide production (VCO₂), body temperatures, presence of sepsis, Sequential Organ Failure Assessment (SOFA) and Modified Nutrition Risk in Critically Ill (mNUTRIC) scores were recorded. The data were analysed using SPSS 24 and p-values 40%. A total of 14 (93.33%) had flame burns; 3 (20.00%) patients deceased, and 12 (80.00%) were discharged. The mean APACHE II score was 11.53±6.83. The measured mean values of REE, VO₂, VCO₂ and fever were seen to be the highest in the first week after admission and decreases were observed in the subsequent weeks. SOFA score averages were the highest at admission, and decreased in the following weeks. Conclusion: Severe burn patients were observed to go through the hypermetabolic process in the acute phase and their energy requirements were high particularly in the first week. It was concluded that regular IC monitoring can be beneficial to fully meet the energy requirements of severe burn patients due to the prolonged hypermetabolic process.

BACKGROUND: Acute kidney injury (AKI) is one of the common complications, associated with high mortality and morbidity in patients with burn injuries. This study aimed to determine the frequency of AKI development, its affective factors, and mortality rates according to kidney disease improving global outcomes (KDIGO) criteria in the burn patients.METHODS: The study included patients who are hospitalized for at least 48 h and aged >18 years, whereas patients with a renal transplant, chronic renal failure, undergoing hemodialysis, <18 years of age, with a glomerular filtration rate of <15 on admission, and toxic epidermal necrolysis was excluded from the study. KDIGO criteria were used to evaluate the occurrence of AKI. Burn mechanism, total body surface area, inhalation injury respiratory tract burn, fluid replacement at 72 h with Parkland Formula, mechanical ventilator support, inotrope/vasopressor support, intensive care unit, lenght of stay, mortality, abbreviated burn severity index (ABSI), acute physiology, and chronic health evaluation II (APACHE II) ve Sequential organ failure assessment (SOFA) were recorded.RESULTS: A total of 48 patients were included in our study, of which 26 (54.2%) developed AKI (+), whereas 22 (45.8%) did not (-). The mean total burn surface area was 47.30% in the AKI (+) group and 19.88% in the AKI (-) group. Mean scores of ABSI, II (APACHE II), and SOFA, the mechanical ventilation and inotrope/vasopressor support and the presence of sepsis were significantly higher in the AKI (+). No mortality was determined in the AKI (-) group, whereas 34.6% in the AKI (+) group which was significantly high.CONCLUSION: AKI was related to high morbidity and mortality in patients with burns. Using KDIGOs, classification in daily follow-up is useful in early diagnosis.

Aim: Conditions during brain and spine surgery, such as trauma, surgery, general anesthesia, fluid infusions, hypothermia, and patient inactivity, may lead to coagulation disorders, increasing the risk of bleeding or thrombosis. This study aimed to evaluate the relationship between thromboelastography (TEG), coagulation, and perioperative transfusion. Materials and Methods: In 2012, 58 adult ASA I–III patients undergoing brain and spine surgery were prospectively included after obtaining ethics committee approval and patient consent. Patients with coagulopathy or anticoagulants were excluded. Fluid requirements were managed with balanced crystalloids, and selected patients were randomly administered 6% hydroxyethyl starch or 4% gelatin solutions. Coagulation was monitored preoperatively, at the end of surgery, and 24 hours postoperatively using TEG and standard coagulation parameters. Results: The mean age of the patients was 46.7 years, the mean BMI was 27.7, and 62.1% were female. Eleven patients (18.9%) required an average of 6.1 (±4.1) mL/kg erythrocyte transfusion. Transfused patients had longer operative times (p=0.022), anesthesia durations (p=0.014), total fluid requirements (p<0.001), and crystalloid infusions (p=0.039). TEG data revealed no coagulation abnormalities causing clinical bleeding. However, postoperative Maximum Amplitude (MA) significantly increased in both groups. MA showed a positive correlation with age (r=0.27, p=0.039) and crystalloid volume (r=0.29, p=0.027), and a negative correlation with the lowest temperature (r=-0.28, p=0.029). Coagulation Index (CI) was positively correlated with preoperative fibrinogen levels (r=0.28, p=0.045). Conclusion: TEG analysis showed similar coagulation profiles in transfused and non-transfused patients. Before drawing general conclusions about perioperative coagulation, these findings should be compared with studies using restrictive transfusion protocols.

Aim: Current permanent catheter fixation techniques may lead to epidural catheter dislodgement or extrusion, resulting in risks such as catheter migration, inadequate analgesia, and unintended spinal block. This study aimed to compare a newly developed fixation device with the conventional suture method used for epidural catheter fixation.Materials and Methods: The Epilock® device, developed at Ege University Technopark CND ARGE, was manufactured using Polylactic Acid Thermoplastic Polymer (PLA+) material via a 3D printer. After obtaining ethical approval, 10 Sprague Dawley rats (5 males, 5 females) were anesthetized and randomly allocated into two groups. In the Control Group (n=5), epidural catheters were fixed 11 cm beneath the skin with silk sutures (20 knots). In the Experimental Group (n=5), catheters were secured using the Epilock® device. Fixation time was recorded, and the rats were monitored for catheter stability and infection for 7 days.Results: In the Control Group (n=5), the mean catheter fixation time was 258 ±250 seconds, while in the Experimental Group (n=5) it was 175 ±150 seconds. The Epilock® device significantly reduced fixation time compared the Control Group (p=0.032). Catheters remained significantly longer in place in the Experimental Group on the first day (p=0.048), whereas no significant difference was found on the second day (p=1.000).Conclusion: The Epilock® device provided a shorter procedure time and improved initial catheter retention compared with conventional suturing. These findings suggest it may enhance patient comfort, especially for those with positioning difficulties, and has the potential to be a valuable option in routine practice with further development and larger studies.