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Some ventilatory parameters and the factors regulating the oxygen-supply to the tissues have been investigated in 10 patients with severe skin burns without any initial signs of pulmonary or facial burn trauma. Special attention was paid to the system regulating the oxygen-releasing capacity of haemoglobin.
The results indicate that periods of refractory respiratory insufficiency often occur in severe burns. The oxygen supply to the tissues during these periods is regulated not only by changes in blood-flow and the haemoglobin mass but also by variations in the oxygen-releasing capacity of the haemoglobin molecule at any given tissue oxygen tension. This release is determined by the diphosphoglycerate (2,3-DPG) content of the erythrocytes and to a lesser extent the content of adenosine triphosphate (ATP). Both of these compounds influence the oxyhaemoglobin dissociation equilibrium thereby making more or less erythrocyte oxygen available to the tissues. Thus changes in the content of erythrocyte 2,3-DPG and ATP afford indirect information about the oxygen-releasing capacity of the circulating haemoglobin mass and the regulatory efforts to maintain a constant tissue oxygen tension. The importance of careful monitoring of the cardiovascular and respiratory functions in burned patients is stressed. Early diagnosis after the onset of disturbances and prompt treatment is essential.
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