Date of Award

2017

Degree Name

Doctor of Philosophy (School of Physiotherapy)

Schools and Centres

Physiotherapy

First Supervisor

Associate Professor Dale W. Edgar

Second Supervisor

Dr Will Gibson

Third Supervisor

W. Prof Fiona Wood & Dr Tiffany Grisbrook

Abstract

Large fluid shifts and oedema are features of burn injuries. Oedema hampers burn wound healing and is directly related to the size and depth of the burn. The degree of oedema in burns covers a broad spectrum: Minor burns cause localised or peripheral oedema, whilst major burns may result in a systemic inflammatory response which can be life threatening and necessitates formal fluid resuscitation. Acute burn fluid resuscitation is paramount in decreasing patient morbidity and mortality but can contribute to already large amounts of oedema. There is currently no single clinically applicable, non-invasive and accurate outcome measure to titrate fluid volumes in acute burns or monitor the effect of treatments on oedema (in minor and major burns). Bioimpedance spectroscopy (BIS) has emerged as a possible solution to these challenges. It can measure body fluid compartments and thus fluid volume changes over time providing a sensitive non-invasive device to estimate resuscitation requirements and oedema change and is emerging as a measure of wound healing. This series of studies therefore aimed to 1) address the potential barriers to use of BIS in the burns population, 2) determine if BIS provides an accurate measure of whole body/systemic fluid volume change and 3) localised burn wound oedema changes, as applied across the spectrum of burn severity, and 4) determine if BIS can monitor wound healing in minor burns.

The studies therefore investigated novel whole body and localised electrode positions in the presence of open and dressed wounds, using repeated measures over time in minor and major burns.

The key novel findings arising from the research series include: 1) alternate electrode placements are interchangeable with standardised placement for the measurement of whole body resistance, extracellular and total body fluid volumes in specified dressing conditions. Therefore BIS can be utilised to monitor changes in fluid shifts when wounds preclude the manufacturer’s standard placement of electrodes in the presence of burn wounds, 2) BIS is a reliable method of monitoring fluid in any dressing condition and electrode position with no systematic bias indicated in both major and minor burns, 3) In both minor and major burns, BIS is a valid indicator of net fluid shifts and oedema change, if dressing condition is adjusted for using the developed algorithms or calculator and 4) BIS resistance variables, R0 and Rinf, can be used to monitor wound healing in minor limb burns as an adjunct to standard practice.

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