Olcay Dilken , Annemieke Dijkstra , Göksel Güven , Bülent Ergin , Nicole Trommel , Margriet E. van Baar , Helma WC Hofland , Can Ince , Cornelis H. van der Vlies
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Fluid management was conducted in accordance with the Parkland formula. Albumin (20%) was administered at a rate of 0.5 mL/(kg·h), starting 12 h after the burn incident. Alterations in the sublingual microcirculation, including capillary perfusion and density, were measured at admission (T0) and 4 h (T4) and 12 h (T12) after admission. Sublingual depth of focus (DOF) of the microcirculation was used to quantify the tissue edema.</div></div><div><h3>Results</h3><div>Nine patients were recruited with a mean total body surface area of 36% ± 23%. By T12, a median of 4085 mL (interquartile range [IQR]: 3714–6756 mL) of crystalloids and 446 mL (IQR: 176–700 mL) of 20% albumin were administered. The DOF increased significantly after crystalloid administration (T4 <em>vs.</em> T0, mean difference [MD]=27.4 µm, 95% confidence interval [CI]: 3.4 to 50.9, <em>P</em>=0.040). Following albumin administration, DOF significantly decreased (T12 <em>vs.</em> T4, MD=−76.4 µm, 95% CI: −116.6 to −36.1, <em>P</em>=0.002). Total vessel density decreased significantly with crystalloid administration (T4 <em>vs.</em> T0, MD=−3.5 mm/mm<sup>2</sup>, 95% CI: −5.7 to −1.4, <em>P</em>=0.004) but increased after albumin administration (T12 <em>vs.</em> T4, MD=6.2 mm/mm<sup>2</sup>, 95% CI: 3.2 to 9.3, <em>P</em>=0.001).</div></div><div><h3>Conclusion</h3><div>Sublingual microcirculation measurement of DOF and other parameters provide a valuable tool for the assessment of tissue perfusion and edema in patients with severe burns. Further investigation is required to evaluate the role of albumin in increasing microcirculatory convection and reducing tissue edema.</div></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"5 1","pages":"Pages 58-63"},"PeriodicalIF":0.0000,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Microcirculatory depth of focus measurement shows reduction of tissue edema by albumin resuscitation in burn patients\",\"authors\":\"Olcay Dilken , Annemieke Dijkstra , Göksel Güven , Bülent Ergin , Nicole Trommel , Margriet E. van Baar , Helma WC Hofland , Can Ince , Cornelis H. van der Vlies\",\"doi\":\"10.1016/j.jointm.2024.05.002\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><div>Severe burns induce volume shifts via capillary leaks, eventually requiring massive fluid resuscitation and promoting tissue edema. Albumin may help to mitigate the edema, thereby improving perfusion. This study shows that sublingual microcirculation measurements can quantify both tissue perfusion and edema.</div></div><div><h3>Methods</h3><div>This prospective observational study was conducted between November 2018 and December 2019 in the intensive care unit of Maasstad Hospital Burn Center, Rotterdam, The Netherlands. Patients with severe burns affecting >15% of the total body surface area were included. Fluid management was conducted in accordance with the Parkland formula. Albumin (20%) was administered at a rate of 0.5 mL/(kg·h), starting 12 h after the burn incident. Alterations in the sublingual microcirculation, including capillary perfusion and density, were measured at admission (T0) and 4 h (T4) and 12 h (T12) after admission. Sublingual depth of focus (DOF) of the microcirculation was used to quantify the tissue edema.</div></div><div><h3>Results</h3><div>Nine patients were recruited with a mean total body surface area of 36% ± 23%. By T12, a median of 4085 mL (interquartile range [IQR]: 3714–6756 mL) of crystalloids and 446 mL (IQR: 176–700 mL) of 20% albumin were administered. The DOF increased significantly after crystalloid administration (T4 <em>vs.</em> T0, mean difference [MD]=27.4 µm, 95% confidence interval [CI]: 3.4 to 50.9, <em>P</em>=0.040). Following albumin administration, DOF significantly decreased (T12 <em>vs.</em> T4, MD=−76.4 µm, 95% CI: −116.6 to −36.1, <em>P</em>=0.002). Total vessel density decreased significantly with crystalloid administration (T4 <em>vs.</em> T0, MD=−3.5 mm/mm<sup>2</sup>, 95% CI: −5.7 to −1.4, <em>P</em>=0.004) but increased after albumin administration (T12 <em>vs.</em> T4, MD=6.2 mm/mm<sup>2</sup>, 95% CI: 3.2 to 9.3, <em>P</em>=0.001).</div></div><div><h3>Conclusion</h3><div>Sublingual microcirculation measurement of DOF and other parameters provide a valuable tool for the assessment of tissue perfusion and edema in patients with severe burns. Further investigation is required to evaluate the role of albumin in increasing microcirculatory convection and reducing tissue edema.</div></div>\",\"PeriodicalId\":73799,\"journal\":{\"name\":\"Journal of intensive medicine\",\"volume\":\"5 1\",\"pages\":\"Pages 58-63\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2025-01-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of intensive medicine\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S2667100X24000732\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of intensive medicine","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2667100X24000732","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
摘要
背景:严重烧伤通过毛细血管渗漏引起体积变化,最终需要大量液体复苏并促进组织水肿。白蛋白可能有助于减轻水肿,从而改善灌注。本研究表明,舌下微循环测量可以量化组织灌注和水肿。方法本前瞻性观察研究于2018年11月至2019年12月在荷兰鹿特丹Maasstad医院烧伤中心的重症监护室进行。烧伤面积占体表总面积15%的严重烧伤患者纳入研究。流体管理按照帕克兰公式进行。在烧伤后12小时开始,以0.5 mL/(kg·h)的速率给药白蛋白(20%)。入院时(T0)、入院后4 h (T4)和12 h (T12)测量舌下微循环的变化,包括毛细血管灌注和密度。用舌下微循环病灶深度(DOF)来量化组织水肿。结果9例患者入组,平均体表面积36%±23%。到T12时,给药晶体中位数为4085 mL(四分位间距[IQR]: 3714-6756 mL), 20%白蛋白中位数为446 mL (IQR: 176-700 mL)。晶体给药后DOF显著增加(T4 vs. T0,平均差值[MD]=27.4µm, 95%可信区间[CI]: 3.4 ~ 50.9, P=0.040)。白蛋白给药后,DOF显著降低(T12 vs T4, MD= - 76.4µm, 95% CI: - 116.6 ~ - 36.1, P=0.002)。晶体给药后血管总密度显著降低(T4 vs. T0, MD= - 3.5 mm/mm2, 95% CI: - 5.7 ~ - 1.4, P=0.004),但白蛋白给药后血管总密度增加(T12 vs. T4, MD=6.2 mm/mm2, 95% CI: 3.2 ~ 9.3, P=0.001)。结论舌下微循环DOF等指标的测定为重度烧伤患者组织灌注和水肿的评估提供了有价值的工具。白蛋白在增加微循环对流和减少组织水肿中的作用有待进一步研究。
Microcirculatory depth of focus measurement shows reduction of tissue edema by albumin resuscitation in burn patients
Background
Severe burns induce volume shifts via capillary leaks, eventually requiring massive fluid resuscitation and promoting tissue edema. Albumin may help to mitigate the edema, thereby improving perfusion. This study shows that sublingual microcirculation measurements can quantify both tissue perfusion and edema.
Methods
This prospective observational study was conducted between November 2018 and December 2019 in the intensive care unit of Maasstad Hospital Burn Center, Rotterdam, The Netherlands. Patients with severe burns affecting >15% of the total body surface area were included. Fluid management was conducted in accordance with the Parkland formula. Albumin (20%) was administered at a rate of 0.5 mL/(kg·h), starting 12 h after the burn incident. Alterations in the sublingual microcirculation, including capillary perfusion and density, were measured at admission (T0) and 4 h (T4) and 12 h (T12) after admission. Sublingual depth of focus (DOF) of the microcirculation was used to quantify the tissue edema.
Results
Nine patients were recruited with a mean total body surface area of 36% ± 23%. By T12, a median of 4085 mL (interquartile range [IQR]: 3714–6756 mL) of crystalloids and 446 mL (IQR: 176–700 mL) of 20% albumin were administered. The DOF increased significantly after crystalloid administration (T4 vs. T0, mean difference [MD]=27.4 µm, 95% confidence interval [CI]: 3.4 to 50.9, P=0.040). Following albumin administration, DOF significantly decreased (T12 vs. T4, MD=−76.4 µm, 95% CI: −116.6 to −36.1, P=0.002). Total vessel density decreased significantly with crystalloid administration (T4 vs. T0, MD=−3.5 mm/mm2, 95% CI: −5.7 to −1.4, P=0.004) but increased after albumin administration (T12 vs. T4, MD=6.2 mm/mm2, 95% CI: 3.2 to 9.3, P=0.001).
Conclusion
Sublingual microcirculation measurement of DOF and other parameters provide a valuable tool for the assessment of tissue perfusion and edema in patients with severe burns. Further investigation is required to evaluate the role of albumin in increasing microcirculatory convection and reducing tissue edema.