Hage Tamer R, Kelly Edward J, Ziedins Eriks, Parajuli Babita, D'Orio Cameron S, Burmeister David M, Moffatt Lauren, Shupp Jeffrey W, Carney Bonnie C
Firefighter's Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, DC 20010, USA.
Departments of Medicine and Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA.
Eur Burn J. 2025 Jul 28;6(3):42. doi: 10.3390/ebj6030042.
Fluid resuscitation after thermal injury is paramount to avoid burn shock and restore organ perfusion. Both over- and under-resuscitation can lead to unintended consequences affecting patient outcomes. While many studies have examined systemic effects, limited data exist on how fluid resuscitation impacts burn wound progression in the acute period. Furthermore, the mechanisms underlying burn wound progression remain not fully understood. This study used a swine model to investigate how varying resuscitation levels affect peri-burn wound dynamics. Twenty-seven female Yorkshire pigs were anesthetized, subjected to 40% total body surface area burn and 15% hemorrhage, then randomized ( = 9) to receive decision-support-driven (adequate, 2-4 mL/kg/%TBSA), fluid-withholding (under, <1 mL/kg/%TBSA), or high-constant-rate (over, >>4 mL/kg/%TBSA) resuscitation. Pigs were monitored for 24 h in an intensive care setting prior to necropsy. Laser Doppler Imaging (LDI) was conducted pre-burn and at 2, 6, 12, and 24 h post burn to assess perfusion. Biopsies were taken from burn, peri-burn (within 2 cm), and normal skin. RNA was isolated at 24 h for the qRT-PCR analysis of IL-6, CXCL8, and IFN-γ. At hour 2, LDI revealed increased peri-burn perfusion in over-resuscitated animals vs. under-resuscitated animals ( = 0.0499). At hour 24, IL-6 ( = 0.0220) and IFN-γ ( = 0.0253) were elevated in over-resuscitated peri-burn skin. CXCL8 showed no significant change. TUNEL staining revealed increased apoptosis in over- and under-resuscitated peri-burn skin. Differences in perfusion and cytokine expression based on resuscitation strategy suggest that fluid levels may influence burn wound progression.
热损伤后的液体复苏对于避免烧伤休克和恢复器官灌注至关重要。复苏过度和不足都会导致影响患者预后的意外后果。虽然许多研究已经探讨了全身影响，但关于液体复苏如何在急性期影响烧伤创面进展的数据有限。此外，烧伤创面进展的潜在机制仍未完全了解。本研究使用猪模型来研究不同的复苏水平如何影响烧伤周围创面动态。27只雌性约克夏猪被麻醉，造成40%体表面积烧伤和15%出血，然后随机分为三组（每组9只），分别接受决策支持驱动的（充足，2 - 4 mL/kg/%TBSA）、液体限制（不足，<1 mL/kg/%TBSA）或高恒定速率（过度，>>4 mL/kg/%TBSA）复苏。在尸检前，猪在重症监护环境中监测24小时。在烧伤前以及烧伤后2、6、12和24小时进行激光多普勒成像（LDI）以评估灌注。从烧伤、烧伤周围（2厘米内）和正常皮肤取活检组织。在24小时提取RNA用于IL - 6、CXCL8和IFN - γ的qRT - PCR分析。在2小时时，LDI显示复苏过度的动物与复苏不足的动物相比，烧伤周围灌注增加（P = 0.0499）。在24小时时，复苏过度的烧伤周围皮肤中IL - 6（P = 0.0220）和IFN - γ（P = 0.0253）升高。CXCL8无显著变化。TUNEL染色显示复苏过度和不足的烧伤周围皮肤中细胞凋亡增加。基于复苏策略在灌注和细胞因子表达上的差异表明，液体水平可能影响烧伤创面进展。
