Cerium nitrate hexahydrate 22mg/g / Sulfadiazine silver 10mg/g cream

BackgroundChoosing adequate topical antimicrobial agents in burn patients still represents a challenge. Therefore, this systematic review was conducted to compile and evaluate current recommendations in international clinical practice guidelines (CPGs) to develop more consistent clinical guidance.MethodsA systematic search for CPGs was conducted independently by two reviewers using PubMed, EMBASE, Google Scholar, and external citations. The quality of the selected CPGs was evaluated separately using the AGREE II instrument, and intraclass correlation coefficients were calculated. Statistical analysis was performed using R V 1.4.1 statistical software.ResultsEleven CPGs were included in the study. Most guidelines tend to recommend silver-containing dressings over antiseptics or antibiotics, regardless of the depth of the burn. Silver sulfadiazine is the most recommended topical antimicrobial in low-resource settings. An overall mean appraisal AGREE II score of 68.2% was obtained. The global intraclass correlation coefficient was 0.62 (95% confidence intervals 0.54-0.69), which corresponds to a substantial global concordance between both appraisers.ConclusionsGreat heterogeneity was found between recommendations and CPGs. The three determining factors considered to issue a recommendation were the clinical scenario, burn-wound depth, and burn severity. There is consensus among the guidelines to use topical antimicrobials as a tool to prevent infection, and most of these recommend the use of silver-containing dressings for most scenarios. However, there is currently no ideal topical antimicrobial agent that can be recommended for all clinical scenarios. The development of more consistent recommendations is warranted to standardize clinical practice.

Abstract licence: CC BY-NC

Ventilator-associated pneumonia (VAP) is a consequence of intubation and mechanical ventilation. Bacteria colonize the inner-lumen of endotracheal tubes (ETT) and develop into a biofilm. One method to reduce/eliminate the develop of biofilms within the ETT is lining the inner-lumen with silver-sulfadiazine. A systematic review was conducted to evaluate the effectiveness of silver-coated ETTs for patients that develop VAP. Multiple databases were searched to identify key literature related to silver-coated ETTs and VAP. Inclusion and exclusion criteria were identified to finalize the studies that were included in this systematic review. Five key studies were included in this review. Studies were further evaluated with PRISMA, a data collection table, the Critical Appraisal Skills Programme (CASP) and the Critical Appraisal for Summaries of Evidence (CASE) worksheet. All studies found either a reduction or elimination of bacteria within the ETT, breathing circuit, or lungs of the study subjects. In addition to the reduced colonization found across the studies, one study found a reduction in the mortality rate for the intervention group following a diagnosis of VAP. Certified Registered Nurse Anesthetists (CRNA) play an important role in educating staff about the impact silver-coated ETTs have on patient outcomes throughout periods of intubation and mechanical ventilation. Additionally, CRNAs are well positioned to identify patients pre-operatively that may require prolonged intubation following surgery. By advocating for silver-coated ETTs for these patients, CRNAs can improve patient outcomes by reducing the likelihood of these patients developing VAP.

Abstract licence: CC BY-NC-ND

Wound healing has been intensely studied in order to develop an "ideal" technique that achieves expeditious recovery and reduces scarring to the minimum, thus ensuring function preservation. The classic approach to wound management is represented by topical treatments, such as antibacterial or colloidal agents, in order to prevent infection and promote a proper wound-healing process. Nanotechnology studies submicroscopic particles (maximum diameter of 100 nm), as well as correlated phenomena. Metal nanoparticles (e.g., silver, gold, zinc) are increasingly being used in dermatology, due to their beneficial effect on accelerating wound healing, as well as treating and preventing bacterial infections. Other benefits include: ease of use, less frequent dressing changes and a constantly moist wound environment. This review highlights recent findings regarding nanoparticle application in wound management.

Abstract licence: CC BY