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Metabolic effects of burns in the periop period (CVS (Cardiac output…
Metabolic effects of burns in the periop period
CVS
Cardiac output
Rapidly reduced
Gradually recovers during 2nd post burn day
Supranormal levels by day 3 - hypermetabolic response
Increased SVR and PVR
Adrenaline, noradrenaline, vasopressin, angiotensin
Myocardial depression
IL-1, TNF-alpha
Decreased coronary blood flow
Hypovolaemia
Increased blood viscosity from capillary leakage
Hypermetabolic state
From approx day 3 until wound substantially healed
Mechanism
Manifestation of SIRS
Partially sustained by heat and fluid loss (energy expenditure reduced by raised ambient temp and occlusive dressing)
Pain, fear, anxiety
Bacterial colonisation
Manifestations
Tachycardia, tachypnoea
catecholamine surge
Increased 02 consumption
Augmented catabolism
Management
Avoid extra fluid loss, resuscitation
Myocardial support may be required initially (inotropes)
Increased 02 and ventilation
Nutritional support
Prevention and treatment of infection