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Benefits of transcutaneous 02 and CO2 measurements
Burns (1992) 18, (6), 5 17-519
Printed in Great Britain
517
Abstracts
CLINICAL STUDIES Selective gut decontamination saves lives Thirty-one consecutive patients with bums covering more than 31 per cent of the body surface area admitted over a 2-year period were treated by selective decontamination of the digestive tract (SDD) using a mixture of polymyxin, co-trimoxazole and amphotericin B. The results were compared with those from a group of patients with similar injuries treated in the 2-year period before the introduction of SDD. Fewer SDD-treated patients developed wound colonization with Pseudomonads or Enterobacteria and there were similar reductions in the number of urine and gastric aspirates which contained Gram-negative organisms. There were fewer respiratory infections in the SDD group and only one patient developed septicaemia compared with eight in the control group. One patient died in the SDD group whereas seven patients died in the control group. Ma&e D. P., van Hertum W. A. J., Schumburg T. et al. (1992) Prevention of infection in bums. Preliminary experience with selective decontamination of the digestive tract in patients with extensive injuries. 1. Trauma 32, (5), 570-575.
Benefits of transcutaneous 0, and CO, measurements The degrees of skin graft vascularity and graft maturity were assessed using measurements of the transcutaneous partial pressures of oxygen (TCPo,) and carbon dioxide (TCPco,). In 13 patients receiving partial thickness sheet skin grafts it was found that TCPco, determinations provide a satisfactory non-invasive and objective measurement of the degree of graft vascularization and that the 7CPo, values indicate the level of graft maturity. Greenhalgh D. G. and Warden G. D. (1992) Transcutaneous oxygen and carbon dioxide measurements for determination of skin graft ‘take’. 1. Burn Cure Rebabil. 13, (3), 334-339.
External warmth attenuates burn hypermetabolism In a study of the effects of environmental temperatures on bum-induced hypermetabolism three groups of patients were studied: those with occlusive dressings and variable ambient temperatures, those with no dressings and variable ambient temperatures and those with no dressings but warmed with electric heaters. Partitional calorimetry indicated metabolic rate when the groups of patients were subjectively warm and when they were cold stressed. Serial plasma catecholamine assays were made in all patients. All three groups of patients showed increased rates of heat production when cold stressed, whereas the contemporary plasma catecholamine values did not increase significantly. Such results do not support the role of the catecholamines as the primary mediator for the postbum hypermetabolic response, which can be greatly reduced but not eliminated by external heating. (0 1992 Butterworth-Heinemann 0305-4179/92/060517-03
Ltd
Caldwell F. T., Wallace B. H., Cone J. B. et al. (1992) Control of the hypermetabolic response to bum injury using environmental factors. Ann. Sttrg. 215, (5), 485-491.
Preoperative fasting and nutritional input The effect that pre- and postoperative fasting has on total calorie intake was explored in patients receiving enteral feeding. Both retrospective and prospective studies were carried out. The retrospective study showed that patients who fasted for 2 h received only 28 per cent of their calculated 24-h calorie input goals, compared with only 11 per cent in those who fasted for 2-8 h and 6 per cent in those who fasted for more than 8 h before surgery. In the prospective study a I-h fast before the induction of anaesthesia enabled patients to achieve 30 per cent of their calorie needs, whereas those who fasted for 4 h achieved only 15 per cent of their target nutritional needs. No patient in either study showed any evidence of pulmonary aspiration. Pearson K. S., From R. P., Symreng T. et al. (1992) Continuous enteral feeding and short fasting periods enhance perioperative nutrition in patients with bums. 1. Bum Care Rehabil. 13, (a), 477-481.
Benefits of growth hormone administration Fourteen patients with bums covering more than 40 per cent TBSA received either placebo or 0.2 mg/kg/day of recombinant human growth hormone. Compared with the findings in the patients receiving placebo the patients treated with the hormone showed significant elevations in insulin-like growth factor-l, total catecholamines, norepinephrine, epinephrine, insulin, glucagon and free fatty acids. In contrast the hormone had no effect on resting energy expenditure per kilogram, the respiratory rate, heart rate, respiratory quotient and the serum level of cortisol and glucose. Fleming R. Y. D., Rutan R. L., Jahoor F. et al. (1992) Effect of recombinant human growth hormone on catabolic hormones and free fatty acids following thermal injury. 1. Truuma 32, (6), 698-703.
Antidietary antigen antibodies and gut mucosal integrity failure If bacteria can cross the gut mucosal barrier following severe bums then might not food proteins also cross this altered mucosal barrier and stimulate the humoral immune response? In six patients with bums covering between 28 and 75 per cent of the body surface area anti gliadin and anti beta lactoglobulin IgG and IgA antibodies were detected. Additionally there were significant correlations between these two groups of antibodies and bum
Printed in Great Britain
517
Abstracts
CLINICAL STUDIES Selective gut decontamination saves lives Thirty-one consecutive patients with bums covering more than 31 per cent of the body surface area admitted over a 2-year period were treated by selective decontamination of the digestive tract (SDD) using a mixture of polymyxin, co-trimoxazole and amphotericin B. The results were compared with those from a group of patients with similar injuries treated in the 2-year period before the introduction of SDD. Fewer SDD-treated patients developed wound colonization with Pseudomonads or Enterobacteria and there were similar reductions in the number of urine and gastric aspirates which contained Gram-negative organisms. There were fewer respiratory infections in the SDD group and only one patient developed septicaemia compared with eight in the control group. One patient died in the SDD group whereas seven patients died in the control group. Ma&e D. P., van Hertum W. A. J., Schumburg T. et al. (1992) Prevention of infection in bums. Preliminary experience with selective decontamination of the digestive tract in patients with extensive injuries. 1. Trauma 32, (5), 570-575.
Benefits of transcutaneous 0, and CO, measurements The degrees of skin graft vascularity and graft maturity were assessed using measurements of the transcutaneous partial pressures of oxygen (TCPo,) and carbon dioxide (TCPco,). In 13 patients receiving partial thickness sheet skin grafts it was found that TCPco, determinations provide a satisfactory non-invasive and objective measurement of the degree of graft vascularization and that the 7CPo, values indicate the level of graft maturity. Greenhalgh D. G. and Warden G. D. (1992) Transcutaneous oxygen and carbon dioxide measurements for determination of skin graft ‘take’. 1. Burn Cure Rebabil. 13, (3), 334-339.
External warmth attenuates burn hypermetabolism In a study of the effects of environmental temperatures on bum-induced hypermetabolism three groups of patients were studied: those with occlusive dressings and variable ambient temperatures, those with no dressings and variable ambient temperatures and those with no dressings but warmed with electric heaters. Partitional calorimetry indicated metabolic rate when the groups of patients were subjectively warm and when they were cold stressed. Serial plasma catecholamine assays were made in all patients. All three groups of patients showed increased rates of heat production when cold stressed, whereas the contemporary plasma catecholamine values did not increase significantly. Such results do not support the role of the catecholamines as the primary mediator for the postbum hypermetabolic response, which can be greatly reduced but not eliminated by external heating. (0 1992 Butterworth-Heinemann 0305-4179/92/060517-03
Ltd
Caldwell F. T., Wallace B. H., Cone J. B. et al. (1992) Control of the hypermetabolic response to bum injury using environmental factors. Ann. Sttrg. 215, (5), 485-491.
Preoperative fasting and nutritional input The effect that pre- and postoperative fasting has on total calorie intake was explored in patients receiving enteral feeding. Both retrospective and prospective studies were carried out. The retrospective study showed that patients who fasted for 2 h received only 28 per cent of their calculated 24-h calorie input goals, compared with only 11 per cent in those who fasted for 2-8 h and 6 per cent in those who fasted for more than 8 h before surgery. In the prospective study a I-h fast before the induction of anaesthesia enabled patients to achieve 30 per cent of their calorie needs, whereas those who fasted for 4 h achieved only 15 per cent of their target nutritional needs. No patient in either study showed any evidence of pulmonary aspiration. Pearson K. S., From R. P., Symreng T. et al. (1992) Continuous enteral feeding and short fasting periods enhance perioperative nutrition in patients with bums. 1. Bum Care Rehabil. 13, (a), 477-481.
Benefits of growth hormone administration Fourteen patients with bums covering more than 40 per cent TBSA received either placebo or 0.2 mg/kg/day of recombinant human growth hormone. Compared with the findings in the patients receiving placebo the patients treated with the hormone showed significant elevations in insulin-like growth factor-l, total catecholamines, norepinephrine, epinephrine, insulin, glucagon and free fatty acids. In contrast the hormone had no effect on resting energy expenditure per kilogram, the respiratory rate, heart rate, respiratory quotient and the serum level of cortisol and glucose. Fleming R. Y. D., Rutan R. L., Jahoor F. et al. (1992) Effect of recombinant human growth hormone on catabolic hormones and free fatty acids following thermal injury. 1. Truuma 32, (6), 698-703.
Antidietary antigen antibodies and gut mucosal integrity failure If bacteria can cross the gut mucosal barrier following severe bums then might not food proteins also cross this altered mucosal barrier and stimulate the humoral immune response? In six patients with bums covering between 28 and 75 per cent of the body surface area anti gliadin and anti beta lactoglobulin IgG and IgA antibodies were detected. Additionally there were significant correlations between these two groups of antibodies and bum