Experimental inhalation injury with concomitant surface burn: dextran resuscitation improves lung water and oxygenation.
The role of extravascular lung water (EVLW) in the pathogenesis of inhalation injury (INH) when associated with concomitant major burn (B) remains controversial. Previous experimental models have investigated isolated INH without surface burn. This study measured the effects of isolated and combined INH on EVLW and pO2 in a porcine experimental model. The beneficial effects of early resuscitation with dextran-40 (DEX) were assessed, using a control group receiving standard Parkland formula (LR). In the first part of the study (INH vs. INH + B), a group of animals with a standardized INH was compared to a group also receiving a standardized 40% BSA third-degree surface burn (n = 8, each group). With serial measurements for 5 hours, EVLW was only modestly increased unless INH was accompanied by surface burn: 20.3 +/- 4.2 vs. 32.0 +/- 4.1 ml/kg at 5 hours (p less than 0.01). Similarly, pO2 fell much more dramatically in the INH + B group, 61 +/- 5 vs. 37 +/- 5 torr (p less than 0.05). The second part of the study compared standard Parkland crystalloid resuscitation with dextran-40 resuscitation in animals receiving a combined INH + B injury (LR vs. DEX, n = 8, each group). DEX resuscitation resulted in substantially lower accumulation of EVLW out to 5 hours, 34.1 +/- 5.0 vs. 13.1 +/- 3.0 ml/kg (p less than 0.01), and significantly better pO2, 35 +/- 5 vs. 64 +/- 4 torr (p less than 0.01).


CONCLUSIONS
Inhalation injury did not dramatically increase EVLW in this animal model unless accompanied by concomitant major surface burn. The deterioration in EVLW and pO2 seen in the combined injury was significantly improved with DEX resuscitation when compared to standard crystalloid resuscitation. Further study is indicated and clinical trials may be warranted.
Schenk
W G
WG
Department of Surgery, University of Virginia Health Sciences Center, Charlottesville 22908.
Aldridge
S C
SC
Farley
P C
PC
D000818:Animals; D002056:Burns / Q000150:complications / Q000503:physiopathology*; D000077324:Crystalloid Solutions; D003911:Dextrans / Q000627:therapeutic use*; D004195:Disease Models, Animal; D015633:Extravascular Lung Water / Q000032:analysis*; D007552:Isotonic Solutions; D010100:Oxygen / Q000502:physiology; D010952:Plasma Substitutes / Q000627:therapeutic use; D015208:Smoke Inhalation Injury / Q000150:complications / Q000503:physiopathology* / Q000628:therapy; D013552:Swine
D000077324:Crystalloid Solutions; D003911:Dextrans; D007552:Isotonic Solutions; D010952:Plasma Substitutes; D010100:Oxygen