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continued. Agreement/diagnostic accuracy between the laser doppler imaging outcome/healing potential category and spontaneous healing/skin grafting.
Source publication
Background
Accurate estimation of burn depth is crucial for correct treatment decision making. Bromelain-based enzymatic debridement (ED) may improve clinical assessment of burn depth. Laser Doppler imaging (LDI) provides a valuable indicator of burn depth by analyzing microcirculation within tissue beds. This study aimed to evaluate bromelain-base...
Citations
... Bromelain is a viable alternative to surgical escharotomy for deep burns [47]. In fact, prompt removal of necrotic tissue leads to better spontaneous healing or better graft application, reducing the risk of infection and improving patient survival [71]. Infection is the leading cause of death in burn patients, especially in children, due to the compromised skin barrier. ...
... Infection is the leading cause of death in burn patients, especially in children, due to the compromised skin barrier. In addition, the risk of infection persists until necrotic tissue remains [71]. Therefore, early eschar debridement within 24 h of the burn significantly reduces the risk of bacterial colonization and infection, especially in pediatric patients. ...
... However, this procedure can be associated with several complications, such as profuse bleeding with hemodynamic disturbances [72] or excision of the fascia, leading to significant skin deformity. Therefore, non-surgical eschar removal (abrasive techniques, hydrosurgery, or enzymatic debridement) is useful to minimize the risks associated with this procedure [71]. Claes et al. [72] found that a bromelain-based debridement agent can selectively remove the necrotic eschar while preserving viable dermal tissue and appendages in the wound bed in deep partialor full-thickness margins; this results in spontaneous re-epithelialization and improved aesthetic and functional outcomes, especially when compared to tangential excision. ...
Bromelain is a complex natural mixture of sulfhydryl-containing proteolytic enzymes that can be extracted from the stem or fruit of the pineapple. This compound is considered a safe nutraceutical, has been used to treat various health problems, and is also popular as a health-promoting dietary supplement. There is continued interest in bromelain due to its remarkable therapeutic properties. The mechanism of action of bromelain appears to extend beyond its proteolytic activity as a digestive enzyme, encompassing a range of effects (mucolytic, anti-inflammatory, anticoagulant, and antiedematous effects). Little is known about the clinical use of bromelain in pediatrics, as most of the available data come from in vitro and animal studies, as well as a few RCTs in adults. This narrative review was aimed at highlighting the main aspects of the use of bromelain in children, which still appears to be limited compared to its potential. Relevant articles were identified through searches in MEDLINE, PubMed, and EMBASE. There is no conclusive evidence to support the use of bromelain in children, but the limited literature data suggest that its addition to standard therapy may be beneficial in treating conditions such as upper respiratory tract infections, specific dental conditions, and burns. Further studies, including RCTs in pediatric settings, are needed to better elucidate the mechanism of action and properties of bromelain in various therapeutic areas.
... 57,66,67 Schulz et al. in a study with 40 patients with hand burns found superior outcomes post-BBD in burn depth evaluation, tissue preservation, completeness of debridement, and wound closure. 68 Although Laser Doppler Imaging (LDI), 69,70 and ultrasound for assessing skin thickness 71 may be helpful, subjective clinical inspection of the remaining dermal elements is the standard method for assessing the post-enzymatically debrided wound bed. ...
In 2012 the European Medicines Agency approved a pineapple stem-derived Bromelain-based debridement concentrate of proteolytic enzymes (NexoBrid®, MediWound Ltd, Yavne, Israel) for adult deep burns. Over 10 000 patients have been successfully treated with NexoBrid® globally, including in the US. The aim of our study is to perform a systematic review of the current literature on Nexobrid® outcomes. We conducted a literature search in PubMed, Google Scholar, Embase, and other search engines (2013-2023). The online screening process was performed by two independent reviewers with the Covidence tool. The protocol was reported using the Preferred Reporting Items for Systematic Review and Meta-Analyses, and it was registered at the International Prospective Register of Systematic Reviews of the National Institute for Health Research. We identified 103 relevant studies of which 34 were found eligible. The included studies report the positive effects of Nexobrid® on burn debridement, functional and cosmetic outcomes, scarring, and quality of life. Also, they validate the high patient satisfaction thanks to enhanced protocols of analgosedation and/or locoregional anaesthesia during Bromelain-based debridement. Two studies investigate potential risks (coagulopathy, burn wound infection) which concluded there is no strong evidence of these adverse events. NexoBrid® is a safe, selective, non-surgical eschar removal treatment modality. The benefits of Bromelain-based debridement are faster debridement and healing times, reduced operations, length of stay, cases of sepsis, blood transfusions, and prevention of compartment syndrome. Existing evidence suggests that the indications and the role of Bromelain-based debridement are expanding to cover "off-label" cases with significant benefits to the global healthcare economy.
