The purpose of this observational study is to examine whether Endotheliopathy of Trauma (EoT) is present in severely burned patients and how it is affected by burn debridement surgery.
The main questions it aims to answer are:
* Do severely burned patients present with EoT before undergoing burn debridement surgery? * Does the surgical intervention worsen EoT, leading to increased postoperative syndecan 1 (sdc 1) levels compared to preoperative levels?
Participants will:
* Undergo debridement surgery where the total area of debrided and donor sites covers 20% or more of the Total Body Surface Area (TBSA). * Have their sdc 1 levels measured before and after surgery. * Have perioperative factors analyzed to assess their impact on endothelial damage and glycocalyx functionality.
This study aims to provide insight into how surgical resuscitation affects the endothelial glycocalyx in severely burned patients.
Patients over 18 years old with burned TBSA greater than or equal to 20%.
Patients who will undergo debridement of at least 20% of the burned TBSA (including the debrided area and the donor site).
Under 18 years old.
Pregnant women.
Patient refusal.
Polytraumatized patients.
Patients admitted to the Burn Unit of Vall d'Hebron University Hospital with burned TBSA ≥ 20% who undergo debridement surgery (total area between the debrided and donor sites ≥ 20% of TBSA).
Cohort
Prospective
Debridement Surgery
Procedure/SurgerySurgical debridement of burn wounds involving ≥ 20% of the TBSA, including debrided and donor sites.
Sdc-1 Level Measurement
Diagnostic testMeasurement of plasma sdc-1 levels in different situations to assess endothelial glycocalyx damage using an enzyme-linked immunosorbent assay (ELISA): Preoperatively: * Upon admission to the Burn Unit. * 24 hours after admission to the Burn Unit. * Prior to the start of surgery, after anesthetic induction. * If surgery is performed after the fifth day following the burn, an additional sdc-1 measurement will be taken on the fifth day of hospital admission. Postoperatively: * 6 hours after surgery. * 24 hours after surgery. * 48 hours after surgery.
Sdc-1 perioperative changes
Sdc-1 levels will be measured upon admission to our Burn Unit, 24 hours after admission, on the 5th day of admission if surgery has not yet been performed, immediately before debridement surgery, and during the first 48 hours postoperatively.
Postoperative complications
1. Cardiovascular complications (yes/no): new-onset atrial fibrillation or other arrhythmias, presence of non-fatal cardiopulmonary arrest, acute myocardial infarction, acute pulmonary edema, and myocardial injury after non-cardiac surgery (MINS). 2. Pulmonary complications (yes/no): pneumonia, whether associated with mechanical ventilation or not, pleural effusion, acute respiratory distress syndrome (ARDS), pneumothorax, bronchospasm, and the need for tracheostomy. 3. Renal failure (yes/no): need for dialysis or hemofiltration (yes/no). 4. Abdominal compartment syndrome (yes/no). 5. Thrombotic complications (yes/no): lower limb thrombosis, pulmonary embolism, and cerebrovascular accident. (The following publication is used as a reference for the definition of complications: DOI: 10.1097/EJA.0000000000000118).
Fluid and transfusion requirements
Volume of fluids and blood products transfused during surgery and in the postoperative period.
Coagulation abnormalities (preoperative and postoperative)
Analysis of the coagulation abnormalities (guided by classic coagulation tests and thromboelastometry parameters) resulting from burn debridement surgery
Duration of Mechanical Ventilation
Number of days on mechanical ventilation after debridement surgery
Inhalation injury
Incidence of inhalation injury in severely burned patients
Preoperative complications
Incidence of pre-surgical complications including: pulmonary infection, urinary tract infection, renal dysfunction, skin infection, shock, pulmonary distress, ischemic heart disease, atrial fibrillation, thrombotic or hemorrhagic stroke.
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