Partial-thickness Burn Clinical Trial
Official title:
Effect of Enteral Albumin on Healing of Superficial Partial Thickness Fresh Flame Burns of Adults
Patients with 10 to 20% Superficial partial thickness fresh flame burn will be recruited.
Burn thickness will be confirmed by using Laser Doppler. After randomly allocating into two
groups, one group will receive enteral supplemental albumin in the form of boiled egg along
with routine diet while other group will receive only routine diet.
Effect of burn healing will be noted in terms of epithelization, oedema, pain and redness and
days of hospital stay
Burn is an insult to the living tissues typically skin leading to coagulative necrosis due to
extreme of temperature, electricity or chemicals. Burn injuries are a global public health
problem with physical, psychological, social and economic implications on patients, their
families and society as a whole. According to WHO, about 265,000 people die each year due to
burn injuries. Vast majority of burn cases occur in middle and low socioeconomic groups of
society. Any age group can be the victim of burn but people belonging to actively working
class i.e. young adults (18-40yr) are more susceptible to burn injury. The most common sites
of burn occurrence are domestic kitchen and workplaces from upset of receptacles containing
hot liquids or directly from flames, electricity or cook stove burst.
Skin has outer covering of epidermis and deeper one is dermis. Burns, from management point
of view, can be classified into superficial, superficial partial thickness, deep partial
thickness and full thickness depending upon the extent of layers of skin involved.
Superficial burns do not need specialized treatment and heal by their own while deep partial
thickness and full thickness burns mostly require surgical procedures for management.
Patients having superficial partial thickness burn wounds are the group of particular
interest in burn centers due to two reasons. Firstly, the majority of burn injuries fall in
this group and secondly, these are the wounds which, if managed well, heal in three weeks
satisfactorily without any surgical intervention. The superficial partial thickness burn
wounds involve damage to epidermis as well as partial dermis and characterized by Slough
(yellowish white fibrinous tissue containing proteinacious material, pus and fibrin on wound
surface), Erythema (redness of burn skin surface), Ooze (excessive fluid loss).
According to American Burn Association recommendations, patients having superficial partial
thickness burn more than 10% body surface area need hospitalization for management. Multiple
factors play role in the healing of superficial partial thickness burn wounds like age,
co-morbidities (diabetes, HTN, obesity etc), immunosuppressive medications (steroids,
chemotherapy) and nutritional status. Management of superficial partial thickness burn wound
requires pain management, dressings, topical ointments and culture guided antibiotics.
Despite of all these maneuvers, good nutritional support in the form of both micronutrients
and macronutrients particularly proteins are critical component of acute burn wound care.
Early optimal nutrition administration in management of burn patients particularly involves
proteins rich diet due to lot of oozing from large wound surface area, high catabolism of
muscles and vast tissue repair.
Protein enrichment of diet, for burn patients, can be achieved by adding albumin, which is
easily available from many sources especially egg and plays vital role in burn wound healing.
Albumin, synthesized by liver, is one the major proteins which has several important
functions. Albumin, composed of essential amino acids, is primary serum binding protein
required for transportation of various substances in blood circulation. Albumin
administration is much easier through enteral route. Deficit of albumin occurs due to
decreased synthesis during inflammatory conditions and, in burns, is further augmented by a
shift in distribution of albumin to interstitial space from vascular compartment. A
deficiency of albumin level can impair burn wound healing process whereas increased albumin
level does not cause significant clinical complication. Hypo-albuminemia caused by wound
exudation is the major predictor after injury that results in shock induction secondary to
major extracellular fluid loss by increasing vascular permeability.
The rationale of this study is to find out effects of albumin supplementation on hospital
stay by affecting healing of superficial partial thickness burn wounds by.
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