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Effect of partial burn excision and closure on postburn oxygen consumption
1Longwood Area Trauma Center, Brigham and Women's Hospital, Boston, MA 02115.
Surgery
|November 1, 1988
Summary
Partial excision of severe burns does not reduce the hypermetabolic state, as oxygen consumption (VO2) remains elevated. This suggests substantial inflammatory wounds, not infection, perpetuate postburn hypermetabolism.
Area of Science:
- Biomedical Engineering
- Physiology
- Burn Management
Background:
- Postburn hypermetabolism is a significant clinical challenge.
- Elevated oxygen consumption (VO2) and cardiac index characterize this state.
- The role of wound size and inflammation in perpetuating hypermetabolism requires further investigation.
Purpose of the Study:
- To investigate the impact of partial burn excision on the postburn hypermetabolic state.
- To determine if wound closure significantly alters oxygen consumption (VO2) and related physiological parameters.
- To assess the contribution of infection to the perpetuation of hypermetabolism.
Main Methods:
- Induction of a 25% total body surface area burn in seven sheep.
- Measurement of oxygen consumption (VO2), cardiac index, and arterial-venous oxygen difference (AvO2).
- Partial excision (60%) of the burn eschar and subsequent grafting on day 7 postburn.
Main Results:
- Significant increase in VO2 (215 +/- 44 ml/min/M2) by day 3 postburn, driven by increased cardiac index.
- Plasma and burn lymph thromboxane B2 levels were elevated.
- VO2 returned to preburn hypermetabolic levels within 2 hours post-anesthesia after partial excision, persisting for 2 days.
Conclusions:
- Postburn hypermetabolism can be perpetuated by a substantial inflammatory wound, even after partial excision.
- Partial excision does not significantly decrease the hypermetabolic state if a significant inflammatory wound remains.
- Infection is not a prerequisite for the perpetuation of increased VO2 in the postburn hypermetabolic state.