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Right ventricular dysfunction in acute thermal injury

J A Martyn, M T Snider, S K Szyfelbein

    Annals of Surgery
    |March 1, 1980
    PubMed
    Summary
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    Thermal injury can cause pulmonary artery hypertension (PAH), leading to right ventricular dysfunction. This dysfunction, marked by reduced ejection fraction and increased volume, may impact fluid resuscitation and survival in burn patients.

    Area of Science:

    • Cardiology
    • Critical Care Medicine
    • Physiology

    Background:

    • Thermal injury commonly causes elevated cardiac output and pulmonary artery hypertension (PAH).
    • The right ventricle (RV) faces increased pressure-flow load, potentially leading to dysfunction.
    • Understanding RV response is crucial for managing burn patients.

    Purpose of the Study:

    • To investigate the effects of pressure-flow load on the RV in burn patients.
    • To identify factors associated with right ventricular dysfunction in thermal injury.
    • To assess the impact of PAH on RV function and hemodynamic response.

    Main Methods:

    • Studied 15 non-septic burn patients (15-75% body surface area) using flow-directed catheters and thermodilution.
    • Measured cardiac output (CO), pulmonary artery pressure (PAP), pulmonary vascular resistance (PVR), RV ejection fraction (RVEF), and RV end-diastolic volume index (RVEDVI).

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  • Categorized patients based on the presence of PAH (mean PAP > 20 mmHg, PVR > 1.2 mmHg/min/L).

    • Main Results:

    • Six patients developed PAH and exhibited RV dysfunction (RVEDVI 188 ml/M², RVEF 0.26).
    • Patients without PAH had better RV function (RVEDVI 115 ml/M², RVEF 0.39).
    • PAH patients were older, had larger burns, lower diastolic pressure, and higher heart rates.

    Conclusions:

    • Pulmonary artery hypertension in burn patients is associated with right ventricular dysfunction.
    • RV dysfunction, indicated by increased RVEDVI and decreased RVEF, may compromise fluid resuscitation effectiveness.
    • These findings highlight the importance of monitoring RV function in burn patients with PAH.