486 The Role of Burn Rehabilitation on Burn Patients Receiving Extracorporeal Membrane Oxygenation
Bibliographic record
Abstract
Recent use of Extracorporeal Membrane Oxygenation (ECMO) in burn patients with severe respiratory failure results in an increased risk for physical and cognitive impairments post-treatment. There is growing evidence that early mobility of patients receiving ECMO improves physical function and reduces health care utilization. Burn rehabilitation has been shown to increase quality of life of burn patients. However, early burn resuscitation with ECMO has special considerations of high volume fluid resuscitation, escharotomies, wound care, and coagulopathy. There is no research examining burn rehabilitation for these patients. The purpose of this case study is to review outcomes from physical therapy (PT), occupational therapy (OT), and speech therapy (ST) sessions with a burn patient receiving ECMO in a hospital setting. A 40-year-old male sustained 33% TBSA partial and full thickness burns to his face, neck, arms, hands, and legs due to a propane explosion. VV ECMO was needed for 13 days (day 6 cannulation) for acute respiratory failure from ventilator associated pneumonia. The 55 day hospitalization was complicated by acute kidney injury, atrial fibrillation, and glottal stenosis. Surgical grafting was needed upon admit, but was not indicated post ECMO. He participated in 64 therapy sessions, including range of motion (ROM), splinting, positioning, mobility, ADLs, swallowing, voice, and cognitive therapy. The CAM-ICU was negative for delirium. Montreal Cognitive Assessment score was 22/30, identifying mild cognitive impairment. The Activity Measure for Post-Acute Care (AMPAC) Daily Activities score was 6/24 at OT evaluation and 22/24 at discharge. AMPAC Mobility score was 5/20 at PT evaluation and 17/20 at discharge. His neck and arm joints were not at baseline ROM. He resumed a normal diet, but remained tracheostomy dependent at discharge. Due to the unique circumstances of burn patients receiving ECMO, burn therapists must work closely with multidisciplinary teams. These patients are at increased risk for deconditioning due to longer bedrest, anoxic cognitive deficits, higher risk of scarring and contractures due to delayed wound closure, prolonged edema, oropharyngeal complications, and increased hospital stay. This case study demonstrates the feasibility for PT, OT, and ST to provide specific therapeutic interventions with patients receiving ECMO and burn care. There is a need to look further into appropriate outcome measures for therapy interventions, as well as long term physical and cognitive impairments. Burn therapists have a specialized role in treating burn patients receiving ECMO by considering unique patient impairments and adapting therapeutic interventions.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".