| Effects of Cutaneous Burn Injury and Resuscitation on the Cerebral Circulation. |
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Cheung Soo Shin, Ji Eung Kim, Yeon Jin Kim, George C Kramer |
1Department of Anesthesiology, Yonsei University collage of Medicine, Seoul, Korea.
2Department of Anesthesiology, University of Texas Medical Branch, Galveston, Texas, USA. |
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| Abstract |
BACKGROUND
Despite the importance of burn-induced encephalopathy, cerebral hemodynamics after burn injury and during resuscitation remains undefined. The aim of our study was to evaluate the effects of a large cutaneous burn injury on the cerebral circulation.
METHODS
Anesthetized sheep(n=8) were prepared with vascular catheters, a urinary catheter and a Richmond bolt for intracranial pressure monitoring. A scald injury was inflicted on 70% of total body surface area with hot water.
Resuscitation was started 30 minutes after scald with Ringer's lactate to restore and then maintain baseline oxygen delivery. Resuscitation maintained blood pressure, cardiac output and urine output at normal levels. Brain blood flow was measured with colored microspheres.
RESULTS
During resuscitation intracranial pressure rose slowly from 10.6+/-1.5 to 17.0+/- 4.0 mmHg(P<0.05) and cerebral perfusion pressure was reduced from 86.4+/- 6.8 to 64.1+/- 2.8 mmHg(P<0.05). During early resuscitation cerebrovascular resistance declined to maintain brain blood flow and oxygen delivery at baseline or better. After 6 hours, cerebrovascular resistance was inappropriately increased during a period of reduced cerebral perfusion pressure which resulted in brain blood flow being half the baseline levels.
CONCLUSIONS
These data suggest that autoregulation maintains brain blood flow immediately after burn shock and early resuscitation, but autoregulation may be less effective as burn resuscitation proceeds. |
| Key Words:
Brain; circulation; resuscitation; Skin; burn |
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