Improved markers for burn wound perfusion in the severely burned patient: the role for tissue and gastric Pco2

Journal of Burn Care & Research : Official Publication of the American Burn Association
James C JengM H Jordan

Abstract

Improved markers of resuscitation are needed in patients with severe burn injuries. In previous animal and human work, we showed 1) wound hypoperfusion plays a role in burn depth progression, 2) that there are periods of repetitive ischemia and reperfusion which correlate closely to wound hypoperfusion, and 3) that wound and splanchnic bed CO2 measurements are dependent on the adequacy of resuscitation. We and others believe that current markers for resuscitation, urine output (U/O), and mean arterial pressure (MAP), lag behind in reflecting wound perfusion. In this study, we explore whether gastric and tissue tonometry are better in reflecting minute-to-minute changes in wound perfusion in humans. During the 48-hour experimental period, burn wound, gastric, and arterial pH, Pco2, and PaO2 were measured every 6 seconds using a Paratrend 7 monitor in four patients with life threatening burns. Slopes of change were analyzed and a proportion derived relative to pooled data on 5-minute intervals. Serum lactate, U/O, and MAP were recorded. Laser Doppler Imager (LDI) scans were performed on burn areas every 4 hours, allowing real-time determination of burn perfusion. Resuscitation followed current clinical guidelines. All four patien...Continue Reading

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Citations

Mar 17, 2009·Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine·David J Dries
Jan 12, 2010·Journal of Burn Care & Research : Official Publication of the American Burn Association·Amín D JaskilleJames C Jeng
Sep 26, 2013·The Journal of Trauma and Acute Care Surgery·Allison E BerndtsonSoman Sen
Dec 9, 2009·Advances in Pediatrics·Renata Fabia, Jonathan I Groner

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