Restrictive pulmonary dysfunction caused by the grafted chest and abdominal burn

Area of Science:

• Burn surgery and critical care medicine.
• Pulmonary physiology and respiratory mechanics.
• Trauma and reconstructive surgery.

Background:

• Large, full-thickness chest and abdominal burns present significant challenges in surgical management and post-operative care.
• Understanding the impact of extensive wound closure on respiratory mechanics is crucial for patient outcomes.

Observation:

• Six patients with severe (72% TBSA) chest and abdominal burns underwent excision and grafting.
• A severe restrictive lung dysfunction was identified, characterized by decreased vital capacity (VC) and dynamic compliance (Cdyn).
• Lung mechanics were notably compromised, particularly under general anesthesia, with limited chest wall excursion.

Findings:

• Post-excision and grafting, vital capacity (VC) was severely reduced (12-14 ml/kg) without parenchymal lung injury.
• Dynamic compliance (Cdyn) decreased significantly, indicating a noncompliant chest and abdominal wall.
• Patients experienced reduced inspiratory pressure (IP) and spontaneous tidal volume (VT), leading to hypercarbia (PCO2 > 50 torr).

Implications:

• The noncompliant nature of excised and grafted burn wounds significantly impairs lung function, necessitating careful anesthetic management.
• Recognizing the limits of chest wall excursion is critical to prevent major cardiopulmonary complications in burn patients.
• Continuous positive airway pressure may be beneficial preoperatively, but vigilant monitoring of respiratory parameters is essential postoperatively.