A Randomized Trial Evaluating EARLY Application of a Surfactant Dressing in Thermal Injury (EARLY)

Burns Clinical Trial

— EARLY  

Official title:

A Randomized, Controlled Study Evaluating a Surfactant-based Wound Dressing for Tissue Salvage and Reduction in Surgical Burden

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT04880655
• Other study ID #: 20-07861-XP
• Status: Completed
• Phase: N/A
• Start date: August 3, 2021
• Est. completion date: October 24, 2023

Study information

• Verified date: October 2023
• Source: University of Tennessee
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

The purpose of this study is to test the following hypotheses:

1. Early use of water-soluble surfactant dressing (WSD) on partial-thickness burn wounds will result in tissue salvage and reduce surgical burden.

2. Early use of WSD on partial-thickness burn wounds will result in faster healing.

3. Use of WSD on partial-thickness burn wounds will result in less painful wound care.

4. Early use of WSD on partial-thickness burn wounds will result in less infection.

5. Early use of WSD on partial-thickness burn wounds will result in lower hospital costs.

Description:

Surfactant-based wound dressings have been utilized in chronic, non-healing wounds and small burn wounds to soften and aid removal of wound debris. In vitro data suggest enhanced healing properties are due the ability to stabilize and potentially reseal plasma membranes, thereby, retaining cellular integrity and enhance wound healing. Improved cellular viability and functionality has also been established in heat-shock, ionizing radiation, and electrical injury models. In one rat model, topically suffused mesentery demonstrated improved microvascular flow and reduction in the number of abnormally flowing microvessels following thermal injury. Intravenous administration has been studied in several disease states. In thermal injury, intravenous administration has shown potential to improve blood flow and reduce the zone of coagulation. Further, surfactant-based wound dressings are non-ionic and may facilitate removal, sensitize, or prevent bacterial biofilms. Biofilms are an evolved, protective mechanism bacteria utilize to reduce antimicrobial efficacy. Removal or penetration of biofilms is essential for bacterial eradication. There is little evidence demonstrating the efficacy of early use of a WSD for treating partial-thickness burn wounds.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 27
• Est. completion date: October 24, 2023
• Est. primary completion date: October 24, 2023
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

• age = 18 years old

• admitted within 24 hours of injury

• partial-thickness burn wounds on at least two non-contiguous areas of < 10% TBSA each and not involving face, fingers, toes, and perineum

• initial management assessed to require inpatient care

Exclusion Criteria:

• chemical, electrical, or inhalation injury

• pregnant

• incarcerated

• TBSA = 20%

• wound expected to heal within 7 days

• patient or authorized representative unable or unwilling to consent

• unable to consent within 24 hours of injury

Related Conditions & MeSH terms

• Burns
• Partial-thickness Burn

Intervention

Device:
• WSD
Post debridement and within 24 hours of injury, wound care and WSD applied daily
• Dressed with bacitracin and petrolatum gauze
Post debridement and within 24 hours of injury, wound care and dressing applied daily

Locations

Country	Name	City	State
United States	Regional One Health	Memphis	Tennessee

Sponsors (2)

Lead Sponsor	Collaborator
University of Tennessee	Medline Industries

Country where clinical trial is conducted

United States, 

References & Publications (17)

Baskaran H, Toner M, Yarmush ML, Berthiaume F. Poloxamer-188 improves capillary blood flow and tissue viability in a cutaneous burn wound. J Surg Res. 2001 Nov;101(1):56-61. doi: 10.1006/jsre.2001.6262. — View Citation

Birchenough SA, Rodeheaver GT, Morgan RF, Peirce SM, Katz AJ. Topical poloxamer-188 improves blood flow following thermal injury in rat mesenteric microvasculature. Ann Plast Surg. 2008 May;60(5):584-8. doi: 10.1097/SAP.0b013e3181651661. — View Citation

Chen R, Salisbury AM, Percival SL. In vitro cellular viability studies on a concentrated surfactant-based wound dressing. Int Wound J. 2019 Jun;16(3):703-712. doi: 10.1111/iwj.13084. Epub 2019 Mar 20. — View Citation

Greenebaum B, Blossfield K, Hannig J, Carrillo CS, Beckett MA, Weichselbaum RR, Lee RC. Poloxamer 188 prevents acute necrosis of adult skeletal muscle cells following high-dose irradiation. Burns. 2004 Sep;30(6):539-47. doi: 10.1016/j.burns.2004.02.009. — View Citation

Kirsner RS, Amaya R, Bass K, Boyar V, Ciprandi G, Glat PM, Percival SL, Romanelli M, Pittinger TP. Effects of a surfactant-based gel on acute and chronic paediatric wounds: a panel discussion and case series. J Wound Care. 2019 Jun 2;28(6):398-408. doi: 10.12968/jowc.2019.28.6.398. — View Citation

Lee RC, Hannig J, Matthews KL, Myerov A, Chen CT. Pharmaceutical therapies for sealing of permeabilized cell membranes in electrical injuries. Ann N Y Acad Sci. 1999 Oct 30;888:266-73. doi: 10.1111/j.1749-6632.1999.tb07961.x. — View Citation

Lee RC, River LP, Pan FS, Ji L, Wollmann RL. Surfactant-induced sealing of electropermeabilized skeletal muscle membranes in vivo. Proc Natl Acad Sci U S A. 1992 May 15;89(10):4524-8. doi: 10.1073/pnas.89.10.4524. — View Citation

Maskarinec SA, Wu G, Lee KY. Membrane sealing by polymers. Ann N Y Acad Sci. 2005 Dec;1066:310-20. doi: 10.1196/annals.1363.018. — View Citation

Mayer D, Armstrong D, Schultz G, Percival S, Malone M, Romanelli M, Keast D, Jeffery S. Cell salvage in acute and chronic wounds: a potential treatment strategy. Experimental data and early clinical results. J Wound Care. 2018 Sep 2;27(9):594-605. doi: 10.12968/jowc.2018.27.9.594. — View Citation

Palumbo FP, Harding KG, Abbritti F, Bradbury S, Cech JD, Ivins N, Klein D, Menzinger G, Meuleneire F, Seratoni S, Zolss C, Mayer D. New Surfactant-based Dressing Product to Improve Wound Closure Rates of Nonhealing Wounds: A European Multicenter Study Including 1036 Patients. Wounds. 2016 Jul;28(7):233-40. — View Citation

Pittinger T, Curran D, Hermans M. Treatment of Burns in Adult Patients With a Concentrated Surfactant Gel: A Real-life Retrospective Evaluation. Wounds. 2020 Dec;32(12):339-344. — View Citation

Pittinger TP, Curran D, Hermans MH. The treatment of paediatric burns with concentrated surfactant gel technology: a case series. J Wound Care. 2020 Jun 1;29(Sup6):S12-S17. doi: 10.12968/jowc.2020.29.Sup6.S12. — View Citation

Rodeheaver GT, Kurtz L, Kircher BJ, Edlich RF. Pluronic F-68: a promising new skin wound cleanser. Ann Emerg Med. 1980 Nov;9(11):572-6. doi: 10.1016/s0196-0644(80)80228-9. — View Citation

Salisbury AM, Percival SL. Efficacy of a Surfactant-Based Wound Dressing in the Prevention of Biofilms. Adv Skin Wound Care. 2018 Nov;31(11):514-520. doi: 10.1097/01.ASW.0000544612.28804.34. — View Citation

Walsh AM, Mustafi D, Makinen MW, Lee RC. A surfactant copolymer facilitates functional recovery of heat-denatured lysozyme. Ann N Y Acad Sci. 2005 Dec;1066:321-7. doi: 10.1196/annals.1363.029. — View Citation

Yang Q, Larose C, Della Porta AC, Schultz GS, Gibson DJ. A surfactant-based wound dressing can reduce bacterial biofilms in a porcine skin explant model. Int Wound J. 2017 Apr;14(2):408-413. doi: 10.1111/iwj.12619. Epub 2016 May 22. — View Citation

Yang Q, Schultz GS, Gibson DJ. A Surfactant-Based Dressing to Treat and Prevent Acinetobacter baumannii Biofilms. J Burn Care Res. 2018 Aug 17;39(5):766-770. doi: 10.1093/jbcr/irx041. — View Citation

* Note: There are 17 references in all — Click here to view all references

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Percent difference (cm2) in partial-thickness wound conversion	Tissue salvage	Up to 14 days
Secondary	Time to 95% re-epithelialization	Healing time	Up to 28 days
Secondary	Daily pain scores for each wound care session	Pain via Numeric Rating Scale (0-10; 0 having no pain and 10 being the worst possible pain)	Up to 7 days
Secondary	Incidence of burn wound infection and cellulitis	Infection up to day of initial excision or day of discharge	Up to 28 days
Secondary	Hospital costs	Cost of care during inpatient stay	Up to 28 days