Evaluation of non-occlusive mesenteric ischemia for burn patients – A matched-pair analysis and treatment algorithm

• Published in: Burns Vol. 50; no. 9; p. 107254
• Main Authors: Bucher, Florian, Dastagir, Nadjib, Tamulevicius, Martynas, Obed, Doha, Dieck, Thorben, Vogt, Peter M., Dastagir, Khaled
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.12.2024
• Subjects: Adult; Aged; Algorithms; Burn; Burns - complications; Burns - therapy; Female; Gastrointestinal dysfunction; Humans; Intensive-care; Lactic Acid - blood; Male; Matched-Pair Analysis; Mesenteric Ischemia - etiology; Middle Aged; Non-occlusive mesenteric ischemia; Prognosis; Registries; Retrospective Studies; Shock - etiology; Vasoconstrictor Agents - therapeutic use; Burn; Non-occlusive mesenteric ischemia; Gastrointestinal dysfunction; Intensive-care
• ISSN: 0305-4179; 1879-1409; 1879-1409
• DOI: 10.1016/j.burns.2024.08.020

Burn injuries may cause gastrointestinal dysfunction leading to intestinal barrier dysfunction, abdominal compartment syndrome, and acute mesenteric ischemia. In the absence of major vascular occlusion, non-occlusive mesenteric ischemia (NOMI) often occurs in critically ill intensive-care burn patients. A retrospective descriptive analysis of the burn registry of the Department of Plastic, Aesthetic, Hand and Reconstructive Surgery of Hannover Medical School was performed from 1st January 2018 to 1st May 2024. Burn patients with NOMI were matched with burn patients who did not acquire acute mesenteric ischemia based on key variables and shared characteristics. A total of 20 patients were included in this study. Patients with NOMI showed a statistically significant elevation in serum lactate (p = 0.005) and were most likely to be in a shock state requiring vasopressors (p = 0.047). Overall prognosis was poor for the NOMI cohort, 80 % of whom had a fatal result (p = 0.024). A total of four patients received intra-arterial administration of alprostadil. NOMI represents a potentially fatal condition for the burn patient. The current lack of sensitive biomarkers and accurate diagnostic tools for the early detection of NOMI onset is a major factor behind the overall poor prognosis. We propose the intra-arterial administration of alprostadil as a novel approach to targeted treatment for NOMI. •Patients with NOMI showed an elevation of serum lactated and were most requiring vasopressors.•We propose intra-arterial administration of alprostadil into the superior mesenteric artery as novel approach to targeted treatment.•20 µg bolus of alprostadil is administered, followed by continuous administration 60–80 µg/ 24 hours.•Prognosis for NOMI was poor with a fatal outcome of 80%.