MEBO is a topic drug specialized for treating burns and wounds by regenerating skin in vivo and in situ with residue of the tissues and cells post–burn so as to replace the skin-grafting therapy.  

However, the clinical efficacy of MEBO is very dependent on the protocols and procedures of local wound management and systemic treatment for burn patients.  

The protocols are called Moist Exposed Burn Treatment, say MEBT.  

Under the coordination of MEBT systemic protocols, MEBO is to realize the skin regeneration in vivo and in situ.  The correct implement level of the application of the technique and medicine determines how much of the pharmaceutical effects of MEBO can be bring into full play.
 
The basic procedure included in systemic treatment of burns is the same as the systemic support treatment in surgical treatment of burns.  While, their differences allow MEBT to have its special characters and requirements:

1. Anti-shock Therapy

• Compositions of Fluid Infusion: The ratio of crystalloid solution (normal saline or 5% GNS) to colloid solution should be 1:1. The colloid solution should be composed of 3/4 parts of plasma and 1/4 part of whole blood when condition allows, otherwise 1/2 part of plasma and 1/2 part of plasma substitute can be used.
• Amount of fluid infusion: According to the basic principles of surgery, the amount of fluid infusion should be equal to the amount of body deficiency. In shock stage of massive burn patients (during 48 ~ 72 hours after injury) we offer a more detailed formula:

• Speed of fluid infusion: During the first 24h postburn, 1/2 of total fluid amount should be infused in the first 8h, another 1/2 amount should be infused over the next 16h evenly, with regard to cardiac and renal functions. During the second 24h postburn, all of the fluid should be infused at a uniform speed. During the third 24h after injury, the amount and speed of fluid infusion must be determined strictly in the light of the symptoms of shock and the amount of urine. When the symptoms of shock are improved remarkably or disappeared, and the amount of urine is over 1ml/h*kg, the speed of fluid infusion should be decreased and the fluid amount should be reduced by 1/3.

2. Support treatment for every system

• Protection and enhancement of cardiac function.  The severely burned patients should be intravenously injected with cedilanid after injury or admission. Then, the amount and frequency of cedilanid should be regulated according to the changes in heart rate and peripheral circulation.
• Protection of Renal Function.  Routinely apply comprehensive diuresis agents to improve renal microcirculation and relieve spasm of microvessel in renal parenchyma.
• Protection of digestive system.  To prevent stress ulcers, eat food at early time, supplement nutrition through gastro-intestine and apply gastric mucous protectant and anti-acids i.e.
• Keep equilibrium of body fluid.  The amount of fluid infusion for the burn patients suffered >50% TBSA should be initially BID in response to physiologic demand. Subsequently, the amount of fluid infusion should be modified in response to changes of urine volume and shock symptoms. The range of increase or decrease in fluid infusion should not be greater than 10% of total volume.
• Regulation of Body Temperature.  Many factors could affect the temperature of burn patients.  Therefore, the reason for temperature variation must be diagnosed clearly and corresponding treatments should be given to patients to keep their normal body metabolism.

• Protective Treatment of Multi-Organs Function.  ①. The consequences of all treatment protocols on internal organs in shock stage should be re-examined. ②. Stop applying any drug that is harmful to the healthy function of heart, lungs, kidneys, liver, digestive tract and other organs. ③. Stop applying any drug that is detrimental to the synthesis of protein. ④. To ensure adequate energy supplement, reduce all factors predisposing to catabolism. …. To apply some drugs temporarily, which can protect the functions of liver, kidneys, digestive tract and other organs.

 
3. Anti-infection Therapy

A. Principles of Anti-infection Treatment

• Routine treatment: Burn patients with <30% TBSA generally do not need to be treated with systemic antibiotics. All the burn patients with >30% TBSA (>10% TBSA in children) must be treated with systemic anti-infection routinely no matter infection happened or not.
• Expectant Treatment. In order to prevent and treat secondary infection and routine infection, the prophylactic antibiotic protocol should be administrated. However, it is very important to rule out inflammatory and noninfectious etiologies initially. Indications for antibiotic use: Three clinical manifestations must occur simultaneously: body temperature >39.5 ℃ or < 36.0 ℃; heart rate > 140/min; toxic granules in neutrophil leukocytes. Clinical vigilance is required.

B. Profile for treatment

• Routine treatment.  To apply one or more powerful broad-spectrum i.v. or i.m. antibiotics as early as possible after injury until 5th~ 7th day for massive deep second-degree burns and 7th~ 10th day for massive III-degree burns.
• Expectant Treatment. One single dose of one or more powerful broad-spectrum renal-sparing antibiotics should be applied. It may be repeated until examination reveals that the neutrophilic toxic granules are no longer present. The patients should be examined for secondary infection sites and treated appropriately.

4. Nutritional Support Treatment

The principles of nutritional support treatment in Burns Regenerative Therapy (MEBT/MEBO) are basically the same as the principle of supporting treatment of traumatic surgery. However, the supplementary amounts of total energy and protein for MEBT/MEBO are significantly greater and of longer duration as compared with general traumatic patients. 

• Recommend nutritional support from the 4th to the 8th day after injury.

• After shock stage, it is optimal to take food by mouth as soon as possible as nutrition supply through the digestive tract is encouraged.
• Daily caloric requirement of burn patients (kcal) = (24(kcal/kg)×body weight (kg) + 40(kcal)×TBSA) ×6.8.
• During wounds repairing phase, protein is mainly provided.

The supplementation of protein and energy is better provided through gastrointestinal tract.