American Surgical Association

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Topic: B. Clinical Burns/Trauma
Severe Burn causes a profound and complex pathophysiologic response
Marc G. Jeschke, David L. Chinkes, Celeste C. Finnerty, Gabriela A. Kulp, Oscar E. Suman, William B. Norbury, Ludwik K. Branski, Gerd G. Gauglitz, Ron P. Mlcak, David N. Herndon
Shriners Burns Hospital for Children, Galveston, TX

Severe burn injury leads to hypermetabolism and catabolism which is associated with morbidity and mortality. The underlying pathophysiology and correlations between humoral changes and organ function have not been well delineated. In order to improve clinical outcome and to determine new treatment options we studied the pathophysiologic response postburn in a large prospective clinical trial.

242 severely burned pediatric patients were enrolled in this study (>30% total body surface area). Demographics, clinical data, hormones, inflammation, organ function, incidence of infections/sepsis, and body composition were obtained throughout acute hospital course.

Demographics are given in table 1. All patients were hypermetabolic with significantly increased REE (150-160% predicted) and insulin resistance, p<0.05. Burn patients were markedly catabolic and lost -4.1±1.9% lean body mass, -3±1% bone mineral content and -2±1% bone mineral density. Patients were hyperinflammatory with drastic changes in IL-8, MCP-1, and IL-6 which were associated with 2.5±0.2 infections and 17% sepsis. Serum hormones, constitutive and acute phase proteins were altered beginning one week postburn, and remained abnormal throughout acute hospital stay, which is associated with cardiac and hepatic dysfunction p<0.05.
In this large prospective clinical trial we delineated for the first time the complexity of the postburn pathophysiologic response and conclude that the postburn response is profound, occurs in a timely manner, and derangements are greater and more protracted than previously thought.

Table 1
Burn Population N=242
Burn size TBSA (%)56±1
3rd degree burn size (%)43±1
Gender (F/M)97/145
Length of Stay (days/% TBSA burn)0.5±0.02
Inhalation Injury (%)32
Mortality (%)8

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