Effect of Intravenous Fluid Volumes on the Adrenal Glucocorticoid Response After Burn Injury in Swine

Journal of Burn Care & Research : Official Publication of the American Burn Association
Belinda I GómezDavid M Burmeister

Abstract

Severe thermal injury induces metabolic and physiological stress, prompting a disruption in the hypothalamic-pituitary-adrenal axis. The objective of this study was to evaluate potential confounding effects of Lactated Ringer's (LR) resuscitation on adrenal damage and cortisol production following burn. Anesthetized swine were instrumented with jugular catheters and sustained 40% TBSA burns from brass probes heated to 100°C. Animals recovered to consciousness and received IV fluid resuscitation with LR at two different volumes: 15 ml/kg/d (limited volume [LV], n = 6) or 2 ml/kg/%TBSA/d (modified Brooke [MB], n = 6). Nonburned animals (Sham) were both oral and IV fluid restricted (S-FR, n = 4) to induce stress. Computed tomography (CT) angiographies were performed at baseline (BL) and 48 hours postburn, while blood and urine samples were collected at BL, 6, 24, and 48 hours postburn, with euthanasia at 48 hours for adrenal harvesting. Urinary cortisol was elevated following burn/surgery in all animals and returned back to BL in S-FR (404 ± 48 pg/mg creatinine) but not MB (1332 ± 176 pg/mg creatinine; P = .005) or LV (1223 ± 335 pg/mg creatinine; P = .07) by 48 hours. Gene expression of cleavage enzymes (3β-HSD, CYP17, CYP11, and...Continue Reading

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Oct 28, 2019·Shock·Matthew K McIntyreDavid M Burmeister
Jun 1, 2021·Journal of Burn Care & Research : Official Publication of the American Burn Association·Tiffany C HeardDavid M Burmeister

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