Effect of extensive excision of burn wound with invasive infection on hypermetabolism in burn patients with sepsis.
OBJECTIVE
To evaluate the effect of extensive excision of invasive burn wound infection on hypermetabolic response in burn patients with sepsis.


METHODS
Eight patients with major burn, complicated by invasive burn wound infection and sepsis, were consecutively admitted to our hospital from September 1997 to October 1998. Resting energy expenditures (REEs) were monitored by means of cardiorespiratory diagnostic system (Medical Graphics Corporation, USA) at patients' bedside. Plasma concentration of IL-6, IL-8, TNF-alpha, and LPS were assayed before and after surgical intervention and at the time when the patients' vital signs became stable. Correlation analysis between REEs and IL-6, IL-8, TNF-alpha, and LPS were made, respectively.


RESULTS
A total of 8 treated patients survived. Values of REE before surgical intervention were significantly higher than those after surgical intervention (P < 0.01), and when patients' vital signs became stable the values were significantly lower than those after surgical intervention (P < 0.01). The plasma concentrations of IL-6, IL-8, TNF-alpha, and LPS after excision of invasive burn wound infection were significantly lower than those before surgical intervention (P < 0.05). The lowest levels of these inflammatory mediators were observed when the conditions of patients became stable, and the values were significantly lower than those before surgical intervention (P < 0.001). There was a significant positive correlation between REE level and respective values of plasma IL-6, IL-8, TNF-alpha, and LPS (P < 0.01).


CONCLUSIONS
It seemed that the extensive excision of invasively infected burn wound in patients with major burn should be performed as early as possible to reduce an increased release of inflammatory mediators and to control the hypermetabolic response during sepsis.
Chai
J
J
Burns Institute, People's Liberation Army, Beijing, China.
Sheng
Z
Z
Diao
L
L
Yang
H
H
Gao
J
J
Xu
M
M
D000293:Adolescent; D000328:Adult; D001481:Basal Metabolism; D002056:Burns / Q000097:blood / Q000378:metabolism* / Q000382:microbiology / Q000601:surgery*; D002648:Child; D005260:Female; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood; D008297:Male; D008875:Middle Aged; D018805:Sepsis / Q000097:blood / Q000209:etiology / Q000378:metabolism*; D014946:Wound Infection / Q000382:microbiology / Q000601:surgery*
D018836:Inflammation Mediators