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BROMELAIN-ENRICHED PROTEOLYTIC ENZYMES CONCENTRATE TREATMENT IN PATIENTS WITH EXTENSIVE BURNS: UPDATED ROMANIAN CONSENSUS

SILVIU ADRIAN MARINESCU ^1,11, TIBERIU PAUL NEAGU ^2,11, ZORIN PETRISOR CRAINICEANU ^3,12, RALUCA TEODORA TATAR ^4,11*, MIHAELA PERTEA ^5,13, SORIN VIOREL PARASCA ^6,11, MARIUS EUGEN CIUREA ^7,14, FLORIAN DOREL BODOG ^8,15, ANA MARIA OPROIU ^9,11, EUGEN GABRIEL TURCU ^1,11, ANA MARIA STEFANESCU ¹, MIRELA TIGLIS ^2,11 , PANCHE TASKOV ³, RALUCA MIHAELA ALEXANDRU ⁴, DOINA IULIA NACEA ^4,11, ILEANA CARMEN BOIANGIU ⁶, MILENA GEORGESCU ⁷, GEORGIANA ALBINA VIERIU ⁸, MIHAELA IULIANA ZAHARIA ⁹, LAURA RADUCU ^10,11 , CRISTIAN RADU JECAN ¹⁰,11

1 “Bagdasar-Arseni” Clinical Emergency Hospital, Bucharest, Romania
² Bucharest Clinical Emergency Hospital, Bucharest, Romania
³ “Pius Brinzeu” County Emergency Hospital, Timișoara, Romania
⁴ “Grigore Alexandrescu” Children’s Emergency Hospital, Bucharest, Romania
⁵ “Saint Spiridon” County Emergency Hospital, Iași, Romania
⁶ Plastic, Reconstructive and Burn Surgery Hospital, Bucharest, Romania
⁷ Emergency County Hospital, Craiova, Romania
⁸ Bihor County Emergency Hospital, Oradea, Romania
⁹ Emergency University Hospital, Bucharest, Romania
¹⁰ “Agrippa Ionescu” Emergency Hospital, Bucharest, Romania
¹¹ “Carol Davila” University of Medicine and Pharmacy, Faculty of Medicine, Bucharest, Romania
¹² “Victor Babeș” University of Medicine and Pharmacy, Faculty of Medicine, Timișoara, Romania
¹³ “Grigore T. Popa” University of Medicine and Pharmacy, Faculty of Medicine, Iași, Romania
¹⁴ University of Medicine and Pharmacy of Craiova, Faculty of Medicine, Craiova, Romania
¹⁵ University of Oradea, Faculty of Medicine, Oradea, Romania

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Enzymatic debridement (ED) has emerged as a crucial method in the treatment of burns, particularly for managing mixed- depth burns. Enzymatic debridement was first introduced in Romania in 2015, and the initial national consensus followed in 2021. This revised consensus encapsulates the shared knowledge of Romanian experts and seeks to optimise its use in clinical practice. A consensus guideline was established through a modified Delphi process, comprising 46 statements on the application of ED in burn management. A multidisciplinary team representing 10 Romanian burn facilities discussed these statements. Consensus was established when at least 80% agreement was reached among the experts. The panellists reached agreement on all statements: 38 statements reflected a firm consensus of 100%, 5 a 90% consensus and 3 an 80% consensus. The recommendations issued by the Romanian consensus panel provide updated guidelines for enzymatic debridement in burn surgery that draw on the Romanian experience and the current scientific literature on the subject. These guidelines, alongside the previous consensus, can be regarded as a national reference protocol on enzymatic debridement.