[Prevention with pseudomonas immune globulin in burn injury patients with inhalation trauma: does it have an effect on lung function and outcome?].
In an evaluation of the effect of prophylactic application of Pseudomonas immunoglobulin on the immunoglobulin serum concentration, infection rate, lung function and mortality in major burn-trauma patients, a clinical, prospective, controlled and randomized trial along with an extensive literature review was carried out in the intensive care unit (ICU) of a major burn-trauma center at a major municipal hospital in the Federal Republic of Germany. A total of 60 patients suffering from major burn trauma were studied. Some of them exhibited inhalation injury as a secondary trauma. Inclusion criteria comprised an age of 15-60 years, burns covering 30%-70% of the body surface area, and second and third degree skin burns. In a randomized fashion, the consecutively admitted patients were assigned to either the study or the control group, each comprising 30 subjects. Study-group patients (PIG-GRP) received 250 mg/kg Pseudomonas immunoglobulin (Psomaglobin; Tropon-Cutter, Cologne, FRG) intravenously on days 3, 5, 7, 10 and 13 following the trauma, whereas controls (CON-GRP) received no prophylaxis. The immunoglobulin concentration was measured in serum on days 1, 3, 5, 7, 10, 13, 16, 19 and 28. From day 3 to day 13, significant higher values were found in study-group patients; however, this held true only for that subgroup of subjects in each group who displayed additional inhalation injury (PIG-SUBGRP = 23; CON-SUBGRP = 16). Immunoglobulin serum levels showed an earlier return to normal in the PIG-SUBGRP (day 7) than in the CON-SUBGRP (day 13). Blood cultures were taken on suspicion of septicaemia. In the above-described subgroups, the number of positive blood cultures was significantly reduced in the study patients (PIG-SUBGRP, 27 bacteremic subjects among a total of 70; CON-SUBGRP, 22 among a total of 36; P = 0.0045). In all, 21 subjects in the PIG-SUBGRP and 13 patients in the CON-SUBGRP were mechanically ventilated according to an adaptive scheme. The target value of pulmonary function was the O2 quotient (P(ALV)O2-P(ART)O2/P(ALV)O2), which was significantly closer to the normal value in the PIG-SUBGRP. Mortality was lower in the PIG-SUBGRP (34.8%, 8 patients) than in the CON-SUBGRP (50%, 8 subjects). In conclusion, prophylaxis with Pseudomonas immunoglobulin does not appear to be beneficial to burn trauma patients in general; however, it was shown to be effective in burn-trauma patients exhibiting inhalation injury.
Stuttmann
R
R
Abteilung für Anästhesiologie, Städtische Krankenanstalten Köln-Merheim.
Hebebrand
D
D
Hartert
M
M
Spilker
G
G
Doehn
M
M
D000293:Adolescent; D000328:Adult; D002056:Burns / Q000401:mortality / Q000628:therapy*; D002059:Burns, Inhalation / Q000401:mortality / Q000628:therapy*; D003131:Combined Modality Therapy; D003422:Critical Care; D006801:Humans; D007074:Immunoglobulin G / Q000627:therapeutic use*; D007262:Infusions, Intravenous; D008176:Lung Volume Measurements; D008875:Middle Aged; D009104:Multiple Trauma / Q000401:mortality / Q000628:therapy; D010100:Oxygen / Q000097:blood; D011175:Positive-Pressure Respiration; D011446:Prospective Studies; D011550:Pseudomonas aeruginosa / Q000276:immunology*; D012772:Shock, Septic / Q000401:mortality / Q000517:prevention & control*; D015996:Survival Rate
D007074:Immunoglobulin G; D010100:Oxygen
Prophylaxe mit Pseudomonasimmunglobulin bei Brandverletzten mit Inhalationstrauma: Hat es einen Einfluss auf die Lungenfunktion und das Outcome?