Potential use of computer simulation in treatment of burns with special regard to oedema formation.

Abstract

The potential usefulness of computer-based 'patient-simulators' in burn care is discussed and illustrated in the special case of oedema formation in three patients with severe thermal injuries. The present model was derived from a model by Wiederhielm (1978), and modified to be applicable to thermal injuries. The model seems to describe accurately the oedema formation as well as the distribution and composition of local and general oedema. Following thermal injuries the general oedema is characterized by typical disturbances in the circulatory state variables such as capillary pressure and plasma colloid osmotic pressure. The net water flow is increased because of an increase in filtration rate and a decrease in reabsorption rate. The resulting interstitial oedema leads to dilution of the free water proteins and a decrease in interstitial colloid osmotic pressure. The elevation of interstitial pressure leads to an increase in lymph flow. The local oedema is caused by changes in both the circulatory system and the interstitial space. There is an increase in both water and protein net flows. The latter is due to increased protein leakage to the interstitium. This results in an interstitial oedema with a higher protein concentration in free water than in general oedema. Because of the higher protein concentration in free water, the interstitial colloid osmotic pressure is at all times larger than the corresponding pressure in general oedema. In all three patients the general shape of the simulated and measured oedema curve were the same, but with minor differences in numerical values. It is interesting to note that the general oedema was larger than the local oedema in all three extensively burned patients. The results from the present investigation indicate the importance of monitoring either the total plasma protein concentration or the plasma colloid osmotic pressure and small vein pressure for guidance of a proper fluid resuscitation. The steady state 'oedema vs. venous pressure'-diagram obtained may also be used for evaluating the dynamic effects on general oedema formation due to changes in venous pressure and plasma protein concentration. It thus turned out that for a typical thermal injury with a decreased small vein pressure a continuous colloid infusion is to be preferred instead of an intermittent model of administration.