Dilken Olcay, Dijkstra Annemieke, Güven Göksel, Ergin Bülent, Trommel Nicole, van Baar Margriet E, Hofland Helma Wc, Ince Can, van der Vlies Cornelis H
Department 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.
J Intensive Med. 2024 Jul 12;5(1):58-63. doi: 10.1016/j.jointm.2024.05.002. eCollection 2025 Jan.
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.
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.
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 T0, mean difference [MD]=27.4 µm, 95% confidence interval [CI]: 3.4 to 50.9, =0.040). Following albumin administration, DOF significantly decreased (T12 T4, MD=-76.4 µm, 95% CI: -116.6 to -36.1, =0.002). Total vessel density decreased significantly with crystalloid administration (T4 T0, MD=-3.5 mm/mm, 95% CI: -5.7 to -1.4, =0.004) but increased after albumin administration (T12 T4, MD=6.2 mm/mm, 95% CI: 3.2 to 9.3, =0.001).
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.
严重烧伤通过毛细血管渗漏导致容量转移，最终需要大量液体复苏并加重组织水肿。白蛋白可能有助于减轻水肿，从而改善灌注。本研究表明，舌下微循环测量可量化组织灌注和水肿。
这项前瞻性观察性研究于2018年11月至2019年12月在荷兰鹿特丹马斯塔德医院烧伤中心重症监护病房进行。纳入全身表面积烧伤>15%的严重烧伤患者。按照帕克兰公式进行液体管理。烧伤事件发生12小时后开始以0.5 mL/(kg·h)的速率输注白蛋白（20%）。在入院时（T0）、入院后4小时（T4）和12小时（T12）测量舌下微循环的变化，包括毛细血管灌注和密度。微循环的舌下聚焦深度（DOF）用于量化组织水肿。
招募了9名患者，平均全身表面积为36%±23%。到T12时，中位数为4085 mL（四分位间距[IQR]：3714 - 6756 mL）的晶体液和446 mL（IQR：176 - 700 mL）的20%白蛋白被输注。输注晶体液后DOF显著增加（T4对比T0，平均差值[MD]=27.4 µm，95%置信区间[CI]：3.4至50.9，P = 0.040）。输注白蛋白后，DOF显著降低（T12对比T4，MD = -76.4 µm，95% CI：-116.6至-36.1，P = 0.002）。输注晶体液后总血管密度显著降低（T4对比T0，MD = -3.5 mm/mm，95% CI：-5.7至-1.4，P = 0.004），但输注白蛋白后增加（T12对比T4，MD = 6.2 mm/mm，95% CI：3.2至9.3，P = 0.001）。
舌下微循环DOF及其他参数的测量为评估严重烧伤患者的组织灌注和水肿提供了一种有价值的工具。需要进一步研究以评估白蛋白在增加微循环对流和减轻组织水肿中的作用。
