Monitoring tissue oxygenation during resuscitation of major burns

Venkatesh, Balasubramanian, Meacher, Roseanne, Muller, Michael, Morgan, Thomas and Fraser, John (2001) Monitoring tissue oxygenation during resuscitation of major burns. Journal of Trauma, 50 3: 485-494. doi:10.1097/00005373-200103000-00013


Author Venkatesh, Balasubramanian
Meacher, Roseanne
Muller, Michael
Morgan, Thomas
Fraser, John
Title Monitoring tissue oxygenation during resuscitation of major burns
Journal name Journal of Trauma   Check publisher's open access policy
ISSN 1079-6061
Publication date 2001
Sub-type Article (original research)
DOI 10.1097/00005373-200103000-00013
Volume 50
Issue 3
Start page 485
End page 494
Total pages 10
Editor Basil A Pruitt Jr
Place of publication USA
Publisher Lippincott Williams & Wilkins
Collection year 2001
Language eng
Subject C1
730117 Skin and related disorders
321099 Clinical Sciences not elsewhere classified
Abstract BACKGROUND: Because subcutaneous and splanchnic oxygenation indices are sensitive indicators of evolving hemorrhagic shock and adequacy of resuscitation, we postulated that these indices might have an equivalent role in the monitoring of severely burned patients. This observational study was undertaken to examine changes in tissue oxygenation indices during burn resuscitation. METHODS: Seven patients with major burns (54 +/- 21% total body surface area) were studied during the first 36 hours of fluid resuscitation. Silastic tubing was placed in the subcutaneous tissue just beneath both normal skin and deep partial thickness burn. Fiberoptic sensors inserted into the tubing measured subcutaneous oxygen and carbon dioxide tensions in the burnt skin (PO2scb and PCO2scb) and normal skin (PO2scn and PCO2scn) continuously. Gastric intramucosal pH (pHi) and the mucosal CO2 (PCO2m) gap were calculated using gastric tonometers. Mean arterial pressure, arterial pH, lactate, and pHi measurements were obtained for 36 hours. RESULTS: There were no significant differences in mean arterial pressure, arterial pH, or lactate concentrations throughout the study period, whereas indices of tissue oxygenation showed deterioration: pHi decreased from 7.2 +/- 0.1 to 6.7 +/- 0.3 (p = 0.06), the PCO2m gap increased from 12 +/- 17 to 108 +/- 123 mm Hg (p < 0.01), PO2scn decreased from 112 +/- 18 to 50 +/- 11 mm Hg (p < 0.01), PO2scb decreased from 62 +/- 23 to 29 +/- 16 mm Hg (p < 0.01), PCO2scn increased from 42 +/- 4 to 46 +/- 10 mm Hg (p = 0.2), and PCO2scb increased from 42 +/- 10 to 52 +/- 5 mm Hg (p = 0.05). CONCLUSION: Despite adequate global indices of tissue perfusion after 36 hours of resuscitation, tissue monitoring indicated significant deterioration in the splanchnic circulation and in the normal and burnt skin.
Q-Index Code C1

Document type: Journal Article
Sub-type: Article (original research)
Collection: School of Medicine Publications
 
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Created: Tue, 14 Aug 2007, 16:56:47 EST