A Descriptive Study of the Temporal Patterns of Volume and Contents Change in Human Acute Burn Edema: Application in Evidence-Based Intervention and Research Design

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Abstract

Edema after burn contributes significantly to burn wound depth conversion. In humans after burn injury, there is a lack of detailed understanding of the contents and temporal changes in volume of acute tissue edema. The novel findings of these studies relate to the collection of edema fluid after partial-thickness burn injury. Edema volume peaks on day 1 after burn without formal fluid resuscitation. The studies indicated that the peak was on day 2 for a resuscitated burn. In contrast, animal studies suggest that the peak of edema occurs by or before day 1 after injury. The findings confirm the pitfalls of evidence derived from animal models and assuming direct transference to humans. Postburn edema was demonstrated to be a high-protein fluid (ie, ≥10 g/L) for the duration of the inflammatory period. The presence of high-protein edema presents greater challenges to clinicians developing novel treatment options. The rate of volume change over time tapered to insignificant levels after day 4 following burn. Greater than 98% of the edema contents was fluid. However, the size of particulate matter did not preclude it passing through patent lymphatic collectors. The results indicate a necessity for urgent postburn intervention, which should incorporate the active stimulation of the lymphatic system to improve efficacy of edema removal.

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