Computed tomographic assessment of airflow obstruction in smoke inhalation injury: Relationship with the development of pneumonia and injury severity

Yamamura, Hisao; Morioka, Takasei; Hagawa, Naohiro; Yamamoto, Tomonori; Mizobata, Yasumitsu

doi:10.1016/j.burns.2015.06.008

Cited by 14 publications

(7 citation statements)

References 22 publications

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“…The Radiologist’s Score for Smoke Inhalation Injury (RADS) stratifies severity of inhalation injuries based on chest CT, and has shown correlation with clinical outcomes, especially when combined with bronchoscopy. 23 However, radiologic correlation with bronchoscopy findings have been limited overall, 23,24 and other limitations to CT include questionable optimal timing, time-consuming assessment, and limited correlation with other clinical findings. In the future, CT may be most useful for “virtual bronchoscopy,” in which a 3-dimensional images are reconstructed to be navigated as if using a bronchoscope.…”

Section: Discussionmentioning

confidence: 99%

Serious Inhalation Injuries From Military Operations in Afghanistan, Iraq, and Syria

Coulter

Mickelson

Dye

et al. 2020

J Intensive Care Med

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Objective: To characterize serious inhalation injuries seen during recent military operations, and assess whether bronchoscopic severity findings were associated with clinical presentation and outcomes. Methods: Service members who suffered inhalation injuries while deployed to Iraq, Afghanistan, or Syria from 2001-2018 were identified using ICD-9 and 10 codes from the Expeditionary Medical Encounter Database (EMED), which is abstracted from patient records in forward-deployed medical facilities. Further information including demographics, mechanism of injury, mortality, total burn surface area (TBSA), degree of facial burn, total Injury Severity Score (ISS), and first post-injury bronchoscopy notes were collected. Patients were excluded with ISS less than 16 or without sufficient details regarding bronchoscopy. Injuries were grouped based on bronchoscopic Abbreviated Injury Scores (AIS) into low-grade (AIS of 1), moderate-grade (AIS of 2), or high-grade (AIS of 3 or 4). Results: 91 patients met inclusion criteria, with no significant differences in age, gender, paygrade, or service branch between degrees of injury. There were no statistical correlations between grade of injury and battle versus non-battle injury, blast versus non-blast mechanism, TBSA, or degree of facial burn. High-grade injuries had significantly higher ISS than low or moderate-grade injuries. After adjusting for ISS, the odds ratio of death was 10.4 (95% CI 1.47 to 74.53) for those with high-grade and 3.7 (95% CI 0.45 to 32.30) for those with moderate-grade compared to low-grade injuries. Conclusion: In this cohort of deployed military members with inhalation injuries, initial bronchoscopic severity findings are strongly associated with mortality even after adjusting for ISS. The AIS may be an important prognostic tool in all of those with serious inhalation injuries.

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Section: Discussionmentioning

confidence: 99%

Serious Inhalation Injuries From Military Operations in Afghanistan, Iraq, and Syria

Coulter

Mickelson

Dye

et al. 2020

J Intensive Care Med

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“…[ 9 , 10 , 12 ] The measurement of bronchial wall thickness by chest computed tomography is a promising technique for evaluating the severity of the injury and determining the clinical course. [ 13 ]…”

Section: Discussionmentioning

confidence: 99%

Nebulized heparin and N-acetylcysteine for smoke inhalational injury

Ashraf

Bajantri

Roa-Gomez³

et al. 2018

Medicine

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Rationale:Every year, ∼40,000 people suffer burn-related injuries in the United States. Despite recent advances, the odds of dying from exposure to fire, flames, or smoke are one in ∼1500. Smoke inhalation causes injury to the airways via a complex physiological process, and the treatment is mainly supportive. Many recent interventions aim to decrease the formation of fibrin casts, the main cause of airway damage in these patients. Among these, treatment with a combination of nebulized heparin and N-acetylcysteine (NAC) has shown benefit.Patient concerns:We describe the case of a 58-year-old man who presented after smoke inhalation during a fire. Soot was found in the nostrils when he was admitted to our hospital, and after he began coughing up carbonaceous material, he was electively intubated and placed on volume assist control ventilation.Diagnosis:Bronchoscopy on the first day of intensive care confirmed the injury from smoke inhalation and revealed mucosal edema and soot involving the tracheobronchial tree.Interventions and outcomes:Inhaled unfractionated heparin of 10,000 IU in 3 mL of 0.9% normal saline alternating every 2 hours with 3 mL of 20% NAC was started 48 hours after admission and continued for 7 days. Bronchoscopy on the fifth day of intensive care showed significant improvement in airway edema and a resolution of soot.Lessons:On the basis of our experience with this case and limited literature, we posit that nebulized heparin and NAC may be of benefit in patients with inhalational smoke-induced lung injury and mild-to-severe lung injury scores.

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“…34 The severity can also be assessed through tomography if patients show airflow narrowing. 35 As there is no clear consensus on the diagnosis and grading of inhalation injury, our patients were diagnosed by bronchoscopy, which allowed us to determine whether there was any evidence of smoke inhalation injury. However, as mentioned, severity of inhalation injury was not graded.…”

Section: Discussionmentioning

confidence: 99%

Safety of Nebulized Epinephrine in Smoke Inhalation Injury

Foncerrada

Lima

Clayton

et al. 2017

Journal of Burn Care & Research

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This pilot study was conducted to profile safety of nebulized racemic epinephrine when used as a therapy for smoke inhalation injury in severely burned children. We enrolled 16 patients who were 7 to 19 years of age ([mean ± SD] 12 ± 4 years) with burns covering over 30% of the total body surface area (55 ± 17%) and smoke inhalation injury, as diagnosed by bronchoscopy at burn center admission. Patients were randomized to receive either standard of care (SOC; n = 8), which consisted of nebulized acetylcysteine, nebulized heparin, and nebulized albuterol, or to receive SOC plus nebulized epinephrine (n = 8). Primary endpoints were death, chest pain, and adverse changes in cardiopulmonary hemodynamics (arrhythmia, arterial blood pressure, electrocardiographic [ST segment] changes, and peak inspiratory pressure). Additional endpoints included total days on ventilator, pulmonary function, and physiological cardiopulmonary measurements at ICU discharge. No adverse events were observed during or after the nebulization of epinephrine, and no deaths were reported that were attributable to the administration of nebulized epinephrine. The groups did not significantly differ with regard to age, sex, burn size, days on ventilator, pulmonary function, or cardiopulmonary fitness. Results of this pilot trial indicate epinephrine to be safe when administered to pediatric burn patients with smoke inhalation injury. Current data warrant future efficacy studies with a greater number of patients.

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Computed tomographic assessment of airflow obstruction in smoke inhalation injury: Relationship with the development of pneumonia and injury severity

Cited by 14 publications

References 22 publications

Serious Inhalation Injuries From Military Operations in Afghanistan, Iraq, and Syria

Serious Inhalation Injuries From Military Operations in Afghanistan, Iraq, and Syria

Nebulized heparin and N-acetylcysteine for smoke inhalational injury

Safety of Nebulized Epinephrine in Smoke Inhalation Injury

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