Restrictive XXXX caused by the grafted chest and abdominal burn.

@entity1 @entity6314 @entity2507 @entity358 @entity130
We report on the effect of the excised and grafted chest and abdominal burn on lung function. Six consecutive @entity1 with 3 degree burns to the entire chest and abdomen (72 +/- 10% total body surface area 3 degree burns) were studied. A severe restrictive @entity358 due to the noncompliant nature of the excised and grafted chest and abdominal wound was identified; this was most evident when inspiratory pressure (IP) was even modestly impaired with general anesthetics. Measured vital capacity (VC) was 12 to 14 ml/kg at 6 to 8 wk postburn, in the absence of any significant @entity130 . The measured VC was identical to the tidal volume (VT) used during the extended period of mechanical ventilatory support. Dynamic compliance (or characteristic) (Cdyn) decreased dramatically from 35 +/- 8 to 15 +/- 9 ml/cm @entity2507 when the positive pressure VT was increased by as little as 100 ml above prior VT settings, indicating the noncompliant nature of the combined chest and abdominal excised and grafted burn. Major cardiopulmonary complications developed in the first two @entity1 after onset of the restrictive process when general anesthesia was used for grafting procedures (n = 8) and the limits of chest wall excursion were unrecognized. @entity1 received only continuous positive airway pressure preoperatively. A modest but significant decrease in IP from -45 +/- 8 to -33 +/- 5 cm @entity2507 and 30% decrease in spontaneous VT were noted in the early postoperative period. These changes, however, resulted in a dramatic @entity6314 leading to hypercarbia, PCO2 greater than 50 torr.(ABSTRACT TRUNCATED AT 250 WORDS)
