Cerium Nitrate Treatment in the Management of Burns.
- 2021
CRITICAL ISSUES: CN+SSD cream is not approved by the FDA, and its efficacy in clinical trials has been challenging to demonstrate. One reason is that CN changes the eschar visibly, introducing unavoidable bias. Also, the market and patient population is small and burn wound presentation is highly variable. FUTURE DIRECTIONS: For use in settings where the once- or twice-daily CN+SSD cream dressing changes are least feasible (low-income, military, and mass casualty settings), it may be possible to develop a solid dressing containing cerium and silver that requires infrequent dressing changes. For future clinical studies, the trial design most suited to comparing silver-containing dressings with and without cerium may be paired difference of matched intra-patient wounds. SIGNIFICANCE: The standard of care for deep burn wounds is eschar excision and autologous skin grafting within the first post-burn days. However, when this is not practical due to medical reasons, unavailable surgical facilities, or lack of donor sites or other coverage, surgeons have used topical cerium nitrate (CN) in a cream with silver sulfadiazine (SSD) for over four decades to convert the eschar into a pliable and protective crust that facilitates the postponement or staging of eschar excision and grafting. CN+SSD treatment is reported to reduce dressing changes, improve patient comfort, and reduce bacterial burden, with unaffected epithelialization and few complications. Recent Advances: CN aqueous solution applied topically alone or with solid silver dressings in animal models has mitigated wound injury progression, wound microbial burden, and systemic immune dysfunction.
English
2162-1918
10.1089/wound.2020.1330 [doi]
IN PROCESS -- NOT YET INDEXED
MedStar Health Research Institute MedStar Washington Hospital Center
Firefighters' Burn and Surgical Research Laboratory MedStar General Surgery Residency Surgery/Burn Services