Respiratory Characteristics in Patients With Major Burn Injury and Smoke Inhalation

Abstract

This study aimed to evaluate pulmonary function measurements and respiratory muscle parameters in patients with major burn injury and smoke inhalation. The inclusion criteria included patients who were diagnosed with a smoke inhalation burn or a major burn of more than 20% of total body surface area (TBSA). All subjects underwent a pulmonary function test, respiratory muscle strength test, peak cough flow and fluoroscopic diaphragmatic movement measurement, and six-minute walk test before starting pulmonary rehabilitation. Evaluations were conducted on the 88 th days after the injury, the average time of admission to the Department of the Rehabilitation Medicine for burn rehabilitation after the completion of the acute treatment. The average degree of burns of the total 67 patients was 34.6% TBSA. All parameters in the patient group were significantly lower than the healthy controls, and a mild restrictive pattern of impairment with a reduction in diffusing capacity and more reduced expiratory muscle, than inspiratory muscle strength were observed. Peak cough flow, respiratory muscle strength, and forced vital capacity in the patient group with inhalation burn were significantly lower than in those without inhalation burn. The conditions of the majority of patients with major burn and inhalation injury were consistent with restrictive impairment and significant reduction in diffusion capacity. The patients had expiratory muscle weakness, decreased diaphragmatic movement, and exercise capacity impairment.

Adults with well‐healed burn injuries have lower pulmonary function values decades after injury

“…Together, these data-the most comprehensive assessment of pulmonary function among adults with well-healed burn injuries-emphasize an impairment that requires attention in the long-term rehabilitation of this clinical population, particularly in those with the lowest pulmonary function values. Previous studies report conflicting findings regarding whether FEV 1 /FVC and/or MVV is reduced in adults with well-healed burn injuries (Grisbrook et al, 2012;Özkal et al, 2021;Willis et al, 2011;Won et al, 2021). We did not find FEV 1 /FVC to be lower in our cohort, which is consistent with some (Özkal et al, 2021;Willis et al, 2011;Won et al, 2021), but not all (Grisbrook et al, 2012) prior work.…”

“…In adults with burn injuries assessed at discharge, the presence of an inhalation injury was associated with a lower FEV 1 /FVC (Özkal et al, 2021). In adults with burn injuries assessed three months after injury, those with an inhalation injury had a lower FEV 1 and FVC (Won et al, 2021). However, a retrospective assessment of long‐term lung function in patients with bronchoscopic evidence of smoke inhalation showed that combined inhalation injury and body surface burn do not necessarily imply long‐term damage to the respiratory airways or lungs (Bourbeau et al, 1996).…”

“…Various lines of evidence suggest that adults who have sustained severe burn injuries have reduced spirometry values and lung volumes. For example, after a burn injury, adults have lower values for forced expiratory volume in one second (FEV 1 ), forced vital capacity (FVC), functional residual capacity (FRC), forced expiratory flow at 25%–75% (FEF 25–75% ), and total lung capacity (TLC) (Grisbrook et al, 2012; Nylen et al, 1995; Özkal et al, 2021; Whitener et al, 1980; Won et al, 2021). Additionally, previous studies have conflicting findings regarding whether FEV 1 /FVC and/or maximal voluntary ventilation (MVV) is reduced in adults with well‐healed burn injuries (Grisbrook et al, 2012; Özkal et al, 2021; Willis et al, 2011; Won et al, 2021).…”

Six Months of Exercise Training Improves Ventilatory Responses during Exercise in Adults with Well-Healed Burn Injuries

“…Indeed, full-thickness (i.e., severe) burn injuries that cover a significant portion of the body (e.g., >15% of total body surface area) and require prolonged hospitalization can contribute to lower pulmonary function for the remainder of their lives (5). Specifically, individuals who have sustained severe burn injuries have reduced forced expiratory volume in 1 s (FEV 1 ), forced vital capacity (FVC), maximal voluntary ventilation (MVV), forced expiratory flow at 25%–75% (FEF 25%–75% ), and lung diffusing capacity (4,6–14). In addition, our laboratory recently demonstrated that adults with well-healed burn injuries have reduced percent predicted FEV 1 , FEV 1 /FVC, FEF 25%–75% , and increased airway resistance decades after their burn injury (15).…”

“…Specifically, individuals who have sustained severe burn injuries have reduced forced expiratory volume in 1 s (FEV 1 ), forced vital capacity (FVC), maximal voluntary ventilation (MVV), forced expiratory flow at 25%-75% (FEF 25%-75% ), and lung diffusing capacity (4,(6)(7)(8)(9)(10)(11)(12)(13)(14). In addition, our laboratory recently demonstrated that adults with well-healed burn injuries have reduced percent predicted FEV 1 , FEV 1 /FVC, FEF 25%-75% , and increased airway resistance decades after their burn injury (15).…”