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Water physiology in burn victims
Linköping University, Department of Medicine and Care, Anaesthesiology. Linköping University, Faculty of Health Sciences.
2000 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Patients who sustain a burn injury of more than 20 - 30 % TBSA will, if untreated, develop burn shock within a couple of hours. Flcid is lost fi·om the vascular compartment due to suction from the interstitium of the wound and due to a generalised increase in vascular permeability. To prevent bum shock intravenous fluids are given during the first two days after a bum in order to ensure adequate organ perfusion. Although organ perfusion will be improved when blood volume is restored, the fluid provided will add to the continuing leak into the tissues. With fluid treatment the patient survives the acute stage, but the resulting oedema interferes with the healing of the burn wound and partially damaged skin may be further compromised.

To describe, follow and understand the development of the general oedema in burn injured patients we used four different techniques. Ethanol dilution was used for measurement of total body water (TBW), iohexol dilution in order to estimate extracellular volume (ECV), bioimpedance analysis (BIA) to register TBW as well as electrical membrane properties and the impression method (IM) for the measurement of visco-elastic properties in non-burned tissues. In order to further examine the non-invasive techniques (BIA and IM) these were used in patients subjected to haemodialysis.

The excess fluid was found to be accumulated in the extracellular space. Interesting alterations in the visco-clastic properties of the skin and cellular electrical membrane properties could also be detected. These alterations were not related to the actual tluid volume in the tissues. Instead, they were related to changes in the fluid equilibrium of the tissues. Still, one week postbum an excess of tissue fluid, altered cellular electrical membrane properties and changed visco-elastic properties of the skin remained.

Albumin supplementation did not influence the amount or distribution of the excess tissue fluid, measured with dilution techniques.

Place, publisher, year, edition, pages
Linköping: Linköpings universitet , 2000. , 61 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 633
Keyword [en]
Total body water, Extracellular fluid, Burn, Bioelectrical impedance, Oedema, Extracellular matrix
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-27560Local ID: 12222ISBN: 91-7219-734-X (print)OAI: oai:DiVA.org:liu-27560DiVA: diva2:248112
Public defence
2000-05-27, Berzeliussalen, Universitetssjukhuset, Linköping, 08:30 (Swedish)
Opponent
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2015-06-09Bibliographically approved
List of papers
1. Human postburn oedema measured with the impression method
Open this publication in new window or tab >>Human postburn oedema measured with the impression method
1993 (English)In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 19, no 6, 479-489 p.Article in journal (Refereed) Published
Abstract [en]

The course of tissue swelling in human non-injured skin after burn injury was investigated with a non-invasive impression method that measures force and tissue fluid translocation during mechanical compression of the skin. Time-dependent changes in the fluid translocation and the interstitial-pressure related to impression force were measured on 11 occasions, during 3 weeks, in seven patients postburn. A mathematical model was fitted to the impression force curves and the parameters of the model depicted the time-dependent compartmental fluid shift in the postburn generalized oedema. Tissue fluid translocation increased significantly (P < 0.05) up to a maximum value after 6 days postburn and declined thereafter. This indicated a continuous increase in the generalized postburn oedema for the first 6 days postburn. Impression force at 3 weeks postburn was significantly lower (P < 0.001) as compared with the half-day postburn value, indicating an increased tissue pressure during the first days postburn. Parameter analysis indicated a flux of water-like fluid from the vasculature to the interstitial space during the first 6 days postburn. The spread of the values registered between different measurement sites was, however, large.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-79563 (URN)10.1016/0305-4179(93)90003-Q (DOI)
Available from: 2012-08-08 Created: 2012-08-08 Last updated: 2017-12-07Bibliographically approved
2. Non-invasive assessment of intercompartmental fluid shifts in burn victims
Open this publication in new window or tab >>Non-invasive assessment of intercompartmental fluid shifts in burn victims
1998 (English)In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 24, no 3, 233-240 p.Article in journal (Refereed) Published
Abstract [en]

Two non-invasive methods (the bioimpedance technique, BIA, and the impression method, IM) were studied, to find out whether they are sensitive enough to detect and chronicle the development of the oedema and fluid resuscitation effects (Parkland formula) that occur secondary to a major burn. Ten patients with a total burned body surface area (TBSA) of more than 10% were included in this prospective study. Total body water (TBW), as measured by the resistance (BIA) or F(0) variable (IM), reached a maximum on day 2. The tissue fluid translocation (INT) variable (IM) followed a different course, increasing slowly to reach a maximum on day 6, when it was 40% higher than the 12 h value. TBW and the interstitial translocatable fluid were still increased 1 week post-burn. The non-invasive measurements of TBW (resistance by BIA and F(0) by IM) reflected the anticipated changes in TBW. The phase angle (BIA) indicative of cellular membrane effects of burn and sepsis had its lowest values at day 1.5, and stayed significantly low until day 4. Interestingly, the phase angle was lowest in the two cases that died subsequently. The different time course of the INT value (IM), which reflected the translocatable interstitial fluid volume in skin, may be the result of resuscitation fluid remaining in this compartment, due to the excess sodium content together with a possible change in tissue compliance secondary to the early total water peak on day 2.

Keyword
Biolectric impedance, Burns, Oedema, Body fluid, Extracellular fluid, Extracellular matrix
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-79564 (URN)10.1016/S0305-4179(98)00016-3 (DOI)
Available from: 2012-08-08 Created: 2012-08-08 Last updated: 2017-12-07Bibliographically approved
3. Non-invasive assessment of fluid volume status in the interstitium after haemodialysis
Open this publication in new window or tab >>Non-invasive assessment of fluid volume status in the interstitium after haemodialysis
2000 (English)In: Physiological Measurement, ISSN 0967-3334, E-ISSN 1361-6579, Vol. 21, no 2, 211-220 p.Article in journal (Refereed) Published
Abstract [en]

During dialysis excess fluid is removed from uraemic patients. The excess fluid is mainly located in the skin and subcutaneous tissues. In this study we wished, with two non-invasive techniques, the IM (impression method) and BIA (bioimpedance analysis), to study what mechanical (IM) and electrical cellular membrane (BIA) effects the fluid withdrawal has on these tissues. The IM measures the resistive force of the tissues when mechanically compressed. From the force curve two parameters are calculated, the F(0), indicative of interstitial tissue pressure and the FT corresponding to the translocation of tissue fluid (interstitial movable water).

The BIA phase angle shift (), i.e. geometrical angular transformation of the ratio between reactance and resistance, which has been associated with cellular membrane function, was used as a measurement of electrical cellular membrane effects.

Twenty patients were studied before and after haemodialysis measuring the F(0), FT and . The results showed that the patients lost a median of 3.7 kg during the haemodialysis. F(0) increased until after dialysis, but did not reach significant values, whereas FT increased significantly after dialysis, p < 0.001, as compared with before. After a peak at one hour postdialysis the FT value returned to predialysis values at four hours after termination of dialysis. Also increased from before to after dialysis, p < 0.001, but already after one hour it returned to predialysis values.

It is common knowledge that dialysis alters the dynamics of fluid in the interstitium of the skin and subcutis. We conclude that the impression method is sensitive enough to detect and chronicle these changes. Furthermore, with the BIA, (phase angle) signs of changes in the electrical properties of the tissues, possibly reflecting cellular membrane function, could be detected.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-47661 (URN)10.1088/0967-3334/21/2/301 (DOI)
Available from: 2009-10-11 Created: 2009-10-11 Last updated: 2017-12-13Bibliographically approved
4. Albumin supplementation during the first week after a burn does not mobilise tissue oedema in humans
Open this publication in new window or tab >>Albumin supplementation during the first week after a burn does not mobilise tissue oedema in humans
2001 (English)In: Intensive Care Medicine, ISSN 0342-4642, E-ISSN 1432-1238, Vol. 27, no 5, 844-852 p.Article in journal (Refereed) Published
Abstract [en]

Objective: To measure water balance and changes in distribution, and the effect of giving supplementary albumin, early after a burn injury.

Design: Consecutive patients (matched groups) and healthy controls.

Setting: National burn unit in a Swedish university hospital.

Patients and subjects: Eighteen patients with 18%-90% total burned surface area and 16 healthy male control subjects.

Interventions: The patients were given an intravenous infusion of ethanol over 1 h, 0.35-0.60 g/kg body weight, and a bolus of 3.3 to 6.5 g of iohexol. The control subjects were given the same amounts of either ethanol or iohexol. Patients were subdivided into two groups according to whether or not they received supplementary albumin starting 12 h post-burn.

Measurements and results: Blood samples were drawn at 20-30 min intervals over 4 h after the start of the infusion. Serum ethanol was measured by headspace gas chromatography, and iohexol with high-pressure liquid chromatography (HPLC). Distribution volume was calculated from the concentration-time profiles. Total body water (TBW) was measured by the ethanol tracer and bioelectric impedance (BIA) techniques, and estimated extracellular water (ECWest) by iohexol tracer. They were all significantly increased after a burn. Excess water was accumulated mainly in the extracellular compartment. It declined towards normal values (those of volunteers) at the end of the week. Albumin supplementation did not influence the amount or distribution of the excess fluid.

Conclusion: Body water increases after a burn. Excess water is mainly deposited in the extracellular space. Tissue oedema fluid is not mobilised by albumin supplementation.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-25136 (URN)10.1007/s001340100935 (DOI)9569 (Local ID)9569 (Archive number)9569 (OAI)
Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2017-12-13Bibliographically approved
5. The effect of hypermetabolism induced by burn trauma on the ethanol-oxidizing capacity of the liver
Open this publication in new window or tab >>The effect of hypermetabolism induced by burn trauma on the ethanol-oxidizing capacity of the liver
1999 (English)In: Critical Care Medicine, ISSN 0090-3493, E-ISSN 1530-0293, Vol. 27, no 12, 2622-2625 p.Article in journal (Refereed) Published
Abstract [en]

Objective: To study the rate of elimination of ethanol after a major burn trauma.

Design: Prospective, controlled study.

Setting: National burns unit in a Swedish university hospital.

Patients and Subjects: Eight consecutive patients suffering from 18%-72% total burned surface area and nine healthy male control subjects.

Interventions: The patients received ethanol, 0.35-0.60 g/kg body weight intravenously, during 1 hr. This was repeated daily during the first week postburn. The control subjects received the same amount of ethanol once.

Measurements and Main Results: Blood samples were drawn at 20- to 30-min intervals during 5 hrs after the start of the infusion. Serum ethanol was determined by headspace gas chromatography. The rate of elimination of ethanol was calculated from the concentration time profile. In the control subjects, the median elimination rate was 0.074 g/kg/hr (range, 0.059-0.083 g/kg/hr). In the patients, it was already 0.138 g/kg/hr (range, 0.111-0.201 g/kg/hr) on the first day; this increased even further over the following 6 days, reaching 0.183 g/kg/hr (range, 0.150-0.218 g/kg/hr) on the seventh day.

Conclusions: Ethanol elimination is augmented postburn. A more effective reoxidation of reduced nicotinamide adenine dinucleotide seems the most likely explanation for the increased rate of ethanol elimination in these hypermetabolic trauma patients. This finding suggests that the oxidative capacity of the liver may be assessed by studying the rate of ethanol elimination in burn victims.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-25135 (URN)9568 (Local ID)9568 (Archive number)9568 (OAI)
Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2017-12-13Bibliographically approved

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