The impact of antithrombin (H) concentrate infusions on pulmonary function in the acute phase of thermal injury.
BACKGROUND
Pulmonary complications occur frequently after thermal injury.


OBJECTIVE
This open pilot study was performed as an initial assessment of the safety and efficacy of antithrombin H [AT(H)] concentrate in ameliorating the respiratory morbidity during the acute phase of injury.


METHODS
Thirty-two patients were eligible for the study; of these, nine opted for treatment with q8 h [AT(H)]. The mean daily peak values of pulmonary parameters such as PaO(2)/FiO(2) ratio, and RAW scores were computed for days 1-8.


RESULTS
Control and AT(H)-treated patients were similar in age, % total burn surface area, inhalation injury, and mortality. Forty-three percent of the burn controls, and 23% of the AT(H)-treated patients had pneumonia, p<0.01. The median hospital stay for both groups was 42 days; however, the median number of ventilatory days for burn controls was 23 days vs 10 days for AT(H)-treated patients. The AT(H)-treated patients had admission AT plasma levels of 46+/-14% vs 49+/-18% in burn controls, (normal=100+/-20%). The AT plasma level was maintained at 120+/-24% in the AT(H)-treated patients vs 50+/-15% in the burn control group for the first four days following the acute injury, p<0.002. Thrombate(R) concentrate infusions were, in general, well tolerated by patients. The median dose was 97 u/kg/dose q8 h. Compared to burn controls, AT(H)-treated patients had higher PaO(2)/FiO(2) ratios between days 4-6, p<0.01. In comparing these two groups with and without inhalation, airway resistance (assessed by the RAW score) was significantly lower in the AT(H)-treated group with inhalation compared to the burn controls with inhalation on days 2 and 6, p<0.02.


CONCLUSIONS
With a trend toward decreased airway resistance during AT(H) concentrate infusions, and increased oxygenation, AT(H)-treated patients had significantly fewer episodes of pneumonia compared to controls. AT(H) concentrates may modify the impact of thrombin on acute inflammation, and improve respiratory function in the acute phase of thermal injury.
Kowal-Vern
A
A
Department of Pathology, Loyola University Medical Center, Maywood, IL 60153, USA.
Walenga
J M
JM
McGill
V
V
Gamelli
R L
RL
D000328:Adult; D000991:Antithrombins / Q000008:administration & dosage* / Q000032:analysis; D002056:Burns / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D010865:Pilot Projects; D011014:Pneumonia / Q000209:etiology; D012129:Respiratory Function Tests
D000991:Antithrombins