Insight in microcirculation and histomorphology during burn shock treatment using in vivo confocal-laser-scanning microscopy

Purpose: Microcirculatory disturbances are well known during shock; however, the accompanied histomorphological alterations are widely unknown. We used high resolution confocal-laser-scanning microscopy for the evaluation of microcirculation and histomorphology during Burn Shock treatment. Methods: Confocal-laser-scanning microscopy was performed in 10 burn shock patients (4 women, 6 men; aged 40.6 +/- 11.4 years, burn extent >20% body surface area) initially and 24 hours after shock resuscitation. Ten matched hemodynamic stable burn intensive care unit patients served as controls. The following parameters were evaluated: quantitative blood cell flow, cell size of the granular layer, basal layer thickness, and epidermal thickness. Results: Quantitative blood cell flow in controls was 62.45 +/- 3.39 cells per minute. Burn shock significantly reduced blood cell flow to 37.27 +/- 3.64 cells per minute; fluid resuscitation effectively restored baseline blood flow (65.18 +/- 3.76 cells per minute) after 24 hours. Granular cell size was 793.61 +/- 41.58 mu m(2) in controls vs 644.27 +/- 42.96 mu m(2) during burn shock. Post resuscitation granular cell size measured 932.74 +/- 38.83 mu m(2). Basal layer thickness was 14.84 +/- 0.59 mu m in controls, 13.26 +/- 0.54 mu m in burn patients at admission and before resuscitation, and 17.50 +/- 0.46 mu m after resuscitation. Epidermal thickness in control patients was 49.60 +/- 2.36 mu m, 37.83 +/- 2.47 mu m in burn patients at admission and 69.50 +/- 3.18 mu m after resuscitation. Conclusions: Confocal-laser-scanning microscopy provides a noninvasive tool for simultaneous evaluation of microcirculation and tissue histomorphology. It may help to assess the adequacy of and response to resuscitation of burn patients early after trauma. (C) 2010 Elsevier Inc. All rights reserved.