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Non-invasive assessment of intercompartmental fluid shifts in burn victims
Linköping University, Department of Medicine and Care, Anaesthesiology. Linköping University, Department of Biomedicine and Surgery, Plastic Surgery, Hand Surgery and Burns. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Clinical and Experimental Medicine, Burn Center. Linköping University, Faculty of Health Sciences.
Department of Biomedical Engineering, University Hospital of Northern Sweden, Umeå, Sweden.
Linköping University, Department of Medicine and Care, Anaesthesiology. Linköping University, Department of Biomedicine and Surgery, Plastic Surgery, Hand Surgery and Burns. Linköping University, Faculty of Health Sciences.
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.

Place, publisher, year, edition, pages
1998. Vol. 24, no 3, 233-240 p.
Keyword [en]
Biolectric impedance, Burns, Oedema, Body fluid, Extracellular fluid, Extracellular matrix
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-79564DOI: 10.1016/S0305-4179(98)00016-3OAI: oai:DiVA.org:liu-79564DiVA: diva2:543584
Available from: 2012-08-08 Created: 2012-08-08 Last updated: 2017-12-07Bibliographically approved
In thesis
1. Water physiology in burn victims
Open this publication in new window or tab >>Water physiology in burn victims
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
Total body water, Extracellular fluid, Burn, Bioelectrical impedance, Oedema, Extracellular matrix
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-27560 (URN)12222 (Local ID)91-7219-734-X (ISBN)12222 (Archive number)12222 (OAI)
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

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Zdolsek, Hans JoachimSjöberg, Folke

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