Wound infections and
sepsis are significant causes of morbidity after
burn injury and can be alleviated by early excision and grafting. In situations that preclude early surgery, topical agents allow for a safer delay.
Cerium nitrate compounded with
silver sulfadiazine (Ce-
SSD) is a
burn cream that provides broad antibacterial activity, forms a temporary barrier, and promotes re-epithelialization.
Methemoglobinemia is a rare, but oft-cited, systemic complication of Ce-
SSD. In this retrospective review, 157 patients treated with Ce-
SSD between July 2014 and July 2018 were identified, and the monitoring protocol for
methemoglobinemia during Ce-
SSD treatment was evaluated. The median age was 59 years (interquartile range [IQR], 47-70.5 years), with TBSA of 8.5% (IQR, 3-27), adjusted Baux score of 76 (IQR, 59-94), and inhalation injury present in 9.9% of patients. Primary endpoints included incidence of symptomatic and asymptomatic
methemoglobinemia. Of the 9.6% (n = 15) of patients with
methemoglobinemia, 73.3% (n = 11) had maximum
methemoglobin levels ≥72 hours from the time of the first application. One patient developed clinically significant
methemoglobinemia. Patients with TBSA ≥20% were more likely to develop
methemoglobinemia (odds ratio 9.318, 95% confidence interval 2.078-65.73, P = .0078); however, neither Ce-
SSD doses nor days of exposure were significant predictors. Ce-
SSD application to temporize
burn wounds until excision and grafting is safe, effective, and, in asymptomatic patients with TBSA <20%, can be used without serial blood gas monitoring. Vigilant monitoring for symptoms should be performed in patients with TBSA ≥20%, but routine blood
gases are not necessary.