Effect on Mortality of Inhalation Injury

Thompson, Paul; Herndon, D. N.; Traber, Daniel L.; Abston, Sally

doi:10.1097/00132586-198610000-00041

Cited by 25 publications

(37 citation statements)

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“…Initially, BULL & SQUIRE 2 defined their prediction of mortality after burn based on age and burn area. Nearly 50 years later, the importance of other factors such as pre-admission shock 6 , inhalation injury 19,21 , sepsis 10,15 and thrombocytopenia 7 have been identified. Over time, various reports have shown progressive improvement in mortality with advances in burn care 1,5,16 .…”

Section: Discussionmentioning

confidence: 99%

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Predictive factors of mortality in burn patients

Macedo¹,

Santos²

2007

Rev. Inst. Med. trop. S. Paulo

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SUMMARYBurn mortality statistics may be misleading unless they account properly for the many factors that can influence outcome. Such estimates are useful for patients and others making medical and financial decisions concerning their care. This study aimed to define the clinical, microbiological and laboratorial predictors of mortality with a view to focus on better burn care. Data were collected using independent variables, which were analyzed sequentially and cumulatively, employing univariate statistics and a pooled, cross-sectional, multivariate logistic regression to establish which variables better predict the probability of mortality. Survivors and non-survivors among burn patients were compared to define the predictive factors of mortality. Mortality rate was 5.0%. Higher age, larger burn area, presence of fungi in the wound, shorter length of stay and the presence of multi-resistant bacteria in the wound significantly predicted increased mortality. The authors conclude that those patients who are most apt to die are those with age > 50 years, with limited skin donor sites and those with multi-resistant bacteria and fungi in the wound.

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Section: Discussionmentioning

confidence: 99%

“…Inhalation injury is a strong predictor of mortality 16,19,21 . However, we could not confirm this owing to the small number of patients in our group with inhalation injury.…”

Section: Discussionmentioning

confidence: 99%

Predictive factors of mortality in burn patients

Macedo¹,

Santos²

2007

Rev. Inst. Med. trop. S. Paulo

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“…1,2 Despite recent advances in burn critical care management, little progress has been made in reducing the death rate associated with inhalation injury. Conventional mechanical ventilation with high tidal volumes and low respiratory rates, likewise, can result in increased interstitial edema and barotrauma in inhalation injury.…”

Section: Discussionmentioning

confidence: 99%

Reduced Ventilator Pressure and Improved P/F Ratio During Percutaneous Arteriovenous Carbon Dioxide Removal for Severe Respiratory Failure

Alpard¹,

Zwischenberger²,

Tao³

et al. 1999

Annals of Surgery

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ObjectiveTo evaluate the effect of percutaneous arteriovenous carbon dioxide removal (AVCO 2 R) on ventilator pressures and P/F ratio in a clinically relevant large-animal model of severe respiratory failure. Summary Background DataAVCO 2 R was developed as a simple arteriovenous shunt with a commercially available low-resistance gas exchange device of sufficient surface area for near-total CO 2 removal. With an AV shunt 10% to 15% of cardiac output, AVCO 2 R allows a reduction in ventilator airway pressures without hypercapnia or the complex circuitry and monitoring required for conventional ECMO. MethodsAVCO 2 R was applied to a new, clinically relevant large-animal model of severe respiratory failure created by smoke inhalation and cutaneous flame burn injury. Adult sheep (n ϭ 9, 38 Ϯ 6 kg) received a 40% total body surface area, third-degree cutaneous flame burn and 36 breaths of cotton smoke insufflation. After injury, all animals were placed on volumecontrolled mechanical ventilation to achieve PaO 2 Ͼ 60 mmHg and PaCO 2 Ͻ 40 mmHg. Animals were placed on AVCO 2 R within 40 to 48 hours of injury when the PaO 2 /FiO 2 was Ͻ200. Animals underwent cannulation of the carotid artery and jugular vein with percutaneous 10F arterial and 14F venous cannulas. Shunt flow was continuously monitored using an ultrasonic flow probe and calculated as a percentage of cardiac output. ResultsAVCO 2 R flows of 800 to 900 ml/min (11% to 13% cardiac output) achieved 77 to 104 ml/min of CO 2 removal (95% to 97% total CO 2 production) while maintaining normocapnia. Significant reductions in ventilator settings were tidal volume, 421.3 Ϯ 39.8 to 270.0 Ϯ 6.3 ml; peak inspiratory pressure, 24.8 Ϯ 2.4 to 13.7 Ϯ 0.7 cm H 2 O; minute ventilation, 12.7 Ϯ 1.4 to 6.2 Ϯ 0.8 L/min; respiratory rate, 25.4 Ϯ 1.3 to 18.4 Ϯ 1.8 breaths/min; and FiO 2 , 0.88 Ϯ 0.1 to 0.39 Ϯ 0.1. The P/F ratio increased from 151.5 Ϯ 40.0 at baseline to 320.0 Ϯ 17.8 after 72 hours. ConclusionsPercutaneous AVCO 2 R allows near-total CO 2 removal and significant reductions in ventilator pressures with improvement in the P/F ratio.

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“…99 Approximately 70% of patients with smoke inhalation injury develop acute respiratory failure, 100 and this is a leading cause of death in burn victims. 101,102 The major pathologic features of inhalational injury include fibrin deposition, cellular debris from epithelial sloughing, and increased mucus production leading to the development of airway casts and severe airway obstruction.…”

Section: Aerosolized Anticoagulants and Oxygen Radical Scavengersmentioning

confidence: 99%

Adjunct Therapies During Mechanical Ventilation: Airway Clearance Techniques, Therapeutic Aerosols, and GasesDiscussion

Kallet

2013

Respir Care

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Mechanically ventilated patients in respiratory failure often require adjunct therapies to address special needs such as inhaled drug delivery to alleviate airway obstruction, treat pulmonary infection, or stabilize gas exchange, or therapies that enhance pulmonary hygiene. These therapies generally are supportive in nature rather than curative. Currently, most lack high-level evidence supporting their routine use. This overview describes the rationale and examines the evidence supporting adjunctive therapies during mechanical ventilation. Both mechanistic and clinical research suggests that intrapulmonary percussive ventilation may enhance pulmonary secretion mobilization and might reverse atelectasis. However, its impact on outcomes such ICU stay is uncertain. The most crucial issue is whether aerosolized antibiotics should be used to treat ventilatorassociated pneumonia, particularly when caused by multi-drug resistant pathogens. There is encouraging evidence from several studies supporting its use, at least in individual cases of pneumonia non-responsive to systemic antibiotic therapy. Inhaled pulmonary vasodilators provide at least short-term improvement in oxygenation and may be useful in stabilizing pulmonary gas exchange in complex management situations. Small uncontrolled studies suggest aerosolized heparin with N-acetylcysteine might break down pulmonary casts and relieve airway obstruction in patients with severe inhalation injury. Similar low-level evidence suggests that heliox is effective in reducing airway pressure and improving ventilation in various forms of lower airway obstruction. These therapies generally are supportive and may facilitate patient management. However, because they have not been shown to improve patient outcomes, it behooves clinicians to use these therapies parsimoniously and to monitor their effectiveness carefully. Key words: high-frequency percussive ventilation; intrapulmonary percussive ventilation; inhaled nitric oxide; aerosolized prostacyclin; aerosolized heparin; metered-dose inhalers; heliox.

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Effect on Mortality of Inhalation Injury

Cited by 25 publications

References 0 publications

Predictive factors of mortality in burn patients

Predictive factors of mortality in burn patients

Reduced Ventilator Pressure and Improved P/F Ratio During Percutaneous Arteriovenous Carbon Dioxide Removal for Severe Respiratory Failure

Adjunct Therapies During Mechanical Ventilation: Airway Clearance Techniques, Therapeutic Aerosols, and GasesDiscussion

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