The authors are quite correct that an air-fluidized bed increases evaporative water loss in patients with toxic epidermal necrolysis (as it does in all patients and even in normal subjects). We also pointed out in our JAMA communication that evaporative loss can increase to 5 or 6 L/d. The Xenograft (biologic dressing) that we have used acts well as a vapor barrier (perhaps the collagen film suggested by the authors would also), so that evaporative losses are generally not as high as suggested by the authors. This sort of treatment does, however, require careful monitoring of fluid and electrolyte balance in these very sick patients. Hypothermia is a constant danger, not so much because of the evaporative water loss but because of the inability of the patient to maintain cutaneous homeostasis. While I have no proprietary interest in the air-fluidized bed (having tried several different beds), in our hands an air-fluidized bed
Heimbach DM. Severe Hypothermia Occurring During the Course of Toxic Epidermal Necrolysis in Patients Treated With Air-Fluidized Beds-Reply. Arch Dermatol. 1991;127(5):739–740. doi:10.1001/archderm.1991.01680040151023
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