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Insight in microcirculation and histomorphology during burn shock treatment using in vivo confocal-laser-scanning microscopy


Altintas, M A; Altintas, A A; Guggenheim, M; Aust, M C; Niederbichler, A D; Knobloch, Ka; Vogt, P M (2010). Insight in microcirculation and histomorphology during burn shock treatment using in vivo confocal-laser-scanning microscopy. Journal of Critical Care, 25(1):173.e1-173.e7.

Abstract

PURPOSE: Microcirculatory disturbances are well known during shock; however, the accompanied histomorphological alterations are widely unknown. We used high resolution confocal-laser-scanning microscopy for the evaluation of microcirculation and histomorphology during Burn Shock treatment. METHODS: Confocal-laser-scanning microscopy was performed in 10 burn shock patients (4 women, 6 men; aged 40.6 +/- 11.4 years, burn extent >20% body surface area) initially and 24 hours after shock resuscitation. Ten matched hemodynamic stable burn intensive care unit patients served as controls. The following parameters were evaluated: quantitative blood cell flow, cell size of the granular layer, basal layer thickness, and epidermal thickness. RESULTS: Quantitative blood cell flow in controls was 62.45 +/- 3.39 cells per minute. Burn shock significantly reduced blood cell flow to 37.27 +/- 3.64 cells per minute; fluid resuscitation effectively restored baseline blood flow (65.18 +/- 3.76 cells per minute) after 24 hours. Granular cell size was 793.61 +/- 41.58 mum(2) in controls vs 644.27 +/- 42.96 mum(2) during burn shock. Post resuscitation granular cell size measured 932.74 +/- 38.83 mum(2). Basal layer thickness was 14.84 +/- 0.59 mum in controls, 13.26 +/- 0.54 mum in burn patients at admission and before resuscitation, and 17.50 +/- 0.46 mum after resuscitation. Epidermal thickness in control patients was 49.60 +/- 2.36 mum, 37.83 +/- 2.47 mum in burn patients at admission and 69.50 +/- 3.18 mum after resuscitation. CONCLUSIONS: Confocal-laser-scanning microscopy provides a noninvasive tool for simultaneous evaluation of microcirculation and tissue histomorphology. It may help to assess the adequacy of and response to resuscitation of burn patients early after trauma.

PURPOSE: Microcirculatory disturbances are well known during shock; however, the accompanied histomorphological alterations are widely unknown. We used high resolution confocal-laser-scanning microscopy for the evaluation of microcirculation and histomorphology during Burn Shock treatment. METHODS: Confocal-laser-scanning microscopy was performed in 10 burn shock patients (4 women, 6 men; aged 40.6 +/- 11.4 years, burn extent >20% body surface area) initially and 24 hours after shock resuscitation. Ten matched hemodynamic stable burn intensive care unit patients served as controls. The following parameters were evaluated: quantitative blood cell flow, cell size of the granular layer, basal layer thickness, and epidermal thickness. RESULTS: Quantitative blood cell flow in controls was 62.45 +/- 3.39 cells per minute. Burn shock significantly reduced blood cell flow to 37.27 +/- 3.64 cells per minute; fluid resuscitation effectively restored baseline blood flow (65.18 +/- 3.76 cells per minute) after 24 hours. Granular cell size was 793.61 +/- 41.58 mum(2) in controls vs 644.27 +/- 42.96 mum(2) during burn shock. Post resuscitation granular cell size measured 932.74 +/- 38.83 mum(2). Basal layer thickness was 14.84 +/- 0.59 mum in controls, 13.26 +/- 0.54 mum in burn patients at admission and before resuscitation, and 17.50 +/- 0.46 mum after resuscitation. Epidermal thickness in control patients was 49.60 +/- 2.36 mum, 37.83 +/- 2.47 mum in burn patients at admission and 69.50 +/- 3.18 mum after resuscitation. CONCLUSIONS: Confocal-laser-scanning microscopy provides a noninvasive tool for simultaneous evaluation of microcirculation and tissue histomorphology. It may help to assess the adequacy of and response to resuscitation of burn patients early after trauma.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Reconstructive Surgery
04 Faculty of Medicine > University Hospital Zurich > Division of Surgical Research
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:2010
Deposited On:11 Feb 2010 17:36
Last Modified:05 Apr 2016 13:54
Publisher:Elsevier
ISSN:0883-9441
Publisher DOI:10.1016/j.jcrc.2009.03.003
PubMed ID:19427756
Permanent URL: http://doi.org/10.5167/uzh-30408

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