The microcirculation in burned patients' skin has been studied on day 3 after the accident with Laser Doppler Flowmetry (LDF). A schedule for interpretation of LDF values has been designed.

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Objective:To determine the safety and possible efficacy of diaspirin cross-linked hemoglobin (DCLHb) in the treatment of patients in Class II–IV hemorrhagic, hypovolemic shock.Design:Multicenter, randomized, normal saline-controlled, dose-escalation study.Setting:Eleven hospitals in the U.S. and Belgium.Subjects:One hundred and thirty-nine (139) hospitalized patients with Class II–IV hemorrhagic, hypovolemic shock within the previous 4 hours who still were requiring therapy for shock.Interventions:Beginning with the lowest dose, patients were randomized to receive 50,100, or 200 mL of either 10% DCLHb or normal saline infused intravenously over 15 minutes. Following infusion of either treatment, further fluid resuscitation could be given, as necessary, to maintain perfusion. Vital signs, laboratory assessments, blood and fluid administration, complications, and adverse events were recorded at various times from the end of infusion through 72 hours after infusion.Results:A total of 29 (13 DCLHb- and 16 saline-treated) patients died during the study period. Adverse events were experienced by 61% of patients in the DCLHb group and 53% of patients in the saline group; serious adverse events occurred in 28% of DCLHb-treated patients and 30% of saline-treated patients. The incidence of prospectively defined, clinical complications, including renal insufficiency and renal failure, was similar between the treatment groups except for the occurrence of dysrhythmias/conduction disorders, which occurred significantly more frequently in the saline-treated patients than the DCLHb-treated patients (p = 0.041). At the highest dose level (200 mL), statistically significant between-group differences were observed with greater increases in serum amylase, LDH, the isoenzymes LD1,2,4 and 5, and CK-MB in the DCLHb group compared to the control group; none were of clinical significance. The volume of blood administered did not differ between the groups. Overall 24- and 72-hour survival rates were similar between treatment groups, although the hospital discharge rate was slightly higher in the DCLHb-treated patients (80%) compared with the saline-treated patients (74%).Conclusion:Administration of 50 to 200 mL of DCLHb to patients in hemorrhagic, hypovolemic shock was not associated with evidence of end organ toxuity or significant adverse events. Further studies involving larger doses and, perhaps, earlier administration of DCLHb are warranted.

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Summary Muscular microcirculation was studied in seven halothane anaesthetised horses in lateral recumbency using a laser Doppler flowmeter. A significant difference between the dependent and the uppermost triceps brachii was recorded. In the dependent muscles, microflow at first decreased and then increased up to the starting value. In the uppermost muscles, a significant rise of the microflow was measured.

Laser Doppler Flowmetry (LDF) is a new noninvasive technique by which microcirculation changes in tissue can be studied. This has been done in a Burns Unit on burned as well as non-burned patients (volunteers). There were no infection problems with this device in a Burns Unit. Four kHz was the upper wave length limit analysing the doppler signal from burns. A topical temperature load test was defined and used in different situations. Homogeneous flows in reference points from a control group were demonstrated in unheated and heated skin, in this way standardizing the LDF analyses of skin microflow. Ability of LDF to define different degrees of burns was demonstrated.

The cardiovascular function of horses was less depressed during anaesthesia with isoflurane than during anaesthesia with halothane. Muscular microcirculation measured by laser Doppler flowmetry was significantly greater in horses anaesthetised with isoflurane.

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