Muscarinic receptor antagonist therapy improves acute pulmonary dysfunction after smoke inhalation injury in sheep

Jonkam, Collette; Zhu, Yong; Jacob, Sam; Rehberg, Sebastian; Kraft, E; Hamahata, Atsumori; Nakano, Yoshimitsu; Traber, Lillian D.; Herndon, David N.; Traber, Daniel L.; Hawkins, Hal K.; Enkhbaatar, Perenlei; Cox, Robert A.

doi:10.1097/ccm.0b013e3181f8557b

Cited by 18 publications

(15 citation statements)

References 34 publications

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“…Sheep with a combined burn and inhalation injury showed increases in ventilatory pressures and upper airway obstruction, as well as decreases in P:F ratio. Treatment with this muscarinic receptor antagonist resulted in a lesser degree of pathologic change in all these variables [121]. …”

Section: Medical Adjuncts For Treatment Of Smoke Inhalationmentioning

confidence: 99%

Inhalation injury: epidemiology, pathology, treatment strategies

Dries

Endorf

2013

Scand J Trauma Resusc Emerg Med

199

137

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Lung injury resulting from inhalation of smoke or chemical products of combustion continues to be associated with significant morbidity and mortality. Combined with cutaneous burns, inhalation injury increases fluid resuscitation requirements, incidence of pulmonary complications and overall mortality of thermal injury. While many products and techniques have been developed to manage cutaneous thermal trauma, relatively few diagnosis-specific therapeutic options have been identified for patients with inhalation injury. Several factors explain slower progress for improvement in management of patients with inhalation injury. Inhalation injury is a more complex clinical problem. Burned cutaneous tissue may be excised and replaced with skin grafts. Injured pulmonary tissue must be protected from secondary injury due to resuscitation, mechanical ventilation and infection while host repair mechanisms receive appropriate support. Many of the consequences of smoke inhalation result from an inflammatory response involving mediators whose number and role remain incompletely understood despite improved tools for processing of clinical material. Improvements in mortality from inhalation injury are mostly due to widespread improvements in critical care rather than focused interventions for smoke inhalation.Morbidity associated with inhalation injury is produced by heat exposure and inhaled toxins. Management of toxin exposure in smoke inhalation remains controversial, particularly as related to carbon monoxide and cyanide. Hyperbaric oxygen treatment has been evaluated in multiple trials to manage neurologic sequelae of carbon monoxide exposure. Unfortunately, data to date do not support application of hyperbaric oxygen in this population outside the context of clinical trials. Cyanide is another toxin produced by combustion of natural or synthetic materials. A number of antidote strategies have been evaluated to address tissue hypoxia associated with cyanide exposure. Data from European centers supports application of specific antidotes for cyanide toxicity. Consistent international support for this therapy is lacking. Even diagnostic criteria are not consistently applied though bronchoscopy is one diagnostic and therapeutic tool. Medical strategies under investigation for specific treatment of smoke inhalation include beta-agonists, pulmonary blood flow modifiers, anticoagulants and antiinflammatory strategies. Until the value of these and other approaches is confirmed, however, the clinical approach to inhalation injury is supportive.

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Section: Medical Adjuncts For Treatment Of Smoke Inhalationmentioning

confidence: 99%

Inhalation injury: epidemiology, pathology, treatment strategies

Dries

Endorf

2013

Scand J Trauma Resusc Emerg Med

199

137

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“…При HFPV обеспечивается частота до 500-600 вдохов в минуту [26]. Преимущества использования HFPV заключаются в более низком пиковом давлении в дыхательных путях, повышенной функциональной резервной емкости (FRC), увеличенном клиренсе секрета и увеличенном клиренсе пробки [11,27,28]. Cioffi и соавторы [29] сравнили HFV и HFPV у пациентов с ингаляционным повреждением и обнаружили более низкий процент пневмоний в группе HFPV [29].…”

Section: стратегии ивлunclassified

“…Существует много литературы с доводами против использования HFOV (высокочастотная осцилляторная вентиляция) [27,30]. К недостаткам HFOV относятся технические сложности аспирации секрета, наличие большого количества способов увеличения объема легких, скопление газов, бронхоспазм и стимуляция образования экссудата и агрегатов [30,31].…”

Section: стратегии ивлunclassified

Diagnosis and Management of Inhalation Injuries in U. S. Children

Shahi

Phillips

Moulton

2020

Rossijskij vestnik detskoj hirurgii, anesteziologii i reanimato

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Ингаляционные травмы являются основной причиной детской смертности при пожарах, так как у детей, из-за анатомо-физиологических особенностей дыхательных путей, риск летальных исходов выше, чем у взрослых. В результате сочетанного воздействия теплового и химического факторов повреждающего агента и возникающих при этом вторичных эффектов возможно прямое повреждение паренхимы легких. Диагностика. Фиброоптическая бронхоскопия является современным диагностическим стандартом при диагностике ингаляционного поражения и констатации его выраженности. КТ (компьютерная томография) органов грудной клетки дает дополнительную возможность определения повреждения паренхимы легких у пациентов с ингаляционным поражением. Лечение. Лечение пациентов с ингаляционной травмой направлено на уменьшение бронхоспазма и отека дыхательных путей. Бронходилятаторы являются основой терапии ингаляционных травм. Преимущества вентиляции с высоким дыхательным объемом у детей заключаются в уменьшении дней на ИВЛ, снижении риска развития ОРДС и ателектазов. Физиотерапия грудной клетки, включая всасывание, технику кашля и раннюю мобилизацию, может быть полезной для пациентов с ингаляционными травмами. Заключение. Большинство детей, перенесших серьезную ожоговую травму, выживают. Хотя те, кто получил термоингаляционную травму, подвержены большему риску развития инфекционных осложнений и неблагоприятному исходу заболевания. Сочетание современных методов лечения поражения дыхательных путей и вентиляционной поддержки, как правило, дают хорошие результаты.Ключевые слова: ингаляционная травма, ожог, дети, педиатрия, интубация, респираторная поддержка Диагностика и лечение ингаляционных травм у детей в США (обзор литературы)* Конфликт интересов: Все авторы согласились на публикацию этой статьи. Авторы декларируют отсутствие явных и потенциальных конфликтов интересов, связанных с публикацией настоящей статьи.Для цитирования: Niti Shahi, Ryan Phillips, Steven L. Moulton. Диагностика и лечение ингаляционных травм у детей в США. Российский вестник детской хирургии, анестезиологии и реаниматологии. 2019; 9(4):11-26 https://doi. AbstractInhalation injuries are the leading cause of mortality in fire related deaths in children, who because of their small and fragile airways have a greater risk of mortality than their adult counterparts. Direct injury to the lung parenchyma can be caused by a combination of heat and chemical damage, and their secondary effects. Diagnosis. Fiberoptic bronchoscopy is the current diagnostic standard when determining the presence and severity of an inhalation injury Chest CT (computed tomography) has been described as an adjunct to identifying parenchymal lung damage in inhalation injury patients. Management. The benefits of high tidal volume ventilation in this patient population include decreased ventilation days, decreased ARDS, and decreased atelectasis [The goals of medical therapy in patients with an inhalation injury are: 1) decrease bronchospasm, and 2) decrease airway edema. Bronchodilators are the mainstay of medical therapy f...

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“…Muscarinic receptor antagonists such as tiotropium decrease airway pressures and mucus secretion and limit cytokine release by causing smooth muscle constriction within the airways, and stimulation of submucosal glands 37,38 .…”

Section: Supportive Carementioning

confidence: 99%

Inhalation Injury

Jones

Williams

Cairns

et al. 2017

Clinics in Plastic Surgery

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Synopsis The classic determinants of mortality from severe burn injury are age, size of injury, delays of resuscitation, and the presence of inhalation injury. Of the major determinants of mortality, inhalation injury remains one of the most challenging injuries for burn care providers. Patients with inhalation injury are at increased risk for pneumonia – the leading cause of death – and multi-system organ failure. There is no consensus amongst leading burn care centers in the management of inhalation injury. Outlined below are current treatment algorithms and the evidence of their efficacy.

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Muscarinic receptor antagonist therapy improves acute pulmonary dysfunction after smoke inhalation injury in sheep

Abstract: This study describes a contribution of acetylcholine to the airway constrictive and lumenal obstructive response after inhalation injury and identifies low-dose nebulization of tiotropium bromide as a potentially efficacious therapy for burn patients with severe inhalation injury.

Cited by 18 publications

References 34 publications

Inhalation injury: epidemiology, pathology, treatment strategies

Inhalation injury: epidemiology, pathology, treatment strategies

Diagnosis and Management of Inhalation Injuries in U. S. Children

Inhalation Injury

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