title: Non-occlusive mesenteric ischaemia: the prevalent cause of gastrointestinal infarction in patients with severe burn injuries.
abstract: BACKGROUND
  Gastrointestinal complications occur frequently in intensive care patients with severe burns. Intestinal infarction and its deleterious consequences result in high mortality despite rapid surgical intervention. Our objective was to evaluate the aetiology of gastrointestinal infarction in intensive care patients with severe burns.
  
  
  METHODS
  We retrospectively evaluated all of the severe-burn victims at the burn unit of the Medical University of Vienna from 01/2002 to 06/2012 for whom a gastrointestinal infarction was diagnosed during their inpatient stay on computed-tomography, in the context of acute laparotomy, or upon autopsy by aetiology.
  
  
  RESULTS
  After a severe thermal injury, 17 patients suffered a gastrointestinal infarction during their stay. In 82% of those patients, non-occlusive mesenteric ischaemia (NOMI) was identified as the cause of the gastrointestinal infarction. Patients with an embolic infarction tended to be older (78.0years embolism vs. 53.4 NOMI, mean, p<0.01), with a lower abbreviated burn severity index (8.7 embolism vs. 10.4 NOMI, mean, p<0.02) and a smaller total body surface area burned (20% embolism vs. 48% NOMI, mean, p<0.01) than those with a non-occlusive mesenterial ischaemia. No patients with an embolic infarction or any of the females in the entire gastrointestinal infarction group survived this event, resulting in a mortality rate of 100% for the embolic infarction group and female group. The decisive factor for surviving a NOMI was age (median age: male survivors 28years vs. nonsurvivors 66years (of this median, males=72years and females=60years), p<0.02).
  
  
  CONCLUSIONS
  The results of our study clearly demonstrate that in severe-burn intensive care patients, non-occlusive mesenteric ischaemia is the most frequent cause of gastrointestinal infarction and that the decisive factor for survival is the patient's age.
authors.affiliation: Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University Vienna, Vienna, Austria. Electronic address: gabriela.muschitz@meduniwien.ac.at.
authors.forename: Gabriela K
authors.initials: GK
authors.lastname: Muschitz
authors.affiliation: Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University Vienna, Vienna, Austria.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Fochtmann
authors.affiliation: Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University Vienna, Vienna, Austria.
authors.forename: Maike
authors.initials: M
authors.lastname: Keck
authors.affiliation: Department of Anaesthesia, General Intensive Care and Pain Management, Medical University Vienna, Vienna, Austria.
authors.forename: Gerald C
authors.initials: GC
authors.lastname: Ihra
authors.affiliation: Section for Clinical Biometrics, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University Vienna, Vienna, Austria.
authors.forename: Martina
authors.initials: M
authors.lastname: Mittlböck
authors.affiliation: Clinical Institute of Pathology, Medical University of Vienna, Vienna, Austria.
authors.forename: Susanna
authors.initials: S
authors.lastname: Lang
authors.affiliation: Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University Vienna, Vienna, Austria.
authors.forename: Martin
authors.initials: M
authors.lastname: Schindl
authors.affiliation: Head of Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University Vienna, Vienna, Austria.
authors.forename: Thomas
authors.initials: T
authors.lastname: Rath
mesh_terms: D000007:Abdominal Injuries / Q000150:complications / Q000401:mortality / Q000473:pathology*; D000328:Adult; D017677:Age Distribution; D000368:Aged; D001830:Body Surface Area; D002056:Burns / Q000150:complications / Q000401:mortality / Q000473:pathology*; D005260:Female; D006801:Humans; D007421:Intestine, Small / Q000098:blood supply / Q000473:pathology* / Q000601:surgery; D007902:Length of Stay; D008297:Male; D008638:Mesenteric Arteries / Q000293:injuries / Q000473:pathology*; D008641:Mesenteric Vascular Occlusion / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D009336:Necrosis / Q000209:etiology / Q000401:mortality / Q000473:pathology*; D015995:Prevalence
keywords: Burn injury; Gastrointestinal infarction; Mesenterial ischaemia; Non-occlusive ischaemia; Thermal injury