The impact of antithrombin (H) concentrate infusions on pulmonary functionin the acute phase of thermal injury

Background: Pulmonary complications occur frequently after thermal injury. Objective: This open pilot study was performed as an initial assessment of the safety and efficacy of antithrombin H [AT(H)I concentrate in ameliorati ng the respiratory morbidity during the acute phase of injury. Materials & Methods: Thirty-two patients were eligible for the study; of th ese, nine opted for treatment with q8 h [AT(H)], The mean daily peak values of pulmonary parameters such as PaO2/FiO(2) ratio, and RAW scores were com puted for days 1-8. Results: Control and AT(H)-treated patients were similar in age, % total bu rn surface area, inhalation injury, and mortality. Forty-three percent of t he burn controls, and 23% of the AT(H)-treated patients had pneumonia, p < 0.01. The median hospital stay for both groups was 42 days; however, the me dian number of ventilatory days for burn controls was 23 days vs 10 days fo r AT(H)-treated patients. The AT(H)-treated patients had admission AT plasm a levels of 46 +/- 14% vs 49 +/- 18% in burn controls, (normal = 100 +/- 20 %). The AT plasma level was maintained at 120 +/- 24% in the AT(H)-treated patients vs 50 +/- 15% in the burn control group for the first four days fo llowing the acute injury, p < 0.002. Thrombate(R) concentrate infusions wer e, in general, well tolerated by patients. The median dose was 97 u/kg/dose q8 h. Compared to burn controls, AT(H)-treated patients had higher PaO2/Fi O(2) ratios between days 4-6, p < 0.01. In comparing these two groups with and without inhalation, airway resistance (assessed by the RAW score) was s ignificantly lower in the AT(H)-treated group with inhalation compared to t he burn controls with inhalation on days 2 and 6, p < 0.02. Conclusions: With a trend toward decreased airway resistance during AT(H) c oncentrate infusions, and increased oxygenation, AT(H)-treated patients had significantly fewer episodes of pneumonia compared to controls. AT(H) conc entrates may modify the impact of thrombin on acute inflammation. and impro ve respiratory function in the acute phase of thermal injury. (C) 2001 Else vier Science Ltd and ISBI. All rights reserved.