NITRIC-OXIDE PRODUCTION IS INCREASED IN PATIENTS AFTER BURN INJURY

Objective: Human burn injury is associated with an inflammatory respon se and related hyperdynamic cardiovascular profile, Increased producti on of nitric oxide (NO), a potent endogenous vasodilator, has been rep orted in patients with inflammatory states, including sepsis, but not after trauma other than burns, We studied whether plasma levels of the stable byproducts of NO, nitrite (NO2-) and nitrate (NO3-), are incre ased in burn patients, Design: Prospective controlled study, Patients and Methods: In consecutive patients admitted to the intensive care un it of the burn center at the Queen Astrid Military Hospital in Brussel s, plasma was drawn daily from day 1 to day 5 postadmission for determ ination of NO2-/N-3(-) levels (Griess' reaction), In a control group o f nonseptic inpatients from the department of neurology in Erasme Univ ersity Hospital who were matched for nutrition (30 to 40 kcal/kg/day o f a standard enteral solution), plasma was drawn once for NO2-/NO3- de termination. Measurements and Main Results: The burn group included 16 patients (age 35 +/- 18 years, total burn surface area (TBSA) 37 +/- 19%) and the control group included six patients (age 64 +/- 18 years) . For each comparison between the groups, NO2-/NO3- plasma levels were higher in those patients with burns than in the control group, In the burn group, there was no correlation between NO2-/NO3- plasma levels and TBSA, age, TBSA x age, blood pressure or time, However, in a subgr oup of five burned patients who became septic during the study period, NO2-/NO3- plasma levels were slightly higher than in the non-infected patients (177 +/- 131 vs, 83 +/- 48 mu moles/L, NS) Conclusion: Human burn injury is associated with an increase in NO production, In this small-size study, NO production was not proportional to burn area, and seemed to be further enhanced in septic patients.