An Analysis of Inhalation Injury Diagnostic Methods and Patient Outcomes

Ching, Jessica A.; Ching, Yiu‐Hei; Shivers, Steven C.; Karlnoski, Rachel; Payne, Wyatt G.; Smith, David J.

doi:10.1097/bcr.0000000000000313

Cited by 23 publications

(8 citation statements)

References 4 publications

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“…The initial laboratory analyses in patients with burn a size of ≥15%TBSA include complete blood count, electrolyte assessment, coagulation profile and arterial blood gas measurement. In patients with suspected smoke inhalation injury, normal oxygenation and chest radiographs do not rule out the diagnosis as the pulmonary inflammatory response may take time to develop 110,111 .…”

Section: Secondary Surveymentioning

confidence: 99%

Burn injury

Jeschke

Baar

Choudhry

et al. 2020

Nat Rev Dis Primers

805

585

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Burn injuries are under-appreciated injuries that are associated with substantial morbidity and mortality. Burn injuries, particularly severe burns, are accompanied by an immune and inflammatory response, metabolic changes and distributive shock that can be challenging to manage and can lead to multiple organ failure. Of great importance is that the injury affects not only the physical health, but also the mental health and quality of life of the patient. Accordingly, patients with burn injury cannot be considered recovered when the wounds have healed; instead, burn injury leads to long-term profound alterations that must be addressed to optimize quality of life. Burn care providers are, therefore, faced with a plethora of challenges including acute and critical care management, long-term care and rehabilitation. The aim of this Primer is not only to give an overview and update about burn care, but also to raise awareness of the ongoing challenges and stigmata associated with burn injuries.

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Section: Secondary Surveymentioning

confidence: 99%

Burn injury

Jeschke

Baar

Choudhry

et al. 2020

Nat Rev Dis Primers

805

585

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“…Our results showed that overall, 30-day in-hospital and inhalation injury mortality rates of 9.6% and 15.8%, respectively, were lower than described in previous literature. 19,21,27,28 Mortality is also highly associated with progressing ARDS severity, with rates as high as 50% reported in patients with P:F ratio less than 100 within the first seven days of admission. 20 Our patient sample displayed in-hospital mortality rates of 18.2% (Table 3) for severe ARDS, with an incidence of 2.4% (Figure 1) by hospital day seven.…”

Section: Discussionmentioning

confidence: 99%

Outcomes in Ventilated Burn Patients With Acute Respiratory Distress Syndrome: An Evaluation of Early High-PEEP Strategy Using Berlin Criteria

Perry

Pinette

Miner

et al. 2021

Journal of Burn Care &Amp; Research

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Introduction Acute respiratory distress syndrome (ARDS) remains a formidable sequela, complication, and mortality risk in patients with large burns with or without inhalation injury. Alveolar recruitment using higher Positive End Expiratory Pressures (PEEP) after the onset of ARDS has been tried with varying success. Studies have identified benefits for several rescue maneuvers in ARDS patients with refractory hypoxemia. A prophylactic strategy utilizing an early recruitment maneuver, however, has not, to our knowledge, been explored in ventilated burn patients. This study was designed to evaluate the natural progression and clinical outcomes of ARDS severity (mild, moderate, and severe) using Berlin criteria in ventilated burn patients treated with an early high-PEEP ventilator strategy. Methods A single-center retrospective review of burn patients who were mechanically ventilated for greater than 48 hours utilizing an early high-PEEP >10 mmHg (10.36) ventilator strategy was performed at our Level 1 trauma and regional burn center. ARDS severity was defined according to the Berlin criteria and then compared to published results of ARDS severity, clinical outcomes, and mortality. Demographic data, as well as respiratory and clinical outcomes were evaluated. Results Eighty-three patients met inclusion criteria and were evaluated. Utilizing the Berlin definition as a benchmark, 42.1% of patients met ARDS criteria on admission and most patients (85.5%) developed ARDS within the first seven days: 28 (34%) mild, 32 (38.6%) moderate, and 11 (13.3%) severe ARDS. The mean percent total body surface area (%TBSA) was 24.6 + 22.1, with 68.7% of patients diagnosed with inhalation injury. The highest incidence of ARDS was 57.8% on day 2 of admission. Most cases remained in the mild to moderate ARDS category with severe ARDS (2.4%) being less common by hospital day 7. Overall, 30-day in-hospital and inhalation injury mortality rates were 9.6% and 15.8%, respectively. No correlation was observed between plateau pressures (22.8), mean arterial pressures (84.4), or vasopressor requirements; and oxygen requirements down trended quickly over the first 24-48 hours. Conclusion In our study, implementing prophylactic, immediate high-PEEP in mechanically ventilated burn patients was associated with trends toward decreased severity and rapid resolution of ARDS in the first week following burn injury. This correlated with low 30-day in-hospital mortality in this population. This short and less severe course suggests that early high-PEEP support may be a viable protective strategy in the treatment of ventilated burn patients with ARDS.

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“…In this study bronchoscopy proved useful in predicting mortality, days of ventilation and duration of intensive care unit (ICU) admission. 11 Therefore bronchoscopy may have the advantage of securing the diagnosis while simultaneously allowing severity assessment (Table 1) and facilitating bronchial toilet and specimen collection. 12 Helical computed tomography (CT) can effectively evaluate airway wall thickness and airway-lumen dimensions in asthma and chronic obstructive pulmonary disease.…”

Section: Diagnosismentioning

confidence: 99%