Effect of early burn excision and grafting on pulmonary function

The effects of early burn excision and grafting on pulmonary function were measured. Blood gases, PaO2/FIO2, and dynamic lung compliance were measured before, during, and after 70 procedures in 37 patients with major body burns, 22 of whom also had significant superimposed impairment in lung function. Excisions were carried out 24 to 48 hours and again 5 to 7 days postburn, only in hemodynamically stable patients in whom ventilation could be safely maintained to, from, and in the operating room. We noted no instances of increased pulmonary dysfunction which were not rapidly reversible in the postoperative period. A modest transient decrease in lung compliance and oxygen exchange, as well as an increase in PaCO2, was seen which we attributed to a discontinuation of PEEP (positive end expiratory pressure) and underestimation of needed minute ventilation intraoperatively and during transport. This was in large part corrected in the latter part of the study period. Seven patients, mean age 67 years, were included in the series. All patients did well. We conclude that if proper precautions are made, early excision can be safely performed in patients with altered lung function.