Fluid resuscitation with deferoxamine prevents systemic burn-induced oxidant injury.
We studied the effect of deferoxamine (DFO) infused after burns on hemodynamic stability as well as local and systemic inflammation and oxidant-induced lipid peroxidation. Eighteen anesthetized sheep were given a 40% of total body surface burn and fluid resuscitated to restore oxygen delivery (DO2) and filling pressures to baseline values. Animals were resuscitated with lactated Ringer's (LR) alone or LR plus 1,500 ml of a 5% hetastarch complexed with DFO (8 mg/ml). Animals were killed 6 hours postburn. The sheep resuscitated with LR and LR plus hetastarch demonstrated significant lung inflammation and significant increases in lung and liver malondialdehyde (MDA) from controls of 47 +/- 6 and 110 +/- 7 nMol/gm to 63 +/- 13 and 202 +/- 59 for LR and 67 +/- 4 and 211 +/- 9 for LR + hetastarch, respectively. The group resuscitated with hetastarch alone required 15% less fluid. VO2 returned to baseline values in both groups by 2 hours. Resuscitation with the 5% hetastarch-DFO decreased total fluids by 30% over LR and prevented the increase in lung and liver MDA. In addition, postburn VO2 increased by 25% above baseline values. Burn tissue edema, measured as protein-rich lymph flow, was significantly increased with the administration of DFO compared with the other groups. We conclude that DFO used for burn resuscitation prevents systemic lipid peroxidation and decreases the vascular leak in nonburn tissues while also increasing O2 utilization. Resuscitation with hetastarch-DFO may accentuate burn tissue edema, possibly by increased perfusion of burn tissue.
Demling
R
R
Longwood Area Trauma Center, Brigham and Women's Beth Israel Hospital, Boston, MA 02115.
LaLonde
C
C
Knox
J
J
Youn
Y K
YK
Zhu
D
D
Daryani
R
R
D000818:Animals; D002056:Burns / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D003676:Deferoxamine / Q000008:administration & dosage / Q000494:pharmacology*; D004487:Edema / Q000209:etiology / Q000517:prevention & control*; D005440:Fluid Therapy / Q000379:methods*; D006878:Hydroxides / Q000494:pharmacology; D006895:Hydroxyethyl Starch Derivatives / Q000008:administration & dosage; D007552:Isotonic Solutions / Q000627:therapeutic use; D015227:Lipid Peroxidation / Q000187:drug effects*; D008099:Liver / Q000737:chemistry; D008168:Lung / Q000737:chemistry; D008315:Malondialdehyde / Q000032:analysis; D010100:Oxygen / Q000378:metabolism; D010101:Oxygen Consumption / Q000187:drug effects; D000077325:Ringer's Lactate; D012756:Sheep
D006878:Hydroxides; D006895:Hydroxyethyl Starch Derivatives; D007552:Isotonic Solutions; D000077325:Ringer's Lactate; D008315:Malondialdehyde; C031356:hydroxide ion; D003676:Deferoxamine; D010100:Oxygen