Characteristics of Patients with Injury Secondary to Smoking on Home Oxygen Therapy Transferred Intubated to a Burn Center

Kassis, Salam Al; Savetamal, Alisa; Assi, Roland; Crombie, Roselle; Ali, Rahmat; Moores, Craig; Najjar, Amanda; Hansen, T I; Ku, Tabitha; Schulz, John

doi:10.1016/j.jamcollsurg.2013.12.055

Cited by 14 publications

(13 citation statements)

References 18 publications

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“…In agreement with previous studies, we suggest that there is a need to update the guidelines regarding smoking during LTOT 2,12,16. Efforts to cease smoking should be optimized.…”

Section: Discussionsupporting

confidence: 91%

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Burn injury during long-term oxygen therapy in Denmark and Sweden: the potential role of smoking

Tanash

Ringbæk

Huss

et al. 2017

COPD

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BackgroundLong-term oxygen therapy (LTOT) increases life expectancy in patients with COPD and severe hypoxemia. Smoking is the main cause of burn injury during LTOT. Policy regarding smoking while on LTOT varies between countries. In this study, we compare the incidence of burn injury that required contact with a health care specialist, between Sweden (a country with a strict policy regarding smoking while on LTOT) and Denmark (a country with less strict smoking policy).MethodsThis was a population-based, cohort study of patients initiating LTOT due to any cause in Sweden and Denmark. Data on diagnoses, external causes, and procedures were obtained from the Swedish and Danish National Patient Registers for inpatient and outpatient care. Patients were followed from January 1, 2000, until the first of the following: LTOT withdrawal, death, or study end (December 31, 2009). The primary end point was burn injury during LTOT.ResultsA total of 23,741 patients received LTOT in Denmark and 7,754 patients in Sweden. Most patients started LTOT due to COPD, both in Sweden (74%) and in Denmark (62%). The rate of burn injury while on LTOT was higher in Denmark than in Sweden; 170 (95% confidence interval [CI], 126–225) vs 85 (95% CI, 44–148) per 100,000 person-years; rate ratio 2.0 (95% CI, 1.0–4.1). The risk remained higher after adjustment for gender, age, and diagnosis in multivariate Cox regression, hazard ratio 1.8 (95% CI, 1.0−3.5). Thirty-day mortality after burn injury was 8% in both countries.ConclusionCompared to Sweden, the rate of burn injury was twice as high in Denmark where smoking is not a contraindication for prescribing LTOT.

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“…In agreement with previous studies, we suggest that there is a need to update the guidelines regarding smoking during LTOT 2,12,16. Efforts to cease smoking should be optimized.…”

Section: Discussionsupporting

confidence: 91%

“…Oxygen accelerates fire through increasing the risk of starting a fire and to make it more violent. Smoking is the main cause of burn injury during LTOT 2. Patients on LTOT are warned that they must avoid contact with sources of sparks and open flames, such as smoking cigarettes, candles flames, and open fire.…”

Section: Introductionmentioning

confidence: 99%

Burn injury during long-term oxygen therapy in Denmark and Sweden: the potential role of smoking

Tanash

Ringbæk

Huss

et al. 2017

COPD

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“…We agree with our colleagues that further work is needed to better characterize the magnitude of these potential risks and to inform the development of practice guidelines that help clinicians make appropriate determinations about the safety and effectiveness of home oxygen, particularly in known smokers [13]. We believe that aggressive educational and smoking cessation efforts should be employed in this population in an effort to avoid the harmful effects of this explosive combination.…”

Section: Discussionmentioning

confidence: 62%

Smoking-Related Home Oxygen Burn Injuries: Continued Cause for Alarm

et al. 2016

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Background: Home oxygen therapy is a mainstay of treatment for patients with various cardiopulmonary diseases. In spite of warnings against smoking while using home oxygen, many patients sustain burn injuries. Objectives: We aimed to quantify the morbidity and mortality of such patients admitted to our regional burn unit over a 6-year period. Methods: A retrospective chart review of all patients admitted to a regional burn center from 2008 through 2013 was completed. Admitted patients sustaining burns secondary to smoking while using home oxygen therapy were selected as the study population to determine morbidity. Results: Fifty-five subjects were admitted to the burn unit for smoking-related home oxygen injuries. The age range was 40-84 years. Almost all subjects were on home oxygen for chronic obstructive pulmonary disease (96%). Seventy-two percent of burns involved <5% of the total body surface area, 51% of patients were intubated, and of those 33% had evidence of inhalation injury. The hospital mortality rate was 14.5%. The mean length of hospital stay was 8.6 days, and 54.5% were discharged to a nursing home or another advanced facility. Finally, concomitant substance abuse was found in 27%, and a previous history of injury from smoking while on home oxygen was discovered in 14.5%. Conclusions: This single-center analysis is one of the largest describing burn injuries stemming from smoking while using home oxygen therapy. We identified the morbidity and mortality associated with these injuries. Ongoing education and careful consideration of prescribing home oxygen therapy for known smokers is highly encouraged.

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“…26 Single-center case series have described the occurrence of significant burn injuries associated with home oxygen therapy. 27,28 The largest case series from a regional burn center in Pennsylvania described outcomes of 86 individuals hospitalized for burn injuries related to oxygen use during an 11-year period. 29 The authors reported that 37% of burn injured patients required tracheal intubation with a median hospital stay of 7.5 days.…”

Section: Discussionmentioning

confidence: 99%

Burn Injury Associated With Home Oxygen Use in Patients With Chronic Obstructive Pulmonary Disease

Sharma

Meena

Goodwin

et al. 2015

Mayo Clinic Proceedings

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Objectives To quantify the risk of burn injury associated with home oxygen use and to examine the risk factors associated with the development of this injury. Patients and Methods We used a nested case-control and a retrospective cohort design to study enrollment and claims data from a national sample of Medicare beneficiaries 66 years and older with a diagnosis of chronic obstructive pulmonary disease (COPD) from January 1, 2001, through December 31, 2010. The primary outcome was burn injury in patients with COPD prescribed home oxygen. Results In the nested case-control method, patients with burn injury were twice (odds ratio, 2.43; 95% CI, 1.57–3.78) as likely to be prescribed oxygen in the preceding 90 days compared with those without burn injury. In the retrospective cohort study, the absolute risk of burn injury in patients prescribed oxygen therapy was 2.98 per 1000 patients compared with 1.69 per 1000 patients not prescribed oxygen during a 22-month period. The excess risk of a burn injury associated with oxygen was 0.704 per 1000 patients per year, and the number needed to harm was 1421. In multivariable analysis, factors associated with burn injury included male sex, low socioeconomic status, oxygen therapy use, and the presence of 3 or more comorbidities. Conclusion The benefits of oxygen therapy in patients with COPD outweigh the modest risk of burn injury associated with home oxygen use. However, with the increasing number of patients being prescribed oxygen, health care professionals must educate and counsel patients regarding the potential risk of burn injury.

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Characteristics of Patients with Injury Secondary to Smoking on Home Oxygen Therapy Transferred Intubated to a Burn Center

Cited by 14 publications

References 18 publications

Burn injury during long-term oxygen therapy in Denmark and Sweden: the potential role of smoking

Burn injury during long-term oxygen therapy in Denmark and Sweden: the potential role of smoking

Smoking-Related Home Oxygen Burn Injuries: Continued Cause for Alarm

Burn Injury Associated With Home Oxygen Use in Patients With Chronic Obstructive Pulmonary Disease

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