Acute respiratory distress syndrome is as important as inhalation injury for the development of respiratory dysfunction in major burns

Steinvall, Ingrid; Bak, Zoltán; Sjöberg, Folke

doi:10.1016/j.burns.2007.10.007

Cited by 70 publications

(46 citation statements)

References 45 publications

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“…The impressively large and fast changes in white blood cell (WBC) count after burns may reflect an early release of leucocytes from the bone marrow and subsequent trapping of leucocytes in the vessels of the lung and other vascular beds. In an earlier study we examined ARDS and inhalation injury during the first week after a burn and found a correlation between changes in the WBC count and the development of respiratory failure, as measured by the Murray lung injury score [9], during this period [6]. A similar effect has also been reported in studies of trauma other than burns [10][11].…”

Section: Introductionsupporting

confidence: 49%

“…Although paralleled by similar studies in trauma from other causes [10][11], and one earlier study from our group on burns [6], this study is to our knowledge the first to show it with the actual measured PVPI and with a high temporal resolution for the dynamics of WBC count during the important first 24-hour period. By looking at these phenomenons in the timeframe within 24 hours it is reasonable to believe that the changes in measured variables are induced by the burn itself (not by the subsequent surgical procedures and not from infections).…”

Section: Discussionmentioning

confidence: 52%

“…Polymorphonuclear cells sampled from burned patients are systemically activated [3][4][5] and the total leucocyte count is increased within a few hours after a burn but return to low normal or subnormal levels within 24 (-48) hours [6][7][8]. The impressively large and fast changes in white blood cell (WBC) count after burns may reflect an early release of leucocytes from the bone marrow and subsequent trapping of leucocytes in the vessels of the lung and other vascular beds.…”

Section: Introductionmentioning

confidence: 99%

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Alteration of Leukocyte Count Correlates With Increased Pulmonary Vascular Permeability and Decreased PaO2

Johansson

Steinvall

Herwald

et al. 2015

Journal of Burn Care & Research

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Leucocytes are activated systemically and their numbers increase soon after a burn followed by a rapid decline to low normal or subnormal levels, possibly by increased extravasation. Experimental data supports that an important target for such extravasation is the lungs and that leucocytes when they adhere to endothelial cells cause an increase in vascular permeability. We investigated a possible relation between early increased pulmonary vascular permeability or a decreased PaO2:FiO2-ratio and the dynamic change in concentration of blood leucocytes after a burn. This is a prospective, exploratory, single-centre study. We measured the dynamic changes of leucocytes in blood starting early after the burn, pulmonary vascular permeability index (PVPI) by thermodilution, and PaO2:FiO2-ratios in 20 patients during the first 21 days after a major burn (>20% total burn surface area %).Median total burn surface area was 40% (IQR 25-52) and full thickness burn 28% (IQR 2-39). There was a correlation between the early (<24 hours) alteration in white blood cell count and both early increased pulmonary vascular permeability (r=0.63, p=0.004) and the decreased oxygenation index defined as PaO2:FiO2<27kPa (p=0.004).We have documented a correlation between dynamic change of blood leucocytes and pulmonary failure early after burns.

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Section: Introductionsupporting

confidence: 49%

Section: Discussionmentioning

confidence: 52%

Section: Introductionmentioning

confidence: 99%

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Alteration of Leukocyte Count Correlates With Increased Pulmonary Vascular Permeability and Decreased PaO2

Johansson

Steinvall

Herwald

et al. 2015

Journal of Burn Care & Research

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“…Increased serum IL-6 is linked to poor survival in patients with acute respiratory distress syndrome (ARDS) (34), although whether IL-6 plays a causative role or is simply a marker of mortality risk remains to be conclusively demonstrated. Similarly, alcohol abuse is also associated with a worsened ARDS prognosis (56) and is a common complication after a thermal injury (50). ARDS is characterized by inflammation and edema in the lung parenchyma, leading to impaired gas exchange.…”

Section: Discussionmentioning

confidence: 99%

An alteration of the gut-liver axis drives pulmonary inflammation after intoxication and burn injury in mice

Chen

Zahs

Brown

et al. 2014

American Journal of Physiology-Gastrointestinal and Liver Physi

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imately half of all adult burn patients are intoxicated at the time of their injury and have worse clinical outcomes than those without prior alcohol exposure. This study tested the hypothesis that intoxication alters the gut-liver axis, leading to increased pulmonary inflammation mediated by burn-induced IL-6 in the liver. C57BL/6 mice were given 1.2 g/kg ethanol 30 min prior to a 15% total body surface area burn. To restore gut barrier function, the specific myosin light chain kinase inhibitor membrane-permeant inhibitor of kinase (PIK), which we have demonstrated to reduce bacterial translocation from the gut, was administered 30 min after injury. Limiting bacterial translocation with PIK attenuated hepatic damage as measured by a 47% reduction in serum alanine aminotransferase (P Ͻ 0.05), as well as a 33% reduction in hepatic IL-6 mRNA expression (P Ͻ 0.05), compared with intoxicated and burn-injured mice without PIK. This mitigation of hepatic damage was associated with a 49% decline in pulmonary neutrophil infiltration (P Ͻ 0.05) and decreased alveolar wall thickening compared with matched controls. These results were reproduced by prophylactic reduction of the bacterial load in the intestines with oral antibiotics before intoxication and burn injury. Overall, these data suggest that the gut-liver axis is deranged when intoxication precedes burn injury and that limiting bacterial translocation in this setting attenuates hepatic damage and pulmonary inflammation.

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“…The systemic change in vascular permeability sets in early after a burn, and is maintained during the first 24-48 hours [29]. We therefore suspected that a mediator of systemicallyincreased permeability would be detected early, and within 48 hours it would also decrease to the normal range or close to it.…”

Section: Discussionmentioning

confidence: 99%

Urinary excretion of histamine and methylhistamine after burns

Johansson

Bäckryd

Granérus

et al. 2012

Burns

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Acute respiratory distress syndrome is as important as inhalation injury for the development of respiratory dysfunction in major burns

Cited by 70 publications

References 45 publications

Alteration of Leukocyte Count Correlates With Increased Pulmonary Vascular Permeability and Decreased PaO2

Alteration of Leukocyte Count Correlates With Increased Pulmonary Vascular Permeability and Decreased PaO2

An alteration of the gut-liver axis drives pulmonary inflammation after intoxication and burn injury in mice

Urinary excretion of histamine and methylhistamine after burns

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