Microalbuminuria: A marker of systemic endothelial dysfunction during burn excision

Vlachou, E.; Gosling, Peter; Moiemen, Naiem

doi:10.1016/j.burns.2007.03.021

Cited by 21 publications

(12 citation statements)

References 31 publications

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“…All recruited patients exhibited systemic inflammatory response syndrome, which results in microvascular leakage of plasma proteins and fluid into the interstitium. Furthermore, systemic endothelial dysfunction is exacerbated during burn debridement (20) as a result of localized release of inflammatory factors from manipulated burn tissue (14). Increased areas under the curve for unbound interstitial levels in the nonburnt and burnt tissue sites are also in keeping with prior published observations of increased antibiotic distribution volumes and third-space sequestration seen in patients with severe edema (15,16), an increased extravascular space, and impaired or delayed lymphatic drainage (5).…”

Section: Discussionsupporting

confidence: 77%

Tissue Accumulation of Cephalothin in Burns: a Comparative Study by Microdialysis of Subcutaneous Interstitial Fluid Cephalothin Concentrations in Burn Patients and Healthy Volunteers

Dalley

Lipman

Deans

et al. 2009

Antimicrob Agents Chemother

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Burn tissue sites are a potential source of bacteremia during debridement surgery. Burn injury is likely to affect the distribution of antibiotics to tissues, but direct evidence of this is lacking. The aim of this study was to directly evaluate the influence of burn trauma on the distribution of cephalothin to peripheral tissues. We used subcutaneous microdialysis techniques to monitor interstitial fluid concentrations of cephalothin in the burnt and nonburnt tissues of adult patients with severe burns following parenteral administration of 1 g cephalothin for surgical prophylaxis. Analogous simultaneous studies conducted with healthy adult volunteers provided reference tissue concentration data. Equivalent tissue exposures were seen for burn and nonburn sites, giving overall median interstitial cephalothin concentrations (from 0 to 240 min) of 2.84 mg/liter and 3.06 mg/liter, respectively. A lower overall median interstitial cephalothin concentration of 0.54 mg/liter was observed for healthy individuals, and the patient nonburnt tissue and volunteer control tissue cephalothin concentrations exhibited significantly different data distributions (P < 0.001; Kolmogorov-Smirnov nonparametric test). The duration of tissue residence for cephalothin was longer for burn patients than for healthy volunteers. The results demonstrate the potential fallibility of using healthy population models to extrapolate tissue pharmacodynamic predictions from plasma data for burn patients.

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Section: Discussionsupporting

confidence: 77%

Tissue Accumulation of Cephalothin in Burns: a Comparative Study by Microdialysis of Subcutaneous Interstitial Fluid Cephalothin Concentrations in Burn Patients and Healthy Volunteers

Dalley

Lipman

Deans

et al. 2009

Antimicrob Agents Chemother

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“…Blood is a far more complex tissue and its components are not necessarily lost at the same rate. Epithelial damage, as seen in burns, leads to a rapid consumption of clotting factors (Vlachou et al, 2008;Rahe-Meyer et al, 2009). By transfusing just red cells, or an inadequate ratio of blood products, this problem can be exacerbated (Luddington, 2005).…”

Section: Future Developmentmentioning

confidence: 98%

Burn surgery and blood loss – a review

Brazier

Sheena

Jeffery

2011

Trauma

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Objectives: Blood loss has long been recognised as a significant problem in burn surgery. Efforts have been made in the past to quantify this loss and determine what factors influence it the most. Several researchers have been able to produce and validate formulae that predict the volume of blood loss during excisional surgery. Accurately determining this allows appropriate volumes of blood to be ordered, reducing risk to patients and saving scarce resources. This article reviews the literature on blood loss in burns surgery, including influencing factors, methods of prediction and effective management. Methods: A literature review was conducted to examine methods used to measure, calculate and reduce blood loss in burn surgery. The validity of these methods and the limitations on accuracy will be discussed. Alternative methods shall also be considered. Results: Most current methods of estimating blood loss attempt to determine the volume of erythrocytes required to return haemoglobin concentrations to their pre-operative level. Various formulae have been developed to calculate this volume. Conclusions: Several authors have produced formulae that predict the volume of blood loss to a significant degree of accuracy. Different techniques have been shown to significantly reduce blood loss. In other areas of surgery, thromboelastometry has been used to identify the levels of specific blood component defects. The use of this method in burns surgery could, in the future, help develop a protocol for operative blood transfusion.

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“…procedures cannot be solely attributed to the general anaesthetic itself since the markers of inflammatory stress remained within normal limits in some patients 17 . Systemic endothelial dysfunction has been attributed to the inflammation or bacteraemia that occur after wound manipulation 18 and greater blood loss at excision due to the relative hyperaemia 19 .…”

Section: Discussionmentioning

confidence: 99%

Inflammatory and oxidative stress after surgery for the small area corrections of burn sequelae

Vinha¹,

Jordão²,

Farina³

et al. 2011

Acta Cir. Bras.

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Purpose: To compare vitamin levels, inflammatory and oxidative stress markers before and after skin autograft surgery to correct burn scar areas. Methods: This prospective study was conducted with 8 patients with a median age of 28 years (range, 16 to 40 years) that had burn sequelae and were admitted to a Burn Unit for correction of small burn scar areas [3.3 (1.0-5.0) % of the corporal surface].The volunteers were evaluated before and 48 hours after excision of scar tissue and skin autograft. Routine laboratory data, along with a food questionnaire and anthropometry were collected in the preoperative period. Serum vitamin A, C, E, B 12 and folic acid levels, inflammatory markers (C-protein reactive, alpha-1-acid glycoprotein, ferritin) and oxidative stress markers (reduced glutathione -GSH and Thiobarbituric Acid Reactive Substances -TBARS) were determined at preoperative and postoperative phases. Data were analyzed with two-sample Wilcoxon test. Results: All volunteers were clinically stable and had adequate nutritional status at admission. After surgery, C-reactive protein serum levels increased [0.4 (0.01-1.0) vs. 2.5 (0.6-4.7) mg/dL, p=0.01] and vitamin A levels decreased Inflammatory and oxidative stress after surgery for the small area corrections of burn sequelae e ferritina) e marcadores de estresse oxidativo (glutationa reduzida -GSH e Substâncias Reativas do Ácido Tiobarbitúrico -TBARS) foram determinados nas fases pré e pós-operatórias. Os dados foram analisados pelo teste de Wilcoxon pareado. Resultados: Todos os voluntários estavam clinicamente estáveis e apresentavam estado nutricional adequado à admissão hospitalar. Após a cirurgia, houve aumento dos níveis séricos de proteína C reativa [0,4 (0,01-1,0) vs 2,5 (0,6-4,7) mg/dL, p=0,01], enquanto houve redução nos níveis de vitamina A [3,4 (2,1-4,2) vs 2,4 (1,6-4,1) µmol/L, p=0,01]. Não houve mudanças nos níveis séricos de outras vitaminas, ferritina, alfa-1-glicoproteína ácida, GSH e TBARS. Conclusão: Em pacientes com bom estado nutricional e sem evidência de atividade inflamatória ou infecciosa ocorrem mudanças metabólicas mínimas após enxerto autólogo de pequenas áreas de cicatrizes de queimadura.

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Microalbuminuria: A marker of systemic endothelial dysfunction during burn excision

Cited by 21 publications

References 31 publications

Tissue Accumulation of Cephalothin in Burns: a Comparative Study by Microdialysis of Subcutaneous Interstitial Fluid Cephalothin Concentrations in Burn Patients and Healthy Volunteers

Tissue Accumulation of Cephalothin in Burns: a Comparative Study by Microdialysis of Subcutaneous Interstitial Fluid Cephalothin Concentrations in Burn Patients and Healthy Volunteers

Burn surgery and blood loss – a review

Inflammatory and oxidative stress after surgery for the small area corrections of burn sequelae

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