Monitoring tissue oxygenation during resuscitation of major burns.
BACKGROUND
Because subcutaneous and splanchnic oxygenation indices are sensitive indicators of evolving hemorrhagic shock and adequacy of resuscitation, we postulated that these indices might have an equivalent role in the monitoring of severely burned patients. This observational study was undertaken to examine changes in tissue oxygenation indices during burn resuscitation.


METHODS
Seven patients with major burns (54 +/- 21% total body surface area) were studied during the first 36 hours of fluid resuscitation. Silastic tubing was placed in the subcutaneous tissue just beneath both normal skin and deep partial thickness burn. Fiberoptic sensors inserted into the tubing measured subcutaneous oxygen and carbon dioxide tensions in the burnt skin (PO2scb and PCO2scb) and normal skin (PO2scn and PCO2scn) continuously. Gastric intramucosal pH (pHi) and the mucosal CO2 (PCO2m) gap were calculated using gastric tonometers. Mean arterial pressure, arterial pH, lactate, and pHi measurements were obtained for 36 hours.


RESULTS
There were no significant differences in mean arterial pressure, arterial pH, or lactate concentrations throughout the study period, whereas indices of tissue oxygenation showed deterioration: pHi decreased from 7.2 +/- 0.1 to 6.7 +/- 0.3 (p = 0.06), the PCO2m gap increased from 12 +/- 17 to 108 +/- 123 mm Hg (p < 0.01), PO2scn decreased from 112 +/- 18 to 50 +/- 11 mm Hg (p < 0.01), PO2scb decreased from 62 +/- 23 to 29 +/- 16 mm Hg (p < 0.01), PCO2scn increased from 42 +/- 4 to 46 +/- 10 mm Hg (p = 0.2), and PCO2scb increased from 42 +/- 10 to 52 +/- 5 mm Hg (p = 0.05).


CONCLUSIONS
Despite adequate global indices of tissue perfusion after 36 hours of resuscitation, tissue monitoring indicated significant deterioration in the splanchnic circulation and in the normal and burnt skin.
Venkatesh
B
B
University of Queensland, Herston, Queensland, Australia. venkateshb@health.qld.gov.au
Meacher
R
R
Muller
M J
MJ
Morgan
T J
TJ
Fraser
J
J
D000328:Adult; D000368:Aged; D001785:Blood Gas Monitoring, Transcutaneous / Q000295:instrumentation / Q000379:methods*; D001794:Blood Pressure; D001830:Body Surface Area; D002056:Burns / Q000145:classification / Q000150:complications*; D002245:Carbon Dioxide / Q000032:analysis; D005440:Fluid Therapy / Q000379:methods / Q000592:standards; D005753:Gastric Mucosa / Q000737:chemistry / Q000378:metabolism; D006439:Hemodynamics; D006801:Humans; D006863:Hydrogen-Ion Concentration; D015601:Injury Severity Score; D019344:Lactic Acid / Q000032:analysis; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000295:instrumentation / Q000379:methods*; D010100:Oxygen / Q000032:analysis; D010101:Oxygen Consumption; D011446:Prospective Studies; D012151:Resuscitation / Q000379:methods / Q000592:standards; D012771:Shock, Hemorrhagic / Q000175:diagnosis* / Q000209:etiology* / Q000378:metabolism / Q000503:physiopathology / Q000628:therapy; D012867:Skin / Q000098:blood supply / Q000737:chemistry / Q000378:metabolism*; D013152:Splanchnic Circulation; D013997:Time Factors; D016896:Treatment Outcome
D002245:Carbon Dioxide; D019344:Lactic Acid; D010100:Oxygen