Haemodynamics and volhaemic stage in patients with respiratory disorders to thermal injury

Introduction

The aim of the investigation was to study the parameters of haemodynamics, gas exchange and volhaemic status in patients with severe thermal injury.

Methods

The trial has covered 30 injured patients aged from 21 to 60 years with 25 to 78% skin burns and PO₂/FiO₂ <300. Patients were randomized into two groups. The first group was n = 13, PO₂/FiO₂ <300, 24 to 72 h after burn. The second group was n = 17, PO₂/FiO₂ <300, 4 to 11 days after burn. Injured persons were subjected to evaluation of cardiac index (CI), intrathoracic blood volume index (ITBI), extravascular lung water index (ELWI0 and pulmonary vascular permeability index (PVPI) by single transpulmonary thermodilution (PiCCOplus; Pulsion Medical Systems, Germany), calculation of oxygen delivery (DO₂), and colloidal osmotic pressure of plasma. Grade of pulmonary damage was evaluated by Murrey, severity of dispragia by SOFA. Correlation analysis was performed using Pearson and Spearman criteria (r; P). Differences were significant at P < 0.05.

Results

Hypoxaemia (PO₂/FiO₂ = 259 ± 19) in the injured of the first group was developing at the background of reduction of CI = 3.2 ± 0.5; ITBI = 751 ± 114; DO₂ = 596 ± 124 (r = -0.92; P = 0.02). ELWI level was normal (7.3 ± 0.8). In the second group, reduction of PO₂/FiO₂ has been developing at the background of burn sepsis (average SOFA point = 7.0 ± 1.9, Murrey = 1.6 ± 0.4) and was caused by increasing of ELWI up to 9.0 ± 1.4 (r = -0.66; P = 0.002) and correlated with PVPI (r = 0.57; P = 0.01). There was no statistically significant correlation ELWI with ITBI and colloidal osmotic pressure of plasma (r = 0.13, r = -0.42).

Conclusions

Gas exchange disorders in patients of the first group were caused by lack of perfusion and misbalance between oxygen delivery and demand. Reduction of oxygenation index in patients from the second group was accompanied by ELWI at the background of alteration of intravascular penetration and sepsis.