A high voltage electrical burn of lung parenchyma

Masanès, Marie-Josée; Gourbiere, E.; Prudent, J; Lioret, N.; Febvre, M.; Prévôt, Sophie; Lebeau, B.

doi:10.1016/s0305-4179(00)00035-8

Cited by 26 publications

(23 citation statements)

References 14 publications

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“…Two subsequent cases in electrical workers were due to the high‐voltage electric current (≥1000 V), had focal consolidation on lung imaging, and were managed with surgical resection. Histopathological findings included lung infarction, coagulative necrosis, and lipid pneumopathy in one case on Day 4 and infarction, liquefaction, and abscess formation in the other on Day 27 . Focal lung injury has also been reported in an electrical worker after a low‐voltage shock (380 V) complicated by respiratory arrest in the field and subsequent cerebral oedema.…”

Section: Discussionmentioning

confidence: 96%

Low‐voltage electricity‐induced lung injury

Truong

Smith

et al. 2017

Respirology Case Reports

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We report a case of bilateral pulmonary infiltrates and haemoptysis following low‐voltage electricity exposure in an agricultural worker. A 58‐year‐old man standing in water reached for an electric watering machine and sustained an exposure to 220 V circuit for an uncertain duration. The electricity was turned off by another worker, and the patient was asymptomatic for the next 10 h until he developed haemoptysis. A chest radiograph demonstrated bilateral infiltrates, and chest computed tomography (CT) revealed ground‐glass opacities with interstitial thickening. Evaluations, including electrocardiogram, serum troponin, N‐terminal pro‐B‐type natriuretic peptide (NT‐pro BNP), coagulation studies, and echocardiogram, found no abnormality. The patient was treated for suspected electricity‐induced lung injury and bleeding with tranexamic acid and for rhabdomyolysis with volume resuscitation. He recovered with complete resolution of chest radiograph abnormalities by Day 7. This is the first reported case of bilateral lung oedema and/or injury after electricity exposure without cardiac arrest.

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Section: Discussionmentioning

confidence: 96%

Low‐voltage electricity‐induced lung injury

Truong

Smith

et al. 2017

Respirology Case Reports

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“…However, our institution’s protocol is to perform diagnostic bronchoscopy upon admission of a burn of any etiology when slight suspicion for inhalation injury is present, making sampling bias an unlikely systematic error. Possible reasons for pulmonary dysfunction following electrical burns may be direct damage to lung parenchyma via the electrical current itself (17) or blunt lung trauma through a shockwave and muscle contraction, as described by Hartford et al (18). Further research is warranted to identify the specific effects of electricity on pulmonary tissue integrity and function.…”

Section: Discussionmentioning

confidence: 99%

The occurrence of single and multiple organ dysfunction in pediatric electrical versus other thermal burns

Hundeshagen

Wurzer

Forbes

et al. 2017

Journal of Trauma and Acute Care Surgery

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Background Multiple organ failure (MOF) is a major contributor to morbidity and mortality in burned children. While various complications induced by electrical injuries have been described, the incidence and severity of single organ failure (SOF) and MOF associated with this type of injury are unknown. The study was undertaken to compare the incidence and severity of SOF and MOF as well as other complications between electrically and thermally burned children. Patients and Methods Between 2001 and 2016, two hundred eighty-eight pediatric patients with electrical burns (EB, N=96) or thermal burns (CTR, N=192) were analyzed in this study. Demographic data, length of hospitalization, number and type of operations, amputations, and complications were statistically analyzed. Incidence of SOF and MOF was assessed using the DENVER2 classification in an additive mixed model over time. Compound scores and organ-specific scores for lung, heart, kidney, and liver were analyzed. Serum cytokine expression profiles of both groups were also compared over time. Significance was accepted at p<0.05. Results Both groups were comparable in age (CTR 11±5 years vs. EB 11±5 years), percent total body surface area burned (CTR 33±25% vs. EB 32±25%), and length of hospitalization (CTR 18±26 days vs. EB 18±21 days). The percentage of high voltage injury in the EB group was 64%. The incidence of MOF was lower in the EB group (2/96, 2.1%) than the CTR group (20/192, 10.4%; p<0.05). The incidence of single organ failure was comparable between groups. Incidence of pulmonary failure was comparable in both groups, but incidence of inhalation injury was significantly higher in the CTR group (p<0.0001). Patients in the EB group had more amputations (p<0.001), major amputations (p=0.001), and combined major amputations (p<0.01). Mortality was comparable between the groups. Serum cytokine expression profiles were also comparable between groups. Conclusions In pediatric patients, electrical injury is associated with a lower incidence of MOF than other thermal burns. Early and radical debridement of nonviable tissue is crucial to improve outcomes in the electrical burn patient population.

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“…With regard to pulmonary electrical injury, Masanes and Robin confirmed the presence of lung infarction and coagulation necrosis related to poration during a histological examination of some resected lungs after electrocution. Suppurative bronchiolitis and lesional edema were similar to inhalation injuries and both correlated to Joule heating [1,2,14].…”

Section: Discussionmentioning

confidence: 99%

Veno-Venous ECMO: An Alternative Strategy for Acute Respiratory Failure After High-Voltage Electrocution. The Utility of Point-of-Care Tests

Boscolo¹,

Saraceni²,

Cin³

et al. 2015

J Med Cases

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We report an extraordinary case of a 43-year-old man who sustained high-voltage electrocution injury associated with severe pulmonary damage due to current flow through the tissue. For the first time, a veno-venous extracorporeal membrane oxygenation (ECMO) was successfully used to provide respiratory support during severe hypoxemia without any limitation for surgical wound excision and homologous skin transplantation. To prevent over-bleeding due to surgery, daily medications and heparin infusion aggregometry and thromboelastometry were used as new point-of-care tests. After more than 400 hours, the patient returned to conventional ventilation with a significant improvement of gas exchanges, total pulmonary restore and without thromboembolic complications. Based on our experience, maximum clot firmness (MCF) in FIBTEM is usually high. Our finding shows that fibrinogen deficiency is not a leading mechanism for bleeding in burn patients also during ECMO; they need plasma transfusion preferably. About whole blood impedance aggregometry, thrombin receptor activating peptide 6-test (AUC) is strongly correlated to surgical bleeding and platelet consumption. We suggest that a rapid correction of coagulopathy, using ROTEM and MULTIPLATE, helps to minimize allogeneic blood products and to avoid thromboembolic complications during ECMO treatment and surgical burn wound excision.

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A high voltage electrical burn of lung parenchyma

Cited by 26 publications

References 14 publications

Low‐voltage electricity‐induced lung injury

Low‐voltage electricity‐induced lung injury

The occurrence of single and multiple organ dysfunction in pediatric electrical versus other thermal burns

Veno-Venous ECMO: An Alternative Strategy for Acute Respiratory Failure After High-Voltage Electrocution. The Utility of Point-of-Care Tests

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