Organ dysfunction among patients with major burns
نویسنده
چکیده
.................................................................................................................................... 1 Abbreviations ............................................................................................................................ 2 List of original papers ............................................................................................................... 3 Introduction ............................................................................................................................... 4 Multiple organ dysfunction or failure ................................................................................... 7 Assessing physiological changes after major burns............................................................ 10 Clinical perspective ............................................................................................................. 13 Aims ........................................................................................................................................ 14 Methods................................................................................................................................... 15 Variables.......................................................................................................................... 15 Clinical assessments made using well-known techniques .............................................. 16 Statistics .......................................................................................................................... 20 Statistical software .......................................................................................................... 20 Results ..................................................................................................................................... 23 Respiratory dysfunction (paper I) ....................................................................................... 23 Acute kidney injury (paper II)............................................................................................. 24 Sex-related difference in mortality (paper III) .................................................................... 25 Liver function (paper IV) .................................................................................................... 27 Discussion ............................................................................................................................... 33 Respiratory dysfunction (paper I) ....................................................................................... 33 Acute kidney injury (paper II)............................................................................................. 36 Incidence ......................................................................................................................... 36 Outcome .......................................................................................................................... 37 Predisposing factors ........................................................................................................ 37 Dysfunction of other organs and sepsis........................................................................... 38 Scoring scales, SOFA, and RIFLE.................................................................................. 38 Assessing physiological changes .................................................................................... 40 Pathophysiology of renal dysfunction in burns............................................................... 41 Sex-related difference in mortality (paper III) .................................................................... 41 Expectations of a survival advantage for women............................................................ 41 Survival advantage of male patients with burns.............................................................. 42 Potential limitations......................................................................................................... 43 Liver function (paper IV) .................................................................................................... 44 Assessing early burn-induced effects on liver function .................................................. 44 Liver dysfunction, static tests.......................................................................................... 45 Multiple organ dysfunction ............................................................................................. 46 Resuscitation ................................................................................................................... 46 Dose and reference range ................................................................................................ 47 General discussion............................................................................................................... 48 Selection of patients ........................................................................................................ 48 General limitations .......................................................................................................... 48 TBSA% and pre-existing medical conditions ................................................................. 49 Sequence and time of onset: possible relations............................................................... 49 The physiological response to thermal injury ................................................................. 50 Good prognosis despite multiple organ failure among burned patients.......................... 52 Mechanisms: inflammatory engines................................................................................ 53 Mechanisms: “two-hit” ................................................................................................... 54 Mechanisms: microcirculatory hypotheses ..................................................................... 55 Central nervous system ................................................................................................... 55 Skin dysfunction.............................................................................................................. 55 Conclusions ............................................................................................................................. 56 Respiratory dysfunction (paper I) ....................................................................................... 56 Acute kidney injury (paper II)............................................................................................. 56 Sex-related difference in mortality (paper III) .................................................................... 56 Liver function (paper IV) .................................................................................................... 56 General conclusions ............................................................................................................ 57 Summary in Swedish............................................................................................................... 58 Acknowledgements ................................................................................................................. 59 References ............................................................................................................................... 60
منابع مشابه
Acute kidney injury is common, parallels organ dysfunction or failure, and carries appreciable mortality in patients with major burns: a prospective exploratory cohort study
INTRODUCTION The purpose of this study was to determine the incidence, time course, and outcome of acute kidney injury after major burns and to evaluate the impact of possible predisposing factors (age, gender, and depth and extent of injury) and the relation to other dysfunctioning organs and sepsis. METHOD We performed an explorative cohort study on patients with a TBSA% (percentage burned ...
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