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University of Illinois at Chicago, Department of Women, Children, and Family Health Science, United States
nce extensive burns re-quire longer hospital
stays and are at increased risk for infection and
hospital acquired conditions. This compar-ative
case study is a two patient matched case control
article info abst design that follows the hospital course of two
ract children who experienced burn injuries. For one
Article history: of these patients, with the consent of the child's
parents, the grandmother treated her
Hospita granddaughter with essential oils. Essential oils
Received 4 August 2016 Revised 27 December 2016 Accepted 29 l have the potential to inhibit microbial growth,
December 2016 Available online xxxx admissi support treatment of wounds, and facilitate
ons healing. However, there have been no large
related scale studies on essential oils. Data for the two
Keywords: to burn cases were retrieved from the electronic medical
injury record at a Midwestern Pediatric Hospital.
reach Retrieved data included burn site description,
Pediatric burns Infection
40,000 treatment for burns, number of days on the
annuall ventilator, white blood cell count, length of
Hospital acquired infections Essential oils y. hospital stay, number of ICU days, infections
Patients diagnosed by positive culture and pain ratings.
who While the goals for treatment were the same for
Case study experie both children, the child who received only
standard care was diagnosed with two blood stream infections findings h is needed to expand understanding of the role
and four hospital acquired conditions while the child who are of essential oils in the treatment of burns.
received supplemental treatment with essential oils did not intrigui
develop any blood stream infections, was diagnosed with one ng,
hospital acquired condition, was in the PICU one day less, and researc © 2017 Elsevier Inc. All rights reserved.
had a four day shorter length of hospital stay. While these case
( approval was not topically and by
P required. Corporate inhalation ( Buckle,
The purpose of this
I Compliance review
case study is to present 2003; Ozata,
Introduction C indicated that
treatment, incidence of 2006).X
U approval from the
infection, length of
) parents was not
Hospital admissions related to burn hospital stay, and
required as we were
injury reach 40,000 annually ( health outcomes of two
s not indicating
children
American Burn Association NBR t patient names and Types of Burns
Advisory Committee, 2012, 2013). a both pa-tients were
Pa-tients who experience extensive y Corresponding author at: well known to two
Children's Hospital of In 2013, the
burns (greater than 30% total body . of the authors. The
Wisconsin, United States. E- American Burn
sur-face area [TBSA]) requiring X children's names
mail address: rwt@uic.edu have been altered to Association
longer hospital stays are at
reported 3400
increased risk for infection and (R. White-Traut). X protect their
fire/burn/ smoke
hospital acquired conditions ( identity. For one of
these patients, with inhalation deaths (
American Burn Association NBR P
the consent of the American Burn
u
Advisory Committee, 2012, 2013). http://dx.doi.org/10.1016/j.p child's parents, the Association NBR
r
While treatment of children with edn.2016.12.018 0882- grandmother Advisory
p
burns is complex, often family 5963/© 2017 Elsevier Inc. supplemented her
o Committee, 2012,
members supplement the care the
s All rights reserved.X granddaughter with
2013). Residential
child receives with alternative essential oils
e fires accounted for
approaches. One alternative because she
2550 of these
approach we review is the use of believed they could
o deaths, 300 deaths
essential oils which have the with similar histories inhibit infection.
f were from vehicle
potential to inhibit microbial of extensive burns The grandmother
crash fires, and 550
growth, support treatment of (40% TBSA and used lavender and a
t from other sources (
wounds, and facilitate healing and consisting of partial blend of essen-tial
h
recovery ( Allard & Katseres, and full thickness oils thought to have Wolf, Phelan, &
e
burns). One child's immune-supportive Arnoldo, 2014). Of
2016). However, there have been
no large scale studies on essential C care was augmented properties. She the 550 deaths, 400
with essential oils diffused the oils oc-curred as a result
oils ( Allard & Katseres, 2016) and a
s while the second child into the air and of contact with
little research on children or with received standard care. applied them to electricity, liquids,
e
burn patients is reported in the This case study was intact skin on the or hot objects. The
literature. The first author of this submitted for IRB soles of her feet and primary cause of
S
case study was the primary nurse approval but was forehead. Two death in burn
t
for both pa-tients presented. The determined it did not means of victims is multi-
u
observations made were only meet the definition of administering organ failure with
d
during the Pediatric Intensive Care research therefore IRB lavender oil are sepsisX
y
recom-mended -
evidence
p
C , Level M
o
X
Cinnamon (Cinnamomum zeylanicum) (from the
Aldehydes, phenols, alcohols,
Astringent, germicide, antibacterial, antifungal,
o
Level M , Level X
cinnamon bark, steam distillation)
sesquiterpenes, carboxylic acid X
d,f
antimicrobial
d,f,g,j,k
X
n
E , Level C
p
X
Clove oil (Eugenia caryophyllata) (from the clove
Phenols, esters, sesquiterpenes, oxides
d,h
X
antifungal, antibacterial, anti-inflammatory
o
Level M , Level X
bud, steam distillation)
4,8,11
constituents
C
p
X
Eucalyptus (Eucalyptus radiata) (from the leaf,
Oxides, monoterpenes, alcohols,
Anesthetic, antiseptic
d,e,i,j,k
X
o
Level M , Level X
steam distillation)
aldehydes
d,i
X
C p X
Rosemary (Rosmarinus officinalis) (from the flower
Oxides, monoterpenes, ketones,
Antimicrobial, antifungal, antimicrobial
d,e,k
X
o
Level M , Level X
& leaf, steam distillation)
alcohols, sesquiterpenes X
d
C X
p
Note. Adapted from “AACN levels of evidence: What's new?” by Armola, R. R., Bourgault, A. M., Halm, M. A., Board, R. M.,
Bucher, L., Harrington, L., …, Medina, J., 2009, Critical Care Nurse, 29(4) pp.70–73.
Cavanagh and Wilkinson (2005), Prashar, Locke, and Evans (2004), and Woronuk, Demissie, Rheault, and Mahmoud (2011).
Cavanagh and Wilkinson (2002), Denner (2009), Price and Price (2007), Daferera et al. (2000), and Roller et al. (2009). X
Barceloux (2009). X
Wu et al. (2010). X
Level C – Qualitative studies, descriptive or correlational studies, integrative reviews, systematic reviews or randomized controlled trials with
inconsistent results.
separate central venous and left femoral
lines (CVL) that totaled arteries, which also
Initially all burns were dressed in the ED with
50 CVL days and two required more than
Silvadene™, Adaptic ™, Kerlix™, and secured with
different arterial lines aver-age dressing
Se Pro Net™. Facial burns were dressed with an
for 30 arterial days. changes because of
antibiotic ointment (Bacitracin™). Vascular access
Three of the CVL's contamination with
was established and fluid replacement was started
were located in her liquid stool.X
using the Parkland Re-suscitation Formula ( Baxter, right and left internal
1978; Fakhry et al., 1995). Upon admission to the jugular veins (IJ),
PICU, a Foley catheter and Nasogastric tube (NG) which necessitated Initial pain management
were placed. Nutritional therapy was initiated on day numerous unplanned included continuous
2, through the NG tube. Kesha was treated in the dressing changes drips of Morphine and
Operating Room (OR) on 10 separate days for because of weeping Midazolam, with
debridement, tangential excisions, dressing changes, wounds, emesis, and intermittent doses of
and skin grafts. While in the PICU, bedside dressing movement. The arterial Lorazepam. Using the
changes occurred as indicated. Kesha had five lines were in her right FLACC pain scale, by
Day 3, Kesha's pain scores were recorded at an 8 left knee and all lines grafts did not take at all.
(possible range 1–10, with 10 as the highest amount were replaced. Days 10 The WBC's elevated to
of pain) ( Merkel et al., 1997) and treated with a through 13 Kesha 3
22.1 (10 /μL) and
received a Pentobar-
continuous drip of Dexmedetomidine (see Fig. 1). bital drip for sedation followed an up and
down pattern over the
General anesthesia was used for all OR procedures. because she had been
Pain management for bedside dressing changes thrashing in bed and next fewX
included intravenous Fentanyl and Propofol doses. disrupting her grafts,
Pain scores averaged 4.8 throughout the PICU stay preventing them from
(see Fig. 1). At the end of the fourth week, a healing. On day 13,
Kesha had a positive
Methadone wean was initiated to help with
withdrawal issues. Then Kesha was slowly weaned urine culture (see Fig.
off her continuous drips and started on a patient 3) for Candida
controlled analgesia pump (PCA) of Morphine. The tropicalis, which is
following week the PCA was switched over to oral considered to be a
Roxicet and Kesha was able to communicate with catheter-associated
staff and start oral feeds.X urinary tract infection
(CAUTI) (see Fig. 4),
and fluconazole was
A temperature spike was noted on day 7 (see Fig. 2) started. On day 18 a
with a maxi-mum of 40.3 °C and white blood cell second CAUTI de-
counts (WBC's) were starting to trend upward. veloped for yeast, at
Streptococcus Viridians grew from an endotracheal this point she was
cul-ture (ETT) and Unasyn™ was started for switched to a 10 day
coverage (see Fig. 3). DuringX course of Micafungin
(see Figs. 3 & 4). A
graft check in the OR
the remainder of the PICU stay, temperatures
occurred on day 21 and
consistently stayed in the 39–41 °C range. On day 10
revealed the grafts over
she was taken to the OR for graft checks. The
her right shoulder and
findings were a successful graft take to 60% of the
axilla did not take at all.
anterior chest and abdomen, 100% to the left upper
She had several other
thigh, and 70% to the right arm. There was an area of
areas on the right chest Fig. 1. Daily high FLACC
burns to bilateral lower extremities with recurrent es-
and the right upper pain score.
char. Quantitative cultures were taken of the right and
extremity where the
Following Journal of (2017),
Traumatic Pediatric
Please cite this article as: Jopke, K., http://dx.doi.org/10.1016/j.pedn.20
Burn Injury: A Nursing
et al., Use of Essential Oils 16.12.018X
Case Study,
4 K. Jopke et al. / Journal of Pediatric Nursing xxx (2017) xxx–xxx
g
.
4
.
H
o
s
pi
ta
l
a
c
q
ui
re
d
c
o
n
di
ti
o
n
s.
F
i
Fig. 2. Highest daily temperature.
dressing changes
occurred daily un-
days. A tracheal aspirate from
less she was in the
day 26 was positive for
methicillin resis-tant OR.X
Staphylococcus aureus
(MRSA), as well as an
Maria had 2 central
arterial and central ve-nous
venous lines (CVL)
line (CVL) culture from day
in her right and left
28 which were positive for
IJ for a total of 74
yeast. This was considered as
days and 7 days
a central line associated blood
respectively, as
stream infection (CLABSI)
well as a right
(see Figs. 3 & 4). femoral arte-rial
Vancomycin and Micafungin line for 18 days. It
were started for a 10 day should be noted
course. On day 33 a CLABSI that the arterial line
for Candida parapsilosis did not have
showed up on a blood culture
from the CVL (see Figs. 3 &
4). A third course of
Micafungin was initiated. On
day 34 Kesha had a positive
culture from a nasal swab for
MRSA (see Figs. 3 & 4). On
day 40, she developed anoth-
er infection from the CVL
that was positive for
Providencia Rettgeri (see
Figs. 3 and 4). A course of
Ciprofloxacin was
administered for 10 days.
Kesha was transferred to the
general floor on day 41 and
remained hos-pitalized for an
additional 41 days.X