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Cardiac dysfunction after burns
Linköpings universitet, Institutionen för medicinsk teknik. Linköpings universitet, Tekniska högskolan.
Linköpings universitet, Institutionen för klinisk och experimentell medicin, Brännskadevård. Linköpings universitet, Hälsouniversitetet.
Linköpings universitet, Institutionen för datavetenskap, Statistik. Linköpings universitet, Filosofiska fakulteten.
Linköpings universitet, Institutionen för klinisk och experimentell medicin. Linköpings universitet, Hälsouniversitetet.
Vise andre og tillknytning
2008 (engelsk)Inngår i: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 34, nr 5, s. 603-609Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

Objectives

Using transoesophageal echocardiography (TEE) we investigated the occurrence, and the association of possible abnormalities of motion of the regional wall of the heart (WMA) or diastolic dysfunction with raised troponin concentrations, or both during fluid resuscitation in patients with severe burns.

Patients and methods

Ten consecutive adults (aged 36–89 years, two women) with burns exceeding 20% total burned body surface area who needed mechanical ventilation were studied. Their mean Baux index was 92.7, and they were resuscitated according to the Parkland formula. Thirty series of TEE examinations and simultaneous laboratory tests for myocyte damage were done 12, 24, and 36 h after the burn.

Results

Half (n = 5) the patients had varying grades of leakage of the marker that correlated with changeable WMA at 12, 24 and 36 h after the burn (p ≤ 0.001, 0.044 and 0.02, respectively). No patient had WMA and normal concentrations of biomarkers or vice versa. The mitral deceleration time was short, but left ventricular filling velocity increased together with stroke volume.

Conclusion

Acute myocardial damage recorded by both echocardiography and leakage of troponin was common, and there was a close correlation between them. This is true also when global systolic function is not deteriorated. The mitral flow Doppler pattern suggested restrictive left ventricular diastolic function.

sted, utgiver, år, opplag, sider
2008. Vol. 34, nr 5, s. 603-609
Emneord [en]
Diastolic and regional systolic dysfunction; Echocardiography; Myocardial injury; Fluid resuscitation in burns; Myocardial infarction; Troponin
HSV kategori
Identifikatorer
URN: urn:nbn:se:liu:diva-12901DOI: 10.1016/j.burns.2007.11.013OAI: oai:DiVA.org:liu-12901DiVA, id: diva2:17347
Tilgjengelig fra: 2008-01-28 Laget: 2008-01-28 Sist oppdatert: 2017-12-13
Inngår i avhandling
1. Cardiovascular response to hyperoxemia, hemodilution and burns: a clinical and experimental study
Åpne denne publikasjonen i ny fane eller vindu >>Cardiovascular response to hyperoxemia, hemodilution and burns: a clinical and experimental study
2007 (engelsk)Doktoravhandling, med artikler (Annet vitenskapelig)
Abstract [en]

The last decades less invasive monitoring and analytical tools have been developed for the evaluation of myocardial mechanics in clinical praxis. In critical care, these are longed-for complements to pulmonary artery catheter monitoring, additionally offering previously inaccessible information. This work is aimed, during fluid-replacement and oxygen therapy, to determine the physiological interface of ventricular and vascular mechanical properties, which result in the transfer of blood from the heart to appropriate circulatory beds. In prospective clinical studies we investigated previously cardiovascular healthy adults during hyperoxemia, and during preoperative acute normovolemic hemodilution or early fluid resuscitation of severe burn victims. Echocardiography was used in all studies, transthoracic for healthy volunteers and transesophageal for patients. For vascular parameters and for control purposes pulmonary artery Swan-Ganz catheter, calibrated external pulse recordings, whole body impedance cardiography, and transpulmonel thermodilution method were applied.

We detected no significant change in blood pressure or heart rate, the two most often used parameters for patient monitoring. During preoperative acute normovolemic hemodilution a reduction of hemoglobin to 80 g/l did not compromise systolic or diastolic myocardial function. Cardiac volumes and flow increased with a concomitant fall in systemic vascular resistance while oxygen delivery seemed maintained. Supplemental oxygen therapy resulted in a linear dose-response between arterial oxygen and cardiovascular parameters, suggesting a direct vascular effect. Cardiac flow decreased and vascular resistance increased from hyperoxemia, and a decrease of venous return implied extracardial blood-pooling. Severe burns result in hypovolemic shock if not properly treated. The commonly used Parkland fluid replacement strategy, with urinary output and mean arterial pressure as endpoints, has recently been questioned. Applying this strategy, only transient early central hypovolemia was recorded, while dimensional preload, global left ventricular systolic function and oxygen delivery or consumption remained within normal ranges during the first 36 hours after accident. Signs of restrictive left ventricular diastolic function were detected in all patients and regional unstable systolic dysfunction was recognized in every other patient, and was consistent with myocardial marker leakage. Severe burns thereby cause myocardial stiffness and systolic regional dysfunction, which may not be prevented only by central normovolemia and adequate oxygenation.

sted, utgiver, år, opplag, sider
Institutionen för medicinsk teknik, 2007
Serie
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1013
Emneord
Anesthesia, general, Burns, Echocardiography, transesophageal, Hemodilution, emodynamic processes, Hyperoxia
HSV kategori
Identifikatorer
urn:nbn:se:liu:diva-10633 (URN)978-91-85831-11-1 (ISBN)
Disputas
2007-10-25, Elsa Brännströmssalen Universitetssjukhuset i Linköping, Campus US, Linköpings universitet, Linköping, 13:00 (engelsk)
Opponent
Veileder
Merknad
On the day of the defence date the status of article II was: In Press.Tilgjengelig fra: 2008-01-28 Laget: 2008-01-28 Sist oppdatert: 2009-08-22

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