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...
Saved in:
| Main Authors: | , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2025-01-01
|
| Series: | Journal of Intensive Medicine |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2667100X24000732 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1841560056087183360 |
|---|---|
| author | Olcay Dilken Annemieke Dijkstra Göksel Güven Bülent Ergin Nicole Trommel Margriet E. van Baar Helma WC Hofland Can Ince Cornelis H. van der Vlies |
| author_facet | Olcay Dilken Annemieke Dijkstra Göksel Güven Bülent Ergin Nicole Trommel Margriet E. van Baar Helma WC Hofland Can Ince Cornelis H. van der Vlies |
| author_sort | Olcay Dilken |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-a2bb01ad46bd4d8a9fd10bc6e1d93545 |
| institution | Kabale University |
| issn | 2667-100X |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of Intensive Medicine |
| spelling | doaj-art-a2bb01ad46bd4d8a9fd10bc6e1d935452025-01-05T04:28:46ZengElsevierJournal of Intensive Medicine2667-100X2025-01-01515863Microcirculatory depth of focus measurement shows reduction of tissue edema by albumin resuscitation in burn patientsOlcay Dilken0Annemieke Dijkstra1Göksel Güven2Bülent Ergin3Nicole Trommel4Margriet E. van Baar5Helma WC Hofland6Can Ince7Cornelis H. van der Vlies8Department of Intensive Care Adult, Erasmus MC, University Medical Center Rotterdam, Erasmus University, Rotterdam, the NetherlandsDepartment of Intensive Care Adult, Erasmus MC, University Medical Center Rotterdam, Erasmus University, Rotterdam, the Netherlands; Association of Dutch Burn Centres, Burn Centre Maasstad Hospital, Rotterdam, the Netherlands; Department of Intensive Care, van Weel Bethesda Hospital, Dirksland, the NetherlandsDepartment of Intensive Care Adult, Erasmus MC, University Medical Center Rotterdam, Erasmus University, Rotterdam, the Netherlands; Department of Internal Medicine, Division of Intensive Care, Faculty of Medicine, Hacettepe University, Ankara, TurkeyDepartment of Intensive Care Adult, Erasmus MC, University Medical Center Rotterdam, Erasmus University, Rotterdam, the Netherlands; Corresponding author: Bulent Ergin, Department of Intensive Care Adult, Erasmus MC, University Medical Center Rotterdam, Erasmus University, EE-1926, Dr. Molewaterplein 40, 3015GD, Rotterdam, the Netherlands.Association of Dutch Burn Centres, Burn Centre Maasstad Hospital, Rotterdam, the NetherlandsAssociation of Dutch Burn Centres, Burn Centre Maasstad Hospital, Rotterdam, the Netherlands; Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Erasmus University, Rotterdam, the NetherlandsAssociation of Dutch Burn Centres, Burn Centre Maasstad Hospital, Rotterdam, the NetherlandsDepartment of Intensive Care Adult, Erasmus MC, University Medical Center Rotterdam, Erasmus University, Rotterdam, the NetherlandsAssociation of Dutch Burn Centres, Burn Centre Maasstad Hospital, Rotterdam, the Netherlands; Department of Trauma and Burn Surgery, Maasstad Hospital, Rotterdam, the Netherlands; Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Erasmus University, Rotterdam, the NetherlandsBackground: 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.http://www.sciencedirect.com/science/article/pii/S2667100X24000732ShockCrystalloid solutionsAlbuminsBurnsMicrocirculation |
| spellingShingle | Olcay Dilken Annemieke Dijkstra Göksel Güven Bülent Ergin Nicole Trommel Margriet E. van Baar Helma WC Hofland Can Ince Cornelis H. van der Vlies Microcirculatory depth of focus measurement shows reduction of tissue edema by albumin resuscitation in burn patients Journal of Intensive Medicine Shock Crystalloid solutions Albumins Burns Microcirculation |
| title | Microcirculatory depth of focus measurement shows reduction of tissue edema by albumin resuscitation in burn patients |
| title_full | Microcirculatory depth of focus measurement shows reduction of tissue edema by albumin resuscitation in burn patients |
| title_fullStr | Microcirculatory depth of focus measurement shows reduction of tissue edema by albumin resuscitation in burn patients |
| title_full_unstemmed | Microcirculatory depth of focus measurement shows reduction of tissue edema by albumin resuscitation in burn patients |
| title_short | Microcirculatory depth of focus measurement shows reduction of tissue edema by albumin resuscitation in burn patients |
| title_sort | microcirculatory depth of focus measurement shows reduction of tissue edema by albumin resuscitation in burn patients |
| topic | Shock Crystalloid solutions Albumins Burns Microcirculation |
| url | http://www.sciencedirect.com/science/article/pii/S2667100X24000732 |
| work_keys_str_mv | AT olcaydilken microcirculatorydepthoffocusmeasurementshowsreductionoftissueedemabyalbuminresuscitationinburnpatients AT annemiekedijkstra microcirculatorydepthoffocusmeasurementshowsreductionoftissueedemabyalbuminresuscitationinburnpatients AT gokselguven microcirculatorydepthoffocusmeasurementshowsreductionoftissueedemabyalbuminresuscitationinburnpatients AT bulentergin microcirculatorydepthoffocusmeasurementshowsreductionoftissueedemabyalbuminresuscitationinburnpatients AT nicoletrommel microcirculatorydepthoffocusmeasurementshowsreductionoftissueedemabyalbuminresuscitationinburnpatients AT margrietevanbaar microcirculatorydepthoffocusmeasurementshowsreductionoftissueedemabyalbuminresuscitationinburnpatients AT helmawchofland microcirculatorydepthoffocusmeasurementshowsreductionoftissueedemabyalbuminresuscitationinburnpatients AT canince microcirculatorydepthoffocusmeasurementshowsreductionoftissueedemabyalbuminresuscitationinburnpatients AT cornelishvandervlies microcirculatorydepthoffocusmeasurementshowsreductionoftissueedemabyalbuminresuscitationinburnpatients |