Loss of Protein, Immunoglobulins, and Electrolytes in Exudates From Negative Pressure Wound Therapy

Wade, Charles E.; Wolf, Steven E.; Salinas, Reuben; Jones, John A.; Rivera, Racheal; Hourigan, Leslie; Baskin, Toney W.; Linfoot, John A.; Mann, Elizabeth A.; Chung, Kevin K.; Dubick, Michael A.

doi:10.1177/0884533610379852

Cited by 58 publications

(19 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Exudate that is obtained from NPWT has approximately the same electrolyte concentrations as that of interstitial fluid ; thus, exudate and interstitial fluid can be said to be equivalent theoretically. In other words, we can conclude that if the antibiotic concentration in the exudate rises, then the interstitial fluid concentration increases.…”

Section: Discussionmentioning

confidence: 99%

Measurement of vancomycin hydrochloride concentration in the exudate from wounds receiving negative pressure wound therapy: a pilot study

Ida

Matsumura

Onishi

et al. 2014

International Wound Journal

View full text Add to dashboard Cite

It has been reported that negative pressure wound therapy (NPWT) is effective in the treatment of contaminated wounds. We hypothesised that systemically administered antibiotics migrate to wound site effectively by NPWT, which provides the antibacterial effect. We measured and compared the concentrations of vancomycin in the exudate and blood serum. Eight patients with skin ulcers or skin defect wounds who were treated with NPWT and were administered an intravenous drip of vancomycin were enrolled in this study. The wound surfaces were muscle, muscle fascia or adipose tissue. We administered vancomycin intravenously to NPWT patients (1-3 g/day). The exudate was obtained using 500 ml V.A.C. ATS canisters without gel. Three days later, the concentrations of vancomycin were measured. The mean concentration of vancomycin in the exudate from NPWT was 67% of the serum vancomycin concentration. We found that concentrations of vancomycin in NPWT exudates are higher than the previously reported concentrations in soft tissue without NPWT. The proactive use of NPWT might be considered in cases of suspected wound contamination when a systemic antibiotic is administered.

show abstract

Section: Discussionmentioning

confidence: 99%

Measurement of vancomycin hydrochloride concentration in the exudate from wounds receiving negative pressure wound therapy: a pilot study

Ida

Matsumura

Onishi

et al. 2014

International Wound Journal

View full text Add to dashboard Cite

show abstract

“…The TBSA was 22% (ranging from 10-41) in eight patients who were burned by fire and 8% (ranging from [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] in three cases with electrical burn. The final sample consisted of 11 burn adults (Burn Group), 34.3 years (SD, 9.3), 82% of males and the body mass index was 22.3 kg/m 2 (SD, 2.9).…”

Section: Methodsmentioning

confidence: 99%

Effect of Acute Thermal Injury in Status of Serum Vitamins, Inflammatory Markers, and Oxidative Stress Markers

Vinha

Martinez

Vannucchi

et al. 2013

Journal of Burn Care & Research

View full text Add to dashboard Cite

The objective of this study was to evaluate the vitamin status, inflammatory markers, and oxidative stress markers in adult patients up to 3 days after thermal injury. This prospective study was conducted with 11 patients 24 to 72 hours after thermal injury (Burn Group), total surface area ranging from 10 to 41%, 34.3 ± 9.3 years, 82% of males, body mass index of 22.3 ± 2.9 kg/m(2). We included 11 healthy adults (Control Group), 36.5 ± 7.6 years, 73% of males, and body mass index of 23.8 ± 2.5 kg/m(2). Laboratory data were measured (plasma total protein, albumin, transferrin, lymphocyte counts, zinc, and iron), as well as serum vitamins (folic acid, vitamin B12, and vitamins A, C, and E), inflammatory stress markers (C-reactive protein, ferritin, and acid α1-glycoprotein) and oxidative stress markers such as glutathione peroxidase (GPx) and thiobarbituric acid reactive substances. The inflammatory stress was characterized by lower levels of total protein (median difference 1.2 g/dL, 95% CI: 0.4-2.1) and albumin (median difference 0.9 g/dL, 95% CI: 0.5-1.5), and higher levels of C-reactive protein (median difference -8.12 mg/dL, 95% CI: -11.62 to 4.61) and α-1 glycoprotein acid (median difference -28.56 mg/dL, 95% CI: -51.57 to -5.07) in burn patients. Decreased serum levels of vitamin A (median difference 1.10 μmol/L, 95% confidence interval [CI]: 0.42-1.66) and vitamin C (median difference 0.82 mg/dL, 95% CI: 0.50-1.04) were also detected. There was no statistical evidence of difference in the serum levels of glutathione peroxidase and thiobarbituric acid reactive substances between burn patients and controls, respectively. Even though there is an inflammatory stress, the obtained data showed that oxidative stress markers are normal 24 to 72 hours after burn injury. The decrease in negative acute phase protein may account for the diminished serum levels of vitamin A, which seems to be related to inflammatory stress. The marked decrease in the serum levels of vitamin C can be justified by augmented cutaneous loss and consumption in the regeneration of vitamin E.

show abstract

“…Negative pressure wound therapy (NPWT), frequently used in the care of wound infections, affords an opportunity to collect wound effluent for evaluation. Previous studies have examined wound effluent for the presence of bacteria [ 10 ], inflammatory cytokines [ 11 - 15 ], and other protein components [ 16 ] but the presence of antimicrobials in wound effluent has not been examined. To gain insight into the penetration of clinically useful antimicrobial agents across wounds under negative pressure, we undertook two prospective observational studies of antimicrobials, including antifungals, in patients with trauma-related wounds.…”

Section: Introductionmentioning

confidence: 99%

Antifungal wound penetration of amphotericin and voriconazole in combat-related injuries: case report

et al. 2015

View full text Add to dashboard Cite

BackgroundSurvivors of combat trauma can have long and challenging recoveries, which may be complicated by infection. Invasive fungal infections are a rare but serious complication with limited treatment options. Currently, aggressive surgical debridement is the standard of care, with antifungal agents used adjunctively with uncertain efficacy. Anecdotal evidence suggests that antifungal agents may be ineffective in the absence of surgical debridement, and studies have yet to correlate antifungal concentrations in plasma and wounds.Case presentationHere we report the systemic pharmacokinetics and wound effluent antifungal concentrations of five wounds from two male patients, aged 28 and 30 years old who sustained combat-related blast injuries in southern Afghanistan, with proven or possible invasive fungal infection. Our data demonstrate that while voriconazole sufficiently penetrated the wound resulting in detectable effluent levels, free amphotericin B (unbound to plasma) was not present in wound effluent despite sufficient concentrations in circulating plasma. In addition, considerable between-patient and within-patient variability was observed in antifungal pharmacokinetic parameters.ConclusionThese data highlight the need for further studies evaluating wound penetration of commonly used antifungals and the role for therapeutic drug monitoring in providing optimal care for critically ill and injured war fighters.

show abstract

Loss of Protein, Immunoglobulins, and Electrolytes in Exudates From Negative Pressure Wound Therapy

Cited by 58 publications

References 17 publications

Measurement of vancomycin hydrochloride concentration in the exudate from wounds receiving negative pressure wound therapy: a pilot study

Measurement of vancomycin hydrochloride concentration in the exudate from wounds receiving negative pressure wound therapy: a pilot study

Effect of Acute Thermal Injury in Status of Serum Vitamins, Inflammatory Markers, and Oxidative Stress Markers

Antifungal wound penetration of amphotericin and voriconazole in combat-related injuries: case report

Contact Info

Product

Resources

About