ISSN:0022-5282    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

Complex immunologic alterations occur following thermal injury. To further delineate the intricacies of the immune response, a longitudinal profile of immunologic parameters was investigated in burned patients with specific reference to clinical criteria (resuscitation, plasma exchange, surgical excisions, sepsis).During a 17-month period, 26 adult patients with a mean age of 32.6 years and a mean burn size of 45.6% TBSA were evaluated with serial (twice weekly) assays of immunocompetence. The immunologic variables monitored included complement components, fibronectin, immunoglobulins, acute-phase reactants, serum proteins, catecholamines, and the mixed lymphocyte reaction. Resuscitation from burn shock and clinical sepsis were associated with a wide array of serologic abnormalities and lymphocyte suppression. Plasma exchange and surgical excision and grafting procedures were also characterized by multiple serologic changes and improvement in lymphocyte function.No specific serologic parameter correlated well with cellular function; however, patterns of humoral alterations were consistently present and may represent a combined effect.

ISSN:0022-5282    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

Traditional teaching recommends major burn procedures be limited to successive 20% total body surface area (TBSA) excision and grafting procedures. This format theoretically reduces the surgical stress and limits the transfusion requirements to a level reasonably tolerated by patients.We have treated 14 patients with thermal burns involving greater than 30% TBSA. These patients underwent excisions ranging from 30 to 70% TBSA at the initial operative escharectomy. Tangential and fascial excisions were employed, depending upon the depth of injury, and autografts and/or allografts were utilized for wound closure. The results of this technique yielded an overall 71% survival. Time from burn to last autograft and hospital stay tended to be shortened or unchanged when compared to national averages.This series demonstrates the feasibility of performing early major escharectomy in a selected burn population without apparent increased surgical risk compared to patients treated by conventional staged excision. Although burn wound sepsis and mortality appeared favorably affected by this technique, the small population size was unsuitable for adequate statistical analysis.

ISSN:0022-5282    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

Our purpose was to determine the effect of anesthesia and positive pressure ventilation, PPV, on early postburn (1–12 hr) cardiopulmonary changes. Adult sheep were given a 40% full-thickness TBS burn not involving chest wall. Halothane anesthesia and PPV alone decreased cardiac output by 20% but also decreased oxygen demands by 30% from the awake state. Systemic vascular resistance, SVR, was increased by 40% over the awake state in the first several hours postburn: cardiac output was decreased despite baseline filling pressures. Low molecular weight dextran, LMWD, prevented the increased SVR by decreasing resistance to flow.A continued decrease in cardiac output was evident during the next 6–12 hr postburn with anesthesia while awake sheep values returned to baseline. Fluid requirements to maintain filling pressures also increased by 30% over the awake state. Static lung compliance, CSTAT, decreased from a baseline of 43 ± 5 to 32 ± 4 ml/cm H2O with anesthesia and ventilation. This was due to nonburn chest wall edema: lung water was normal. The 7-cm H2O increase in inspiratory pressure necessary to maintain constant volume was the cause of the decreased cardiac output, because maintaining pressure constant resulted in no decrease in cardiac output. &OV0312;O2remained relatively constant due to increased O2extraction. LMWD prevented the CSTATchanges and, in turn, the decreased output.We conclude that both the increase in SVR and decrease in CSTATpostburn resulted in a significant decrease in cardiac output with anesthesia not seen in the awake burn state. The decreased output was, however, in large part compensated for by decreased O2demands and increased O2extraction.

ISSN:0022-5282    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

Since the most common site of infection in burned patients is the burn wound, we have previously studied the biologic effect of burn wound blister fluid (BF) on control lymphocyte and neutrophil activity. BF will not support the phagocytosis ofPseudomonasby normal neutrophils, and a subset of the BF samples suppressed the maximal mitogen response of control lymphocytes by more than 50%. The current work was carried out to analyze in depth the composition of BF using crossed immunoelectrophoresis. Twenty BF and six serum specimens collected from 20 patients between 6 and 18 hours postburn had 19 separate proteins measured. These proteins included immunologic proteins, antiproteases, acute-phase reactants, carrier proteins, and lipoproteins. A total of 546 protein measurements were made. The concentrations of all subgroups of proteins were significantly lower in the BF and burn serum specimens than in control serum. When the blister fluids were stratified according to their effect on normal lymphocyte activity, the suppressive blister fluid samples had higher levels of C3 and lower levels of I α I than the nonsuppressive samples. The elevation in C3 was secondary to the local activation of C3 and the generation of multiple C3 breakdown products. These changes in C3 are of potential biologic importance, since evidence has accumulated indicating that the various fragments of C3 can modulate both neutrophil and lymphocyte function. Thus, the results of this study suggest that local changes in the blister fluid may adversely affect local immunity and predispose the patient to burn wound sepsis.

ISSN:0022-5282    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

Burn injuries and blood transfusions both have been implicated as causes of suppressed immune responses. Skin allograft survival in a burned mouse model was studied to determine the relationships among burn injury, blood transfusion, and phlebotomy before transfusion as they affected immunocompetence.At 7 days after 20% TBSA full-thickness burn injury, allograft skin survival was prolonged compared to nonburned control. When increasing volumes of blood were transfused, allograft survival times decreased accordingly. Phlebotomy before transfusion tended to enhance this response. Similar results were seen at 14 days after burn injury, although phlebotomy before transfusion did not further decrease allograft survival time at 14 days.This study demonstrated that blood transfusions were not additively immunosuppressive over burn injury alone. Increased amounts of transfused blood restore allogeneic responsiveness. Phlebotomy may enhance this response when performed early after burn injury.

ISSN:0022-5282    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

The digital recording and processing of information on burn size provides a useful adjunct to the care of patients with burn injuries in the critical care setting. Record keeping is improved and accuracy is enhanced using a simple, portable system based on the widely available IBM Personal Computer. Diagramming burns on a graphic outline of a human body with color coding of burn depth produces a visual representation of the burned patient. Computations of areas of burn are automatically produced from the graphic images.

ISSN:0022-5282    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

Excessive blood loss can limit the area of burn excised per sitting, lead to selection of en bloc rather than tangential excision, and increase the number of surgical procedures required per patient. Twenty-four burned extremities were studied to measure blood loss, complications, and effectiveness of a technique for tangentially excising burns of extremities using tourniquet hemostasis followed by application of steel-wool-pad ‘compression’ dressings before tourniquet release. An average of 7.3 days postburn (PB), a mean of 7% body surface area (BSA) burn was excised per extremity with a mean blood loss of 29 ml/% BSA burn excised (less than one fifth of recently published values). Graft take averaged 91%. There was no evidence of neurocirculatory injury or other complications.When applied as described and carefully monitored, hemostatic tourniquets followed by ‘compression’ dressings can safely reduce blood loss associated with the exclision of limb burns and allow larger areas to be excised at each operation.

ISSN:0022-5282    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

In order to study the relation between length of operation and postoperative morbidity in patients with burns greater than 30% TBSA a retrospective review was done. Seven categories of morbidity were chosen and points assigned for significant change from the preoperative state. There were no intraoperative or immediate postoperative deaths. The overall morbidity was 19%. The eventual mortality was 19%. There was no correlation between length of operation and postoperative morbidity.

ISSN:0022-5282    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

Blood transfusions are known to improve allograft survival times, and this effect is enhanced with recipient immunosuppression. The focus of the present study was to determine the effect of pretransplant and perioperative donor-specific (DST) or nonspecific (NST) blood transfusion on skin allograft survival in thermally injured mice. Allogeneic immune responsiveness was suppressed in 20% TBSA burned mice, but not to a degree which was protective against DST-induced sensitization. Pretransplant DST resulted in accelerated graft rejection in burned recipients, although high-dose cyclosporine partially reversed this sensitization. Additionally, burn-related immunosuppression in this model did not enhance perioperative transfusion-induced graft prolongation. However, when burn-injured perioperatively transfused mice were further immunosuppressed with cyclosporine, significant graft prolongation occurred. These data suggest that perioperative NST may contribute to prolonged skin graft survival in burned recipients, provided that the mice are sufficiently immunosuppressed.

ISSN:0022-5282    

出版商:OVID    

年代:1986

数据来源: OVID