Plasma concentrations of tumour necrosis factor-α and interleukin-6 during burn wound surgery or dressing

Background: Clinical deterioration after burn wound manipulation may be related to the release of cytokines including tumour necrosis factor-α (TNF) and interleukin-6 (IL-6).Methods: The two cytokines were assayed by immunoenzymetric assay in blood samples taken before and during manipulation of the burn wound. An antibiotic, teicoplanin, was administered to half the patients at the start of the procedure in a randomized fashion as part of a separate trial.Findings: Sixty patients with a median burn size of 8% (range 1–56%) were studied during dressing change (n = 40) or burn excision (n = 20). There was little change in TNF levels between preoperative and recovery samples but IL-6 concentrations increased three-fold, particularly in those with large recent burns or bacteraemia, and were correlated with poor clinical outcome. The presence of teicoplanin did not significantly affect the levels of either cytokine.Interpretation: The systemic cytokine response to burn wound dressing or debridement is predominantly that of IL-6 and it is not significantly reduced by preventing Gram-positive bacteraemia during the procedure.