Cardiovascular Biomarkers and Lung Edema in Severe Burns Patients

Study Overview
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Brief Summary
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Burn injury leads to hypovolemic then distributive shock. Fluid resuscitation remains the cornerstone of initial treatment of burn shock. However, fluid rescucitation can lead to fluid overload, which manifests most notably as lung edema. The peptide NT-pro-BNP, a biomarker of cardiac congestion secreted by the myocardium, as well as plasma CD146, an endothelial factor involved in angiogenesis and a marker of vascular congestion, may help identifying patients with risk of pulmonary edema and hypoxia . Our hypothesis is that these biomarkers may predict the occurence of pulmonary edema in severe burns patients.

Official Title
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The Role of CARdiovascular biOmarkers (NT-pro-BNP and CD146) in Predicting Lung Edema in Severely Burned Patients

Conditions
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Burns

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Intubated mechanically-ventilated patients within the first 24 hours of admission And/or patients with total body surface area (TBSA) burn-injured >20 % And/or patients with at least 10% full-thickness burns And/or receiving vasopressors within the first 24 hours of admission And monitored by a PiCCO system (PiCCO-2 Pulsion Medical Systems AG, Munich, Germany) Exclusion Criteria: Admission delay to ICU > 24 hours post burn Age less than 18 years Pregnancy Chronic renal impairment with a baseline eGFR < 15 ml/min Patients with chemical or electrical burns Coexisting non-burn trauma Patients moribund on admission or dead within 72 h from admission Patients with do-not-resuscitate orders

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Lung edema | Extravascular lung water (EVLW) > 10 mL/Kg as measured by transpulmonary thermodilution (TPTD) | During the first 7 days of admission | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Hypoxemia | PaO2/FiO2 ratio of <200 | During the first 7 days of admission for mechanically-ventilated patients | 
| Hypercapnia | PaCO2> 45 mmHg | During the first 7 days of admission for mechanically-ventilated patients | 
| Corrected minute ventilation > 10L/min | Minute ventilation × partial [Paco2]/40) > 10L/min | During the first 7 days of admission for mechanically-ventilated patients | 
| Multiple organ dysfunction syndrome (MODS) | Sequential Organ Failure Assessment score (SOFA) ≥ 8 | During the first 7 days of admission | 
| 28-day mortality |  | 28 days | 
| 90-day mortality |  | 90 days | 
| Length of stay in the ICU |  | until 90 days of hospitalization | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Vascular filling, Fluid overload, Biomarkers, Lung edema