Hypothermia during burn surgery and postoperative acute lung injury in extensively burned patients.
BACKGROUND
Respiratory dysfunction remains one of the major complications after burn surgery in extensively burned patients. We evaluated the relationship between the invasiveness of burn surgery and acute lung injury (ALI).


METHODS
Patients admitted to our burn unit between 2006 and 2007 with burns greater than or equal to 30% of the total body surface area without severe inhalation injury were entered into this study. Of sixteen patients (mean age, 49.4 +/- 19.3 years, total body surface area 46.0% +/- 14.9%) who underwent burn surgery (3-6 days postburn), vital signs, hemodynamic parameters, blood gas analysis, and peak inspiratory pressure were recorded. Lung injury severity (LIS) score was serially determined. Bronchoalveolar lavage (BAL) was performed before and 24 hour postoperatively.


RESULTS
Body temperature and LIS score preoperatively (baseline) were 37.1 degrees C +/- 0.9 degrees C and 3.8 degrees C +/- 2.2 degrees C, respectively. LIS score increased with increased polymorphonuclear neutrophil in BAL 24 hour postoperatively in 7 of 10 patients with intraoperative temperature decreasing more than 1 degrees C. Extent of excision (20.3% +/- 6.7%), transfusion (4.3 +/- 3.0 units), or duration of surgery (147 +/- 49 minutes) alone did not show significant correlation with the development of ALI postoperatively.


CONCLUSIONS
In patients with severe burn injury, hypothermia during surgery despite aggressive intraoperative warming is significantly correlated with the development of ALI with increased polymorphonuclear neutrophil in BAL and may reflect the severity of invasiveness.
Oda
Jun
J
Department of Emergency and Critical Care Medicine, Tokyo Medical University, Tokyo, Japan. junoda@v001.vaio.ne.jp
Kasai
Kosuke
K
Noborio
Mitsuhiro
M
Ueyama
Masashi
M
Yukioka
Tetsuo
T
D055371:Acute Lung Injury / Q000209:etiology* / Q000276:immunology; D000328:Adult; D000368:Aged; D001992:Bronchoalveolar Lavage Fluid / Q000276:immunology; D002056:Burns / Q000150:complications / Q000601:surgery*; D005260:Female; D006801:Humans; D007035:Hypothermia / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D009504:Neutrophils; D011184:Postoperative Period; D013514:Surgical Procedures, Operative / Q000009:adverse effects; D055815:Young Adult