Pulmonary Injury in Burned Patients

Herndon, David N.; Thompson, Paul; Traber, Daniel L.

doi:10.1016/s0749-0704(18)30672-9

Cited by 96 publications

(59 citation statements)

References 75 publications

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“…In addition, factors such as age and airway obstruction caused by smoke inhalation injury (SSI) also affect prognosis. (1)(2)(3)(4) Not all signs and symptoms of SII are perceived by the examiner. Dyspnea, hypoxemia, cyanosis, abnormal respiratory sounds and chest X-ray abnormalities might not be present at the initial stage of the treatment of such patients.…”

Section: Introductionmentioning

confidence: 99%

“…(8) In suspected cases of SII, the injury needs to be confirmed so that a prognosis can be determined and protective therapeutic measures, such as intubation and the use of inhaled heparin, can be instituted. (4,9,10) Bronchoscopy is a method that has higher sensitivity and specificity for the diagnosis of SII than does the gold standard-histopathological analysis of a fragment of bronchial mucosa. (11) During bronchoscopy, it is possible to safely determine whether there was airway injury or not.…”

Section: Introductionmentioning

confidence: 99%

“…(11) The treatment of patients with SII should be initiated at the site of the accident, with the administration of pure oxygen. (4) The use of bronchodilators should be initiated whenever there is wheezing or signs of endobronchial secretion. (17) Orotracheal intubation should be performed when there is cyanosis or respiratory depression, secretion with laryngeal obstruction, significant thickening of the nasolabial region due to burn or a burn covering the entire neck circumference.…”

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confidence: 99%

“…If laryngoscopy shows significant mucosal edema, the possibility of using tracheostomy should be evaluated. (4) Humidification of the inhaled air and the use of continuous positive pressure are effective measures. The use of nebulized heparin and acetylcysteine reduces the need for reintubation, as well as the incidence of atelectasis and mortality.…”

mentioning

confidence: 99%

“…Corticosteroids are not routinely indicated and should be used only in cases of bronchospasm that is unresponsive to the initial measures. (4,18,19) Although the use of surfactant, deferoxamine and nitric oxide has proven efficacious in animal models, (20)(21)(22) clinical studies are needed. Cytological, immunocytochemical and biochemical analyses performed in bronchoalveolar lavage (BAL) specimens can be useful for determining the pulmonary response to injury and predicting the clinical evolution of patients with SII.…”

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confidence: 99%

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Análise do lavado broncoalveolar em vítimas de queimaduras faciais graves

et al. 2009

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Objective: To analyze bronchoalveolar lavage (BAL) specimens of burn victims who inhaled smoke, in order to identify alterations associated with mortality or survival. Methods: Eighteen victims of facial burns were submitted to BAL up to 24 h after the event. We investigated cell and protein content, including TNF-α, HLA-DR, CD14, CD68 and iNOS. Results: Of the 18 patients submitted to bronchoscopy, 8 (44.4%) died during the follow-up period. The mean age of patients who died was significantly higher (44.7 vs. 31.5 years). On average, the patients who died had burns covering 60.1% of the total body surface area, compared with 26.1% in the survivors (p < 0.0001). Of the 18 patients submitted to bronchoscopy, 11 (61.1%) showed endoscopic signs of smoke inhalation injury, and 4 (36.4%) of those 11 died. Of the 7 patients with no signs of smoke inhalation injury, 4 (57.1%) died. The mean number of ciliated epithelial cells in the BAL fluid was significantly higher in the patients who died than in the survivors (6.6% vs. 1.4%; p = 0.03). There were no significant differences between the groups in terms of any of the other parameters evaluated. Conclusions: The total body surface area burned was a predictive factor for mortality. Increased numbers of ciliated epithelial cells in the BAL fluid, denoting bronchial epithelial desquamation, were associated with higher mortality in patients with facial burns. (44,7 vs. 31,5 anos). A superfície corporal queimada foi em média de 60,1% nos pacientes que morreram e de 26,1% nos sobreviventes (p < 0,0001). Entre os 18 pacientes submetidos à broncoscopia, 11 (61,1%) apresentaram sinais endoscópicos de lesão por inalação de fumaça, e 4 (36,4%) destes faleceram. Dos 7 pacientes sem sinais de lesão por inalação de fumaça, 4 (57,1%) faleceram. A média do número de células epiteliais ciliadas no LBA dos pacientes que morreram foi significativamente maior daquela dos sobreviventes (6,6% vs. 1,4%; p = 0,03). Os demais parâmetros analisados não mostraram diferença entre os grupos. Conclusões: A superfície corporal queimada mostrou ser um fator preditivo de mortalidade. O aumento do número de células epiteliais ciliadas no LBA, denotando descamação epitelial brônquica, esteve associado à maior mortalidade de pacientes com queimaduras faciais.Descritores: Queimaduras; Lesão por inalação de fumaça; Lavagem broncoalveolar; Células epiteliais brônquicas; Macrófagos; Fator de necrose tumoral alfa.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Análise do lavado broncoalveolar em vítimas de queimaduras faciais graves

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Impaired alveolar macrophage function in smoke inhalation injury

Herlihy

Vermeulen

Joseph

et al. 1995

Journal Cellular Physiology

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The high incidence of both bacterial pneumonia and the adult respiratory distress syndrome (ARDS) associated with smoke inhalation injury (SII) may result, at least in part, from smoke-induced injury to the alveolar macrophage (AM). Specifically, we hypothesized that AM antimicrobial function, ability to phagocytose apoptotic PMNs, and capacity to prevent apoptosis in PMNs are impaired by smoke. To test these hypotheses, AMs were harvested by bronchoalveolar lavage from sheep before and after the animal was exposed to cotton smoke. The two populations of AMs were incubated with Pseudomonas aeruginosa (PSA) in vitro. Normal AMs (NAMs) phagocytosed a mean of 99 +/- 11% of the PSA placed in their wells, whereas smoke-exposed AMs (SAMs) ingested only 60 +/- 8%. NAMs killed 80 +/- 8% of PSA ingested, whereas SAMs killed only 56 +/- 16% (P < 0.05). When sheep PMNs, allowed to undergo apoptosis, were incubated with the two AM populations, 66 +/- 3% of the NAMs and 40 +/- 6% of the SAMs demonstrated phagocytosis of these apoptotic PMNs (P < 0.05). Fresh sheep PMNs were incubated in unconditioned media, NAM and SAM-conditioned media, and followed over 48 hr for the development of apoptosis and maintenance of viability. The NAM-conditioned media markedly prevented apoptosis and augmented PMN survival relative to the unconditioned and SAM-conditioned media (P < 0.05). The poor antimicrobial function known to be characteristic of apoptotic PMNs, together with the directly impaired antimicrobial function of AMs, may contribute to the infectious complications of SII. If the PMNs recruited to the lung in SII are not properly supported by the AMs following smoke injury, large numbers may undergo apoptosis. If not properly disposed of by these SAMs, the apoptotic PMNs could eventually lyse, releasing tissue toxins, resulting in escalation of lung injury and leading to ARDS.

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Emergency Room and Acute Care of the Critically III Burned Patient

Bittner¹,

Grecu²,

Martyn³

Intensive Care Medicine

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Pulmonary Injury in Burned Patients

Cited by 96 publications

References 75 publications

Análise do lavado broncoalveolar em vítimas de queimaduras faciais graves

Análise do lavado broncoalveolar em vítimas de queimaduras faciais graves

Impaired alveolar macrophage function in smoke inhalation injury

Emergency Room and Acute Care of the Critically III Burned Patient

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