pituitrin and Burns

Burn injury represents a significant problem worldwide. Advances in therapy strategies, based on better understanding of the pathophysiologic responses after burn injury have improved the clinical outcome of patients with burn injuries over the past years. This article describes the present understanding of the pathophysiology of a burn injury including both the local and systemic responses, focusing on the many facets of organ and systemic effects directly resulting from hypovolemia and circulating mediators following burn trauma.

Topics: Angiotensin II; Animals; Burns; Catecholamines; Edema; Hemodynamics; Histamine; Humans; Hypovolemia; Inflammation Mediators; Platelet Activating Factor; Prostaglandins; Serotonin; Skin; Soft Tissue Injuries; Thromboxanes; Vascular Resistance; Vasopressins

Exogenous arginine vasopressin (VP) has been increasingly used in the hemodynamic management of critically ill patients with septic shock, but its use in septic burn patients has not been systematically examined.. To review our experience with the use of VP in septic burn patients.. Retrospective review of all patients who received VP at a tertiary care adult regional burn centre. Only patients who strictly met the American College of Chest Physicians/Society of Critical Care Medicine Consensus Criteria for sepsis at the time of VP initiation were analysed.. There were 30 septic burn patients treated on 43 distinct occasions with VP. This group had a mean (+/-S.D.) age of 49+/-19 years, a mean % TBSA burn of 41+/-15% and a 37% incidence of inhalation injury. A significant increase in mean arterial pressure (MAP), a significant decrease in heart rate (HR), and a trend towards increased urine output (UO) occurred following initiation of VP. When VP was added to an existing infusion of norepinephrine (NE), there was a significant NE sparing effect. VP was implicated in the death of one patient who developed diffuse upper gastrointestinal necrosis while on VP. Other complications in patients treated with VP included peripheral ischemia (2), skin graft failure (1) and donor site conversion (1). In all complications, VP had been administered in combination with prolonged NE infusions (mean of 10 microg/min over a mean of 177 h).. VP is a useful adjunctive pressor that spares NE requirements in septic burn patients, but its use is not without risks, particularly when VP is combined with sustained moderate to high infusions of NE.

Topics: Adult; Blood Pressure; Burns; Graft Survival; Heart Rate; Hemostatics; Hospital Mortality; Humans; Middle Aged; Retrospective Studies; Sepsis; Skin Transplantation; Vasoconstrictor Agents; Vasopressins

Topics: Acute Kidney Injury; Anesthesia, General; Angiotensin II; Blood Pressure; Burns; Cell Membrane Permeability; Glomerular Filtration Rate; Glucocorticoids; Humans; Kidney; Methoxyflurane; Mineralocorticoids; Pressoreceptors; Renin; Sodium; Surgical Procedures, Operative; Vasopressins; Water-Electrolyte Balance

The stress response to surgery, critical illness, trauma, and burns encompasses derangements of metabolic and physiological processes that induce perturbations in the inflammatory, acute phase, hormonal, and genomic responses. Hypermetabolism and hypercatabolism result, leading to muscle wasting, impaired immune function and wound healing, organ failure, and death. The surgery-induced stress response is largely similar to that triggered by traumatic injuries; the duration of the stress response, however, varies according to the severity of injury (surgical or traumatic). This spectrum of injuries and insults ranges from small lacerations to severe insults such as large poly-traumatic and burn injuries. Burn injuries provide an extreme model of trauma induced stress responses that can be used to study the long-term effects of a prolonged stress response. Although the stress response to acute trauma evolved to confer improved chances of survival following injury, in modern surgical practice the stress response can be detrimental.

Topics: Burns; Critical Illness; Growth Hormone; Humans; Hydrocortisone; Inflammation; Muscular Diseases; Stress, Physiological; Surgical Procedures, Operative; Vasopressins; Wound Healing; Wounds and Injuries

Topics: Aquaporins; Brain Edema; Burns; Diarrhea; Fluid Therapy; Humans; Hypotonic Solutions; Inappropriate ADH Syndrome; Isotonic Solutions; Kidney; Neurons; Transcription Factors; Vasopressins; Vomiting; Water-Electrolyte Balance

The relationship between effective blood volume and related hormones in burn patients following resuscitation is not well understood. Previous reports have suggested that hormone secretion is altered by a resetting of neural control mechanisms. Serum and urine sodium, plasma renin activity, serum ADH, cardiac index, effective renal plasma flow, and total blood volume were measured in seven burn patients (mean age, total burn size, and postburn day: 32 years, 56%, and 9 days, respectively). The same values (with the exception of cardiac index and blood volume) were measured in 10 control patients (mean age, 24 years). The blood volume of patients was measured by 51chromium red blood cell (RBC) labeling and compared to normal predicted values based on body surface area and sex. Mean serum sodium and osmolality were 138 mmol/L (millimolar) and 286 mosm/kg, respectively, in both patients and control subjects. Mean +/- standard error of the mean total blood volume in the patients was low, 81% +/- 4% of predicted values. Cardiac index and renal plasma flow were significantly elevated. Plasma renin activity and antidiuretic hormone (ADH) levels were elevated and altered in the direction expected from blood volume measurements despite the findings of increased blood flow. Dissociation of organ flow and hormonal response suggests that simultaneous direct blood volume measurements are necessary to elucidate factors other than altered neural control settings to explain hormonal changes in the flow phase of injury. Depressed total blood volume appears to promote elevated ADH levels in burn patients following resuscitation. Whether there is an additional role of altered neural control settings remains to be established.

Topics: Adrenocorticotropic Hormone; Adult; Aldosterone; Atrial Natriuretic Factor; Blood Volume; Burns; Erythrocyte Volume; Female; Hemodynamics; Humans; Hydrocortisone; Male; Osmolar Concentration; Plasma Volume; Potassium; Renin; Sodium; Vasopressins; Water-Electrolyte Balance

Excision and skin grafting is the best treatment for burn wounds. In order to avoid excessive bleeding during the operation, sub-eschar infiltration with POR 8 (para ornithine 8 - vasopressin) has been performed in 115 patients between 1979 and 1984. The results being encouraging, infiltration was later also performed under the donor site. Bleeding was reduced enough by this technique to allow one stage excision and grafting of surfaces up to 20% of the body surface. No general or local complication of POR 8 infiltrations has been observed except a slight increase of blood pressure without clinical consequence.

Topics: Adolescent; Burns; Child; Child, Preschool; Hemorrhage; Humans; Infant; Ornipressin; Skin Transplantation; Vasopressins

It has been suggested that post-burn myocardial depression may be due to coronary constriction which results in myocardial ischaemia. It has been demonstrated that the levels of vasopressin, a potent natural constrictor of blood vessels, increase four- to six-fold immediately after thermal trauma. Therefore, this substance could be responsible for post-burn coronary constriction and myocardial depression. This was tested using the dog anaesthetized with sodium pentobarbital receiving a 15 per cent total body surface area full thickness flame burn as the experimental model. Cardiac output was measured by the thermal dilution technique. Arterial blood pressure was sensed by a Stathem P-23 transducer. Cardiac force of contraction was measured by a Walton-Brody strain gauge arch sewn on the left ventricle. The results of this study showed a significant decrease in cardiac output, increase in peripheral resistance and decrease in myocardial force of contraction immediately after thermal trauma in untreated animals. The decrease in cardiac output and increase in peripheral resistance remained for the duration of the experimental observations (3 h). The decrease in force of contraction returned to pre-burn levels 1 h post-burn. Pretreatment of the experimental animals with d(CH2)5 Tyr(Me)AVP (SK&F 100273), a vasopressin V-1 receptor blocking agent, prevented the initial decrease in cardiac output, increase in peripheral resistance and decrease in the force of contraction. A correlation plot of peripheral resistance vs. cardiac force of contraction showed a positive correlation between these two variables in the pretreated animals.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Animals; Arginine Vasopressin; Burns; Cardiac Output; Dogs; Myocardial Contraction; Premedication; Receptors, Angiotensin; Receptors, Vasopressin; Vascular Resistance; Vasopressins

Topics: Burns; Fluid Therapy; Humans; Hyponatremia; Infant; Male; Vasopressins; Water Intoxication

Previous investigators have shown that hypotension will cause an increase in plasma levels of both vasopressin and angiotensin II. Significant increases in peripheral resistance after thermal trauma suggested that a similar increase in plasma vasopressin and angiotensin II levels might occur under this condition. This possibility has been studied in the pentobarbital anesthetized dog. Peripheral resistance was calculated from measured cardiac output and mean arterial blood pressure. Vasopressin and angiotensin II levels were measured by radio-immunoassay. The results of this study showed that vasopressin plasma levels increase 4 to 6 fold 15 minutes after thermal trauma and remained elevated (3 to 4 fold) for at least 6 hours. Angiotensin II increased in a linear manner from 15 minutes to 6 hours post trauma. At 6 hours post trauma angiotensin II plasma levels were 4 times pretrauma levels. For the first 4 hours post trauma there was a positive correlation between the sum of vasopressin and angiotensin II plasma levels and the increase in peripheral resistance. These results suggest that the trauma induced increase in peripheral resistance is due to increases in plasma vasopressin and angiotensin II.

Topics: Angiotensin II; Animals; Burns; Cardiac Output; Dogs; Hypotension; Radioimmunoassay; Vascular Resistance; Vasopressins

Using the dog anaesthetized with sodium pentobarbital receiving a 15 per cent total body surface full skin thickness flame burn as an experimental model, it was observed that administration of the vasopressin, V-1 receptor, blocking agent d(CH2)5Tyr(Me)AVP (SK&F100273) prior to burn could significantly reduce the increase in peripheral resistance which occurs in untreated burned animals. At 30 min post-burn peripheral resistance was 60.2 +/- 7.8 units in treated animals and 117.1 +/- 16.8 units in untreated animals. At 60 min post-burn these values were 71.3 +/- 7.2 units and 117.0 +/- 13.5 units, respectively. Changes in cardiac output were significantly less in treated than untreated experimental animals. The mean arterial blood pressures were not significantly different. Plasma levels of vasopressin were measured by radio-immunoassay prior to burn and at 30-min intervals for 6 h following burn. At the time of taking blood samples for vasopressin levels, mean arterial blood pressure and cardiac output were measured and peripheral resistance was calculated. The results of this study showed that immediately post-burn vasopressin plasma levels increased from 6.2 +/- 2.2 pg/ml to 27.3 +/- 9.5 pg/ml and peripheral resistance increased from 62.3 +/- 6.3 units to 128.0 +/- 20.3 units. During the remaining 6 h of the experimental study both vasopressin plasma levels and peripheral resistance remained elevated. These results show that following thermal injury there is a significant release of vasopressin and suggest that the increase in peripheral resistance observed could be due in part to the vasoconstrictor action of the released vasopressin.

Topics: Animals; Arginine Vasopressin; Blood Pressure; Burns; Cardiac Output; Dogs; Vascular Resistance; Vasopressins

In the paediatric burn unit of Brugmann University Hospital, children are treated conservatively for three weeks before excision and grafting. In order to avoid excessive bleeding during tangential excision of the granulating tissue, sub-eschar infiltration with Para-Ornithin-8-Vasopressin (POR 8), a synthetic neurohypophyseal-like hormone, has been performed since 1979 on 145 children. Bleeding is reduced dramatically by this technique. Therefore, since 1984, infiltration of the donor site with POR 8 was also performed in 25 children. Excision and grafting of areas up to 20% of total body surface are possible in one operation with a graft take rate of 95 to 100%. We didn't record any variation in heart rate. A 5 to 10% increase of arterial blood pressure occurred in all children. No general or local complications have been observed. We believe this technique to be of great help in the operative treatment of burns in children.

Topics: Adolescent; Burns; Child; Child, Preschool; Hemorrhage; Humans; Infant; Ornipressin; Prospective Studies; Retrospective Studies; Skin Transplantation; Vasopressins

Diabetes insipidus was encountered in a 58-year-old woman after injury in an closed space fire. Carboxyhemoglobin measured 26% after 30 minutes of assisted ventilation with an FIO2 of 1.0. The failure of antidiuretic hormone was a sign of a diffuse cerebral insult caused by carbon monoxide poisoning. The hormonal deficit was easily corrected by exogenous vasopressin. Mortality was related to the cerebral lesion.

Topics: Burns; Burns, Inhalation; Carbon Monoxide Poisoning; Diabetes Insipidus; Female; Humans; Middle Aged; Prognosis; Vasopressins

The time-course of changes in the antidiuretic activity of plasma in response to burn injury has been assayed in intact rabbits and in those with an altered body reactivity induced by a preliminary injury to the anterior and posterior hypothalamus. It was demonstrated that in control animals and in rabbits with an injury to the anterior hypothalamus, the burn led to a phasic activation of the hypothalamo-neurohypophyseal system. In animals with an injury to the posterior hypothalamus, the burn, in contrast, inhibited the activation of the system, while the phasic pattern of the responses remained unchanged. The experiments on rats have shown that the decreased activity of the hypothalamo-neurohypophyseal system induced by the pharmacological blockade of the supraoptic nuclei of the hypothalamus raised the body resistance in burn injury.

Topics: Animals; Burns; Diuresis; Ethanol; Hypothalamus; Hypothalamus, Anterior; Hypothalamus, Posterior; Male; Rabbits; Supraoptic Nucleus; Vasopressins

Eight burn patients with smoke inhalation were studied. High levels of plasma vasopressin and plasma cortisol in the presence of polyuria were observed. Stress and pain seem to be the main factors in the vasopressin oversecretion; the polyuria probably resulted from fluid administration and osmotic diuresis.

Topics: Burns; Humans; Hydrocortisone; Polyuria; Shock, Traumatic; Vasopressins

ADH has been implicated in the development of a positive water balance in thermal injury. However, the association of plasma ADH levels to the hemodynamic response and water and electrolyte balance of early thermal injury has not been defined. Plasma ADH was measured by radioimmunoassay in 13 patients with greater than 15% body surface area burns. In three patients frequent hemodynamic measurements were also made. Large individual variations of ADH were noted, but in general the ADH levels peaked early in the postburn period and declined thereafter. The highest mean ADH value was on day 2 (53.8 = 27 pg/ml); the lowest value on day 7 (13.4 +/- 8 pg/ml). Urine electrolytes demonstrated wide variation (Na+, 2 to 236 mEq/L; K+, 2 to 228 mEq/L) as did serum (261--331 mOsm/kg) and urine (557--785 mOsm/kg) osmolalities. No correlation was noted between ADH levels and osmolalities or hemodynamic variables. These data suggest that ADH response following burns is a stress response producing levels beyond the physiologic range for an antidiuretic effect and that the osmolar, hypovolemic, and hypotensive feedback loops are not involved: ADH seems to act as a vasoconstrictor and to have no significant effect on quality or quantity of urine. We conclude that the positive water balance following burns is not ADH mediated.

Topics: Adult; Aged; Body Water; Burns; Humans; Middle Aged; Osmolar Concentration; Potassium; Sodium; Vasopressins

Earlier published results have shown an increased 5-day survival in burned mice treated with Triglycylvasopressin. In order to analyze the cause of the increased survival, the distribution of cardiac output was studied in 51 mice divided into three groups. The investigation was performed on the 5th day after burn using a soluble indicator technique (86Rb). The first group consisted of unburned animals. In the second and third groups, a standardized burn of 15% of the body surface was undertaken. The animals in the second group were used as controls and received isotonic saline solution for 5 days. The third group were used as controls and received isotonic saline solution and in addition Triglycylvasopressin, a vasopressin with prolonged effect, 100 microgram/kg body weight subcutaneously twice a day in such a way that the total volume of fluid was identical in the different groups. Cardiac output distribution showed an increased fraction to kidney, liver and small bowel and a decreased fraction to carcass in the Triglycylvasopressin-treated animals compared to burned controls.

Topics: Animals; Burns; Cardiac Output; Drug Evaluation, Preclinical; Female; Gastrointestinal Hemorrhage; Lypressin; Male; Mice; Vasopressins

Cardiac output and regional blood flow to different organs were determined at one hour and at 24 hours after burn in untreated mice and in mice treated with triglycylvasopressin (TGLVP). A decrease in cardiac output was found in all animals at one hour after burn. At 24 hours cardiac output was decreased in the burned untreated group, while cardiac output of TGLVP-treated animals did not differ from that of unburned animals. Organ blood flow was decreased in all animals at one hour after burn. Such a decrease was seen in the untreated group also at 24 hours after burn, while organ blood flow in the TGLVP-treated group had returned to preburn values.

Topics: Animals; Burns; Cardiac Output; Female; Hemodynamics; Male; Mice; Regional Blood Flow; Vasopressins

Cardiac output distribution, blood pressure and flow in a carotid artery catheter during the first five days after a standardized 15% third degree burn were studied in groups of mice treated with triglycylvasopressin, and in groups used as controls. All animals received isotonic saline solution amounting to 20% of the body weight twice daily, and the treated groups received in addition triglycylvasopressin (TGLVP), a vasopressin analogue with prolonged effect, 100 microgram/kg body weight twice daily. Cardiac output distribution was determined by the 86Rubidium-technique, and showed in burned animals a decreasing fraction to kidneys and small bowel as well as an increased share to the carcass during the experimental period. These changes were partly counteracted by TGLVP-treatment. Flow in the carotid artery catheter in the treated group far exceeded that in the controls, which might be explained by a lower viscosity of the blood in the treated group.

Topics: Animals; Blood Pressure; Blood Viscosity; Burns; Cardiac Output; Drug Evaluation, Preclinical; Female; Hemodynamics; Male; Mice; Regional Blood Flow; Vasopressins

Topics: Animals; Antacids; Burns; Central Nervous System Diseases; Humans; Peptic Ulcer; Postoperative Complications; Stomach Ulcer; Stress, Physiological; Vasopressins; Wounds and Injuries

Standardized skin burn injuries were induced in 253 NMRI mice. The burned surface corresponded to 15% of the total surface of a 25-gram mouse. All animals received intraperitoneal injection of an isotonic saline solution in a dose of 20% of body weight/day for 5 days. The material was divided into three groups, i.e. group A (controls) which received no further treatment, groups B and C which, in addition, received triglycylvasopressin (a vasopressin with prolonged effect) 100 and 200 mug/kg body weight, respectively, subcutaneously twice a day. The highest survival rate was registered in group B (61%), while the controls had a survival of 36%.

Topics: Animals; Burns; Disease Models, Animal; Dose-Response Relationship, Drug; Female; Male; Mice; Vasopressins

Topics: Adolescent; Blood Transfusion; Burns; Child; Child, Preschool; Humans; Infant; Skin Transplantation; Transplantation, Autologous; Vasopressins

Topics: Acute Kidney Injury; Aldosterone; Animals; Anuria; Burns; Diabetes Insipidus; Disease Models, Animal; Diuresis; Diuretics; Furosemide; Kidney; Male; Mineralocorticoid Receptor Antagonists; Rats; Shock, Traumatic; Sodium; Sodium Chloride; Time Factors; Urea; Vasopressins; Water

Topics: Adult; Blood Glucose; Blood Urea Nitrogen; Blood Volume; Burns; Diabetes Complications; Diuresis; Female; Glycosuria; Humans; Hypernatremia; Infusions, Parenteral; Male; Middle Aged; Nitrogen; Osmolar Concentration; Sepsis; Vasopressins; Water-Electrolyte Balance

Topics: Animals; Blood Circulation; Bradykinin; Burns; Drug Synergism; Duodenum; Edema; Epinephrine; Female; Guinea Pigs; Ileum; In Vitro Techniques; Inflammation; Phenoxybenzamine; Propranolol; Rats; Uterus; Vasopressins

Topics: Anesthesia, General; Burns; Child; Epinephrine; Hemorrhage; Humans; Infant; Norepinephrine; Ornithine; Skin Transplantation; Transplantation, Autologous; Transplantation, Heterologous; Transplantation, Homologous; Vasoconstrictor Agents; Vasopressins

Topics: Adult; Age Factors; Body Surface Area; Burns; Burns, Electric; Female; Glomerular Filtration Rate; Humans; Kidney; Kidney Concentrating Ability; Male; Middle Aged; Osmolar Concentration; Sodium; Vasopressins; Water-Electrolyte Balance

Topics: Aldosterone; Arginine Vasopressin; Body Fluids; Burns; Humans; Vasopressins

Topics: Animals; Ascorbic Acid; Burns; Diuresis; Diuretics; Dogs; Hormones; Pituitary Gland; Pituitary Gland, Posterior; Pituitary Hormones, Posterior; Vasopressins