The Effect of thermal injury and its Management on Systemic Vascular Endothelial Permeability Dysfunction and Tissue Perfusion

• Main Author: Vlachou, Evangelia
• Published: University of Birmingham 2007
• Subjects: 616.5
• Online Access: http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.487479

This is the first attempt at evaluating the systemic endothelial damage/capillary leak following human thermal injury. This was quantified by Microalbuminuria, an immunoassay method for measuring traces of albumin in the urine, expressed as the Albumin Creatinine Ratio (ACR). ACR showed a significant correlation with the proportion of full-thickness burn, inhalation injury, alcohol intoxication and accelerant involvement. The variability in endothelial response to thermal injury between patients is not addressed by standard resuscitation formulae. The initial post-burn ACR was a sensitive predictor of the difference between resuscitation fluid volume predicted and that actually required in the first 24 hours post-injury. Exacerbations of capillary leak occur during post-burn surgical intervention, vary with timing of surgery and are higher in the presence of complications. The potential benefit ofcolloid supplementation in burns resuscitation was assessed. Patients randomised to receive supplemental 6% Hydroxyethylstarch, required smaller resuscitation fluid volumes and demonstrated less total body fluid retention during the first 24 hours post-burn. Tissue perfusion (known to be critical in this injury model) was also studied. Subcutaneous tissue oxygen tension correlated with post-burn ACR. Gastric pH monitoring revealed a degree ofgastric hypoperfusion and predicted physiological patient deterioration before the disturbance of traditional haemodynamic parameters.