Experimental wound healing in severe sepsis and septic shock in humans

Introduction

Sepsis and systemic inflammatory response syndrome have been assumed to disturb wound healing. However, the effect of sepsis in maintaining epithelial barriers and in the restoration of barrier function is only partly understood [1]. To date there are no controlled human studies looking at wound healing in severe sepsis.

Methods

Suction blisters were induced on 35 patients with severe sepsis and 15 healthy controls [2]. The first set of suction blisters were made within 48 hours of the first organ failure and the second set on the fourth day of the study. The healing of the suction blisters were studied by measuring transepidermal water loss (TEWL) and blood flow with a Laser-Doppler flowmeter (BF). These measurements were also made on the intact skin.

Results

The average age in the whole study population was 62 years (SD 12). Fifty-four percent of (n = 19) patients were surgical, and an intra-abdominal focus of infection was the most common in these patients. In medical patients the most common focus of infection was lungs. The mean APACHE II score on admission was 25. In the surgical group 68% and in the medical group 63% developed MOF (P = not significant). The healing of the blister wound was not affected during the first 4 days of the study. After the first set of blisters, septic patients had significantly higher BF compared with controls. However, on the eighth day of the study the SOFA scores correlated positively with TEWL and negatively with BF (Figures 1 and 2).

Figure 1

Correlation between TEWL and SOFA scores on the eighth day of study.

Figure 2

Correlation between BF and SOFA scores on the eighth day of study.

Conclusion

The epidermal barrier function remains intact for the first 4 days of severe sepsis but subsequently, following increasing organ dysfunction, leads to impaired barrier function and decreasing BF.