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Biomedical subjects

C W Goodwin

Publications and source records attributed to C W Goodwin.

At least 55 records · Page 3Linked to original sources
PubMed1985

Upper airway sequelae in burn patients requiring endotracheal intubation or tracheostomy.

During a period of 11 1/2 months, 41 of 217 adult burn patients admitted to the U.S. Army Institute of Surgical Research Burn Center required endotracheal intubation or tracheostomy for management of the airway and/or ventilatory assistance. Permanent upper airway sequelae were recorded and related to presence of inhalation injury, duration of tube placement, cuff pressure, and pulmonary compliance. An "inhalation injury scoring system" based upon history, physical examination, bronchoscopic findings, and abnormalities at 133xenon lung scan correlated well with postinjury alteration in compliance and subsequent sequelae. Significant inhalation injury was found in 35 patients. Seventeen of the study patients survived (Group I) and 24 patients expired (Group II). Group I patients were screened for permanent airway sequelae by fiberoptic bronchoscopy, xeroradiograms, and spirometry undertaken an average of 11 weeks after extubation or decannulation. Four patients developed tracheal stenosis and five patients had significant tracheal scar granuloma formation. Sequelae were generally more frequent and more severe after tracheostomy than after translaryngeal intubation, and duration of tube placement and presence of a tracheal stoma were the most important etiological factors in permanent damage. For initial respiratory support, we favor the use of translaryngeal (nasotracheal) tubes for periods up to 3 weeks. Fiberoptic bronchoscopic examination is the most reliable follow-up method for detecting anatomic damage in such patients. Spirometry can be used as a noninvasive screening test and xeroradiograms are helpful in assessing the degree of tracheal stenosis.

Adolescent↗
PubMed1985

O2 exchange between blood and brain tissues studied with 18O2 indicator-dilution technique.

A technique has been developed to record 18O2 dilution curves of an organ in vivo by use of 51Cr-labeled erythrocytes as a reference tracer. The technique employs anaerobic sampling of venous outflow following an intraarterial injection of tracer-laden blood and off-line determination of [18O2] and [51Cr] profiles in the venous outflow. O2 and reference indicator-dilution curves of cerebral circulation were recorded in eight experiments with six halothane-anesthetized dogs. Autologous blood labeled with the tracers was injected into a carotid artery, and brain venous outflow was sampled from the sagittal sinus. The total net extraction of O2 tracer was equal to the extraction of elemental O2. Instantaneous extraction of 18O2 along the outflow curve fell linearly with time, from an initial value of 0.6-0.7 to very small or even negative values toward the end of a pulse. This indicates that O2 undergoes a flow-limited distribution. In all experiments, the mean transit time of unmetabolized 18O2 was longer than the mean transit time of the Cr tracer. An index of the tissue O2 dilution space, hence the mean tissue PO2, is calculated from this data with the use of a modified central volume principle. This estimate of mean tissue PO2 increases as a linear function of sagittal sinus PO2 with a slope of 0.97. The method may provide an index of the critical PO2 of venous blood, the PO2 below which O2 diffusion from blood to tissue may limit its rate of metabolic uptake.

Animals↗
PubMed1985

Metabolism and nutrition in the thermally injured patient.

Following severe thermal injury, the metabolic rate increases to a level often exceeding twice that of the uninjured individual. This hypermetabolic response necessitates a corresponding increase in nutritional support, which must be maintained until the wound has closed and fully matured. Nutrient composition and administration techniques are determined by the patient's ongoing physiologic response to injury.

Basal Metabolism↗
PubMed1985

Thermal injury in the pregnant patient.

Thermal injury sustained during pregnancy presents special management problems for both the gravid woman and her unborn child. Of 6,573 admissions to this burn center during the period of 1950 through 1982, 1,157 (17.6 per cent) were female and 448 (6.8 per cent) were of reproductive age. Thirty of this latter group (6.7 per cent) of burned patients were pregnant at the time of injury. These 30 patients ranged in age from 16 to 37 years old (an average of 22.7 years) and the burned portion of the total body surface area ranged from 6 to 92 per cent (an average of 39.7 per cent). A review of the clinical courses of these 30 patients suggests several observations and conclusions. Pregnancy does not alter the maternal outcome after thermal injury and maternal survival is usually accompanied by fetal survival in the absence of significant complications. If the injury of the gravid patient is lethal, the pregnancy will usually terminate spontaneously prior to her death. Obstetric support and aggressive fetal monitoring is recommended for all moderately and severely burned pregnant patients. Obstetric intervention may be considered in the ill patient with a near term fetus in whom significant complications (such as, hypotension, hypoxemia or sepsis) jeopardize the life of the fetus.

Adolescent↗
PubMed1984

Altered protein metabolism in diaphragms from thermally injured rats.

Thermal injury is known to cause increased muscle catabolism, but the mechanisms involved in this process are not clear. Diaphragms from thermally injured rats were removed and incubated in vitro on the third postburn day in order to determine the rates of protein synthesis and degradation using [14C]tyrosine uptake and release as an indicator of these processes. Diaphragms from rats that received 50% total body surface, full-thickness wounds and unburned sham-treated controls were examined. The rate of protein synthesis in the absence of insulin supplementation was found to decrease (26%) and the rate of protein degradation increased (81%) under these conditions. Insulin supplementation (0.1 U/ml) to the incubation media caused a significant increase (39%) in the rate of synthesis in the sham-controls but did not stimulate synthesis in the burned group. Degradation rates measured in the presence of insulin were increased in the burned group (64%), but were somewhat blunted in comparison to the insulin-deficient degradation rates (81%). These results indicate that diaphragm muscles from thermally injured rats show a decreased insulin stimulation of protein synthesis after injury, and insulin does not significantly alter the enhanced rate of protein degradation observed in these muscles after injury.

Animals↗
PubMed1984

Use of vitamin supplements for burned patients: a national survey.

Vitamin losses and requirements of critically ill and burned patients remain undefined in the current research and clinical literature. A survey was conducted to determine the vitamin supplementations routinely prescribed for burned patients, dosages, and the criteria for administration. A questionnaire was sent to 271 health care providers (dietitians and physicians) who work in burn care facilities in the United States. Forty-seven percent of the questionnaires were completed and returned. They showed that 87% of the respondents routinely prescribed vitamin supplementation. Of those, 97% used some kind of multivitamin preparation. Fifty-eight percent of the multivitamin dosages exceeded 100% of the Recommended Dietary Allowances. Several respondents indicated that extra vitamins were given in addition to the multivitamin preparations. Most facilities used more than one specific criterion for prescribing vitamins when supplementation was not routine. Burn size, nutritional status prior to admission, and poor dietary intake were the criteria most commonly identified. Further research is needed to provide guidelines for the kind and amount of vitamin supplements needed for burned patients.

Burns↗
PubMed1983

Subeschar treatment of burn-wound infection.

Within a 24-month period, 454 patients were admitted with burns (average size, 33% of the total body surface [TBS]). Wound infection developed in 19, who subsequently were treated with subeschar antibiotics. The average burn size in those 19 patients was 63% of the TBS, with an average full-thickness injury of 47%. Five (26%) of the 19 survived, and five others died without evidence of wound infection, giving a would clearance rate of 52.6%. The five surviving patients (average burn size, 59% TBS) underwent excision of infected tissue, with split-thickness cutaneous autograft closure of the burn wound, after the course of subeschar antibiotic infusion. All surviving patients were infected with Pseudomonas aeruginosa. Subeschar infusion of semisynthetic penicillins, therefore, is an effective adjunct in the care of the patient with Pseudomonas burn-wound infection.

Administration, Topical↗
PubMed1983

Neutral proteinase activity in skeletal muscle from thermally injured rats.

Male Sprague-Dawley rats that received 60% total body surface, full-thickness, scald burns on the dorsum and abdomen were used in this study. Neutral proteinase and Ca2+-activated neutral proteinase activities were measured in gastrocnemius and soleus muscles at 3 and 21 days after the thermal injury. Neutral proteinase activity decreased significantly in the soleus (50%) and gastrocnemius (46%) muscles on the third postburn day. Ca2+-activated neutral proteinase was unchanged at this time. Neutral proteinase and Ca2+-activated neutral proteinase activities were unaltered at 21 days postinjury. These results may reflect a protein-sparing effect on the third postburn day which could be an early intracellular change prior to an increase in selected enzyme proteins during the hypermetabolic phase after thermal injury.

Animals↗
PubMed1983

Randomized trial of efficacy of crystalloid and colloid resuscitation on hemodynamic response and lung water following thermal injury.

To assess the effects of crystalloid and colloid resuscitation on hemodynamic response and on lung water following thermal injury, 79 patients were assigned randomly to receive lactated Ringer's solution or 2.5% albumin-lactated Ringer's solution. Crystalloid-treated patients required more fluid for successful resuscitation than did those receiving colloid solutions (3.81 vs. 2.98 ml/kg body weight/% body surface burn, p less than 0.01). In study phase 1 (29 patients), cardiac index and myocardial contractility (ejection fraction and mean rate of internal fiber shortening, Vcf) were determined by echocardiography during the first 48 hours postburn. Cardiac index was lower in the 12- to 24-hour postburn interval in the crystalloid group, but this difference between treatment groups had disappeared by 48 hours postburn. Ejection fractions were normal throughout the entire study, while Vcf was supranormal (p less than 0.01 vs. normals) and equal in the two resuscitation groups. In study phase 2 (50 patients), extravascular lung water and cardiac index were measured by a standard rebreathing technique at least daily for the first postburn week. Lung water remained unchanged in the crystalloid-treated patients (p greater than 0.10), but progressively increased in the colloid-treated patients over the seven day study (p less than 0.0001). The measured lung water in each treatment group was significantly different from one another (p less than 0.001). Cardiac index increased progressively and identically in both treatment groups over the study period (p less than 0.01). These data refute the existence of myocardial depression during postburn resuscitation and document hypercontractile left ventricular performance. The addition of colloid to crystalloid resuscitation fluids produces no long lasting benefit on total body blood flow, and promotes accumulation of lung water when edema fluid is being reabsorbed from the burn wound.

Adolescent↗
PubMed1983

Prospective study of burn wound excision of the hands.

To examine the role of early excision and grafting in the preservation of maximal function of hands with deep dermal burns, we prospectively evaluated 164 burned hands in consecutively admitted patients (mean age, 29 years; mean burn size, 37% of body surface). All hands with burn depths of second degree, deep second degree, or third degree above the level of the tendons and joint capsules were assessed preoperatively, intraoperatively, and at discharge from the hospital. Patients were treated by excision and grafting in the first or second postburn week, by delayed grafting alone, or by allowing primary healing. Total active range of motion measurements were made on the day of discharge (mean, 64th postoperative day). Mean operative blood loss per hand was 1,270 ml. When all (alive and dead) patients undergoing early excision and grafting were examined by a binomial probability model, early surgery was shown to produce no adverse affect on survival. Excision and grafting of hands with deep dermal burns, whether early or late, offered no advantage over physical therapy and primary healing in maintaining hand function. Likewise, hands with more superficial burns responded equally to operative and nonoperative treatment. While early excision and grafting of hands with third-degree burns tended to produce poorer results than did initial nonoperative care and late grafting, the differences are just outside the range of significance. Early excision and grafting of selected third-degree injuries of the hands may be indicated in patients with small total body surface burns in order to shorten hospital stay. However, early surgical intervention in patients with massive burns should be directed toward area coverage, not toward hand excision.

Adolescent↗
PubMed1982

Altered muscle metabolism in rats after thermal injury.

Burn injury is associated with an elevation in total body oxygen consumption, increased hepatic alanine uptake and conversion to glucose, and a negative nitrogen balance. The primary source of the alanine used for gluconeogenesis by the liver and of the nitrogen lost as urea is believed to be from skeletal muscle. Selected muscle regulatory enzymes and pyruvate and oleate oxidation rates were assayed for maximal activity during the postburn period. Male Sprague-Dawley rats that received 50% total body surface scald burns on the dorsum and abdomen were examined for citrate synthase (CS), phosphofructokinase (PFK), and glutamate-pyruvate transaminase (GPT) activity in uninjured muscle at 3, 7, 13, and 20 days postburn, and the ability of muscle to oxidize pyruvate and oleate was measured at 3 and 13 days after injury. Cs, PFK, and GPT activities increased significantly (p less than 0.05) by 13-20 days after injury in the soleus and diaphragm. The epitrochlearis showed no change in CS, but PFK and GPT were elevated within this time frame. The gastrocnemius muscle showed an elevated oleate oxidation rate at 13 days after injury, but no change at 3 days postburn. Pyruvate oxidation rates were unaltered. The results of this study indicate that during the postburn period several metabolic alterations occur in muscle. These adaptations include: (1) elevated CS activity which may be associated with increased oxidative capacity,, (2) increased PFK activity which implies that more substrate is being shuttled through the glycolytic pathway, (3) increased GPT activity which may reflect increased pyruvate conversion to alanine, and (4) increased oleate oxidation rates which demonstrate that muscle is utilizing more fatty acid substrates during the postburn period.

Adaptation, Physiological↗
PubMed1982

Management of abdominal wounds in thermally injured patients.

Over a 10-year period, 103 burned patients (mean age, 25 years; mean burn size, 43% of the total body surface) required an intra-abdominal operation. Life-threatening complications dictated operative intervention, and the complications resulted in increased mortality. Abdominal incisions dehisced in 33 patients. In 75 patients whose 91 incisions were closed with retention sutures, 18 wounds (20%) separated postoperatively, including seven in which synthetic sutures disrupted. In 28 patients whose 35 abdominal incisions were closed without retention sutures, 15 wounds (43%) dehisced. Placement of the abdominal incision through the burn wound appeared not to affect the incidence of dehiscence. When an abdominal operation is required in burned patients, their wounds should be closed by stainless steel wire, usually as retention sutures, placed through all muscle and facial layers of the abdominal wall.

Abdominal Injuries↗
PubMed1982

Cortisol and corticotrophin in burned patients.

In a study of 36 men burned in a fire, based on sequential early morning samples, plasma cortisol concentration was elevated in proportion to burn size. Plasma corticotrophin (ACTH) was not correlated with burn size, suggesting that factors other than ACTH contribute to the elevated cortisol. Cortisol levels did not fall on the days preceding death in nonsurvivors. During 24-hr sampling, burned patients exhibited a fitted cortisol curve mean that was elevated in proportion to burn size, a rhythm amplitude that was significantly less than that in uninjured controls, and a normal peak time. Metabolic rate, rectal temperature, and urinary catecholamine excretion were also elevated in proportion to burn size. Although plasma cortisol was positively correlated with metabolic rate and with temperature, this appeared to result from a common relationship of these variables with burn size. On the other hand, urinary catecholamine values significantly reduced the residual variance of metabolic rate and temperature after accounting for variance related to burn size. Cortisol appears to be less prominent than catecholamines as a possible mediator of the elevated thermogenesis.

Adolescent↗
PubMed1982

Underestimation of thermal lung water volume in patients with high cardiac output.

When utilizing the intravascular double-indicator dilution technique to measure extravascular lung water, blood flow may be so high that diffusion equilibrium of the diffusible indicator fails to occur and the water distribution space is underestimated during the first 7 days after thermal injury. We serially measured cardiac index and lung water in five severely burned patients (mean age 24 years, range 18 to 33 years; mean burn size 56% total body surface, range 43% to 80%) by a rebreathing method utilizing two gases of differing solubility and by the thermal-indocyanine green dye (ICG) double-indicator dilution technique. Rebreathing lung water, determined by a time- and blood flow-insensitive method, increased significantly over the study period, from 6.6 ml/kg on admission to the hospital 11.3 ml/kg on postburn day 6 (+70%, P less than 0.01). Thermal-ICG lung water decreased slightly as blood flow rose. Rebreathing lung water correlated with clinical data in a patient with pulmonary edema, while thermal-ICG lung water changed in the opposite direction. Our data suggest that the thermal-ICG technique may be diffusion limited by short transit times at the high flows characteristic of burned and other critically ill patients with hyperdynamic circulations. Additionally, segmented redistribution of pulmonary blood flow known to occur in burn patients may contribute to underestimation of lung water.

Adolescent↗