Bromelain-based enzymatic burn debridement: Spanish multidisciplinary consensus
Jordi Serracanta, Jacinto Baena, J.R. Martínez-Méndez, Manuel Sánchez-Sánchez, Eugenia Lopez-Suso, Rita Galeiras, María Dolores Pérez-Del-Caz, Carmen Vivo-Benlloch, Enrique Monclus-Fuertes, Jacobo Casalduero-Viu, Patricia Martin-Playa, Marta Ugalde-Gutierrez, Purificación Gacto-Sánchez, Maria Dolores Rincon-Ferrari, José María Piqueras-Pérez, Ana Isabel Martín-Luengo
Abstract
Abstract Background Bromelain-based enzymatic debridement is gaining increased interest from burn specialists in the last few years. The objective of this manuscript is to update the previous, first Spanish consensus document from 2017 (Martínez-Méndez et al. 43:193–202, 2017), on the use of enzymatic debridement with NexoBrid ® in burn injuries, adding the clinical experience of a larger panel of experts, integrating plastic surgeons, intensivists, and anesthesiologists. Methods A consensus guideline was established by following a modified Delphi methodology of a 38-topic survey in two rounds of participation. Items were grouped in six domains: general indication, indication in critical patients, pain management, conditions for NexoBrid ® application, NexoBrid ® application technique, and post-debridement wound care. Results In the first round, experts established consensus (strongly agree or agree) on 13 of the 38 statements. After the second round, a consensus was reached on 24 of the 25 remaining statements (97.2%). Conclusions The present updated consensus document provides recommendations on the use of bromelain-based enzymatic debridement NexoBrid ® , integrating the extensive clinical experience of plastic surgeons, intensivists, and anesthesiologists in Spain. Further clinical trials and studies are required to corroborate, modify, or fine tune the current statements. Level of evidence: Not ratable