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Epidermal wound healing in severe sepsis and septic shock in humans.

Koskela M, Gäddnäs F, Ala-Kokko TI, Laurila JJ, Saarnio J, Oikarinen A, Koivukangas V - Crit Care (2009)

Bottom Line: On the fourth day, septic patients had significantly higher blood flow in the wound compared with the control subjects (septic patients 110 units versus control subjects 47 units, P = 0.001).No difference in transepidermal water loss from the intact skin was found between septic patients and controls.Septic patients had higher blood flow in the intact skin on the fourth and on the eighth day of study compared with the controls.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Anesthesiology, Division of Intensive Care Medicine, Oulu University Hospital, 90029 OUH, Finland. masipola@paju.oulu.fi

ABSTRACT

Introduction: The effect of sepsis on epidermal wound healing has not been previously studied. It was hypothesised that epidermal wound healing is disturbed in severe sepsis.

Methods: Blister wounds were induced in 35 patients with severe sepsis and in 15 healthy controls. The healing of the wounds was followed up by measuring transepidermal water loss and blood flow in the wound, reflecting the restoration of the epidermal barrier function and inflammation, respectively. The first set of suction blisters (early wound) was made within 48 hours of the first sepsis-induced organ failure and the second set (late wound) four days after the first wound. In addition, measurements were made on the intact skin.

Results: The average age of the whole study population was 62 years (standard deviation [SD] 12). The mean Acute Physiology and Chronic Health Evaluation II (APACHE II) score on admission was 25 (SD 8). The two most common causes of infections were peritonitis and pneumonia. Sixty-six percent of the patients developed multiple organ failure. The decrease in water evaporation from the wound during the first four days was lower in septic patients than in the control subjects (56 g/m2 per hour versus 124 g/m2 per hour, P = 0.004). On the fourth day, septic patients had significantly higher blood flow in the wound compared with the control subjects (septic patients 110 units versus control subjects 47 units, P = 0.001). No difference in transepidermal water loss from the intact skin was found between septic patients and controls. Septic patients had higher blood flow in the intact skin on the fourth and on the eighth day of study compared with the controls.

Conclusions: The restoration of the epidermal barrier function is delayed and wound blood flow is increased in patients with severe sepsis.

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Related in: MedlinePlus

Skin blood flow on the first day of the late wound. A significant difference was found between the study group and the control group. The lower and upper edges of each box indicate the interval between the 25th and 75th percentiles. The vertical line represents the range and the horizontal line within the box represents the median of each group. BF, blood flow.
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Figure 3: Skin blood flow on the first day of the late wound. A significant difference was found between the study group and the control group. The lower and upper edges of each box indicate the interval between the 25th and 75th percentiles. The vertical line represents the range and the horizontal line within the box represents the median of each group. BF, blood flow.

Mentions: In the early wound, there were no differences in blood flow after blister induction between groups (Table 4). This suggests that the initial inflammation does not show any alteration in the early phase of sepsis. On the contrary, the mean blood flow on the fourth day of healing in the early wound was significantly higher in the septic group, which suggests that sepsis aggravates the healing-related induction of inflammation (Figure 2 and Table 4). In the late wound, the mean blood flow after blister induction was significantly higher in septic patients than in the control subjects (Figure 3). It was also higher on the fourth day of healing (eighth day of the study) (Table 4). This suggests that both initial and induced wound inflammation are intensified in patients with established septic disease, which is possibly the result of systemic inflammation. The blood flow values did not differ between patients who received or did not receive steroid treatment. On the first day, there were no differences in mean blood flow from the intact abdominal skin in the septic group (15 units, SD 12) and in the control group (14 units, SD 9). However, on the fourth day, the mean blood flow from intact skin was higher in the septic group (24 units, SD 18) compared with the controls (6 units, P = 0.000) (Figure 4).


Epidermal wound healing in severe sepsis and septic shock in humans.

Koskela M, Gäddnäs F, Ala-Kokko TI, Laurila JJ, Saarnio J, Oikarinen A, Koivukangas V - Crit Care (2009)

Skin blood flow on the first day of the late wound. A significant difference was found between the study group and the control group. The lower and upper edges of each box indicate the interval between the 25th and 75th percentiles. The vertical line represents the range and the horizontal line within the box represents the median of each group. BF, blood flow.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2717472&req=5

Figure 3: Skin blood flow on the first day of the late wound. A significant difference was found between the study group and the control group. The lower and upper edges of each box indicate the interval between the 25th and 75th percentiles. The vertical line represents the range and the horizontal line within the box represents the median of each group. BF, blood flow.
Mentions: In the early wound, there were no differences in blood flow after blister induction between groups (Table 4). This suggests that the initial inflammation does not show any alteration in the early phase of sepsis. On the contrary, the mean blood flow on the fourth day of healing in the early wound was significantly higher in the septic group, which suggests that sepsis aggravates the healing-related induction of inflammation (Figure 2 and Table 4). In the late wound, the mean blood flow after blister induction was significantly higher in septic patients than in the control subjects (Figure 3). It was also higher on the fourth day of healing (eighth day of the study) (Table 4). This suggests that both initial and induced wound inflammation are intensified in patients with established septic disease, which is possibly the result of systemic inflammation. The blood flow values did not differ between patients who received or did not receive steroid treatment. On the first day, there were no differences in mean blood flow from the intact abdominal skin in the septic group (15 units, SD 12) and in the control group (14 units, SD 9). However, on the fourth day, the mean blood flow from intact skin was higher in the septic group (24 units, SD 18) compared with the controls (6 units, P = 0.000) (Figure 4).

Bottom Line: On the fourth day, septic patients had significantly higher blood flow in the wound compared with the control subjects (septic patients 110 units versus control subjects 47 units, P = 0.001).No difference in transepidermal water loss from the intact skin was found between septic patients and controls.Septic patients had higher blood flow in the intact skin on the fourth and on the eighth day of study compared with the controls.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Anesthesiology, Division of Intensive Care Medicine, Oulu University Hospital, 90029 OUH, Finland. masipola@paju.oulu.fi

ABSTRACT

Introduction: The effect of sepsis on epidermal wound healing has not been previously studied. It was hypothesised that epidermal wound healing is disturbed in severe sepsis.

Methods: Blister wounds were induced in 35 patients with severe sepsis and in 15 healthy controls. The healing of the wounds was followed up by measuring transepidermal water loss and blood flow in the wound, reflecting the restoration of the epidermal barrier function and inflammation, respectively. The first set of suction blisters (early wound) was made within 48 hours of the first sepsis-induced organ failure and the second set (late wound) four days after the first wound. In addition, measurements were made on the intact skin.

Results: The average age of the whole study population was 62 years (standard deviation [SD] 12). The mean Acute Physiology and Chronic Health Evaluation II (APACHE II) score on admission was 25 (SD 8). The two most common causes of infections were peritonitis and pneumonia. Sixty-six percent of the patients developed multiple organ failure. The decrease in water evaporation from the wound during the first four days was lower in septic patients than in the control subjects (56 g/m2 per hour versus 124 g/m2 per hour, P = 0.004). On the fourth day, septic patients had significantly higher blood flow in the wound compared with the control subjects (septic patients 110 units versus control subjects 47 units, P = 0.001). No difference in transepidermal water loss from the intact skin was found between septic patients and controls. Septic patients had higher blood flow in the intact skin on the fourth and on the eighth day of study compared with the controls.

Conclusions: The restoration of the epidermal barrier function is delayed and wound blood flow is increased in patients with severe sepsis.

Show MeSH
Related in: MedlinePlus