Respiratory Morbidity After Childhood Burns: A 10-Year Follow-up Study

Duke, Janine M.; Randall, Sean; Fear, Mark W.; Boyd, James H.; Rea, Suzanne; Wood, Fiona

doi:10.1542/peds.2016-1658

Cited by 12 publications

(10 citation statements)

References 43 publications

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“…It is important to note, however, that such speculation must be confirmed with longitudinal data among adults with well‐healed burn injuries. Lastly, our findings of lower pulmonary function are consistent with findings among children (Duke et al, 2016) and an appreciably smaller cohort of adults with well‐healed burn injuries (Mlcak et al, 1998) several years after injury.…”

Section: Discussionsupporting

confidence: 91%

“…Advances in the sub-acute and acute care of burn injuries have improved rates of survival (Porter et al, 2015;Wolf et al, 2018). However, survivors of severe burn injuries are at an increased risk of long-term complications (Peck, 2011;Duke et al, 2015Duke et al, , 2016Duke et al, , 2017Jeschke et al, 2008Jeschke et al, , 2011Stanojcic et al, 2018). Poor respiratory function, as observed in children, following discharge from intensive care (Desai et al, 1993) may contribute to epidemiological findings of low cardiorespiratory fitness and physical activity levels in survivors of severe burn injuries later in life (Dodd et al, 2017;Duke et al, 2017;Ferrando et al, 1997;Ganio et al, 2015;Willis et al, 2011).…”

Section: Introductionmentioning

confidence: 99%

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

Watso

Romero

Moralez

et al. 2022

Physiological Reports

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Sub‐acute (e.g., inhalation injury) and/or acute insults sustained during a severe burn injury impairs pulmonary function. However, previous work has not fully characterized pulmonary function in adults with well‐healed burn injuries decades after an injury. Therefore, we tested the hypothesis that adults with well‐healed burn injuries have lower pulmonary function years after recovery. Our cohort of adults with well‐healed burn‐injuries (n = 41) had a lower forced expiratory volume in one second (Burn: 93 ± 16 vs. Control: 103 ± 10%predicted, mean ± SD; d = 0.60, p = 0.04), lower maximal voluntary ventilation (Burn: 84 [71–97] vs. Control: 105 [94–122] %predicted, median [IQR]; d = 0.84, p < 0.01), and a higher specific airway resistance (Burn: 235 ± 80 vs. Control: 179 ± 40%predicted, mean ± SD; d = 0.66, p = 0.02) than non‐burned control participants (n = 12). No variables were meaningfully influenced by having a previous inhalation injury (d ≤ 0.44, p ≥ 0.19; 13 of 41 had an inhalation injury), the size of the body surface area burned (R2 ≤ 0.06, p ≥ 0.15; range of 15%–88% body surface area burned), or the time since the burn injury (R2 ≤ 0.04, p ≥ 0.22; range of 2–50 years post‐injury). These data suggest that adults with well‐healed burn injuries have lower pulmonary function decades after injury. Therefore, future research should examine rehabilitation strategies that could improve pulmonary function among adults with well‐healed burn injuries.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

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

Watso

Romero

Moralez

et al. 2022

Physiological Reports

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“…While similar studies are lacking in adults, the observation that even non-severe burn injury is associated with significantly increased risk and severity of infectious diseases and respiratory infections (determined by both admission rates and length-of-stay in hospital) over a follow-up period of around 15 years post-burn injury [ 6 , 8 ], suggests that immune dysfunction is also likely occurring in the adult burn population. The increase in respiratory infections observed in these studies was also observed in paediatric patients after burn [ 13 ], providing further evidence that burn has similar effects on immune function in adults. However, the mechanisms that underlie immune dysfunction in children and adults may not be the same and will be important to investigate in future studies.…”

Section: Introductionsupporting

confidence: 66%

Non-severe burn injury increases cancer incidence in mice and has long-term impacts on the activation and function of T cells

et al. 2022

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Background Recent evidence suggests that burn patients are at increased risk of hospital admission for infection, mental health conditions, cardiovascular disease and cancer for many years after discharge for the burn injury itself. Burn injury has also been shown to induce sustained immune system dysfunction. This change to immune function may contribute to the increased risk of chronic disease observed. However, the mechanisms that disrupt long-term immune function in response to burn trauma, and their link to long-term morbidity, remain unknown. In this study we investigated changes to immune function after burn injury using a murine model of non-severe injury. Methods An established mouse model of non-severe burn injury (full thickness burn equivalent to 8% total body surface area) was used in combination with an orthotopic model of B16 melanoma to investigate the link between burns and cancer. Considering that CD8+ T cells are important drivers of effective tumour suppression in this model, we also investigated potential dysregulation of this immune population using mouse models of burn injury in combination with herpes simplex virus infection. Flow cytometry was used to detect and quantify cell populations of interest and changes in immune function. Results We demonstrate that 4 weeks after a non-severe burn injury, mice were significantly more susceptible to tumour development than controls using an orthotopic model of B16 melanoma. In addition, our results reveal that CD8+ T cell expansion, differentiation and memory potential is significantly impaired at 1 month post-burn. Conclusions Our data suggests that CD8+ T cell-mediated immunity may be dysfunctional for a sustained period after even non-severe burn injury. Further studies in patients to validate these findings may support clinical intervention to restore or protect immunity in patients after burn injury and reduce the increased risk of secondary morbidities observed.

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“…A study by the same group of 5,290 Australian children who sustained a first burn revealed that these children had an increased risk of influenza over a 10-year period (IRR 1.78, 95% CI 1.10-2.87), with the highest rates of respiratory tract infections over the first 5 years. 11 Children who sustained a burn demonstrated 1.24 times higher risk for readmission from resulting respiratory tract infection. Amongst the pediatric population, the immune system and lung epithelia are still immature, and it may be that early insult predisposes to impaired future immunity and subsequent infection.…”

Section: Risk Of Influenza Postburn Injury and Evidence For Immunizationmentioning

confidence: 99%

Recommendations for Influenza Vaccination in Burns Patients Based on a Systematic Review of the Evidence

Nweze

Hart-Pinto

Philip

et al. 2021

Journal of Burn Care &Amp; Research

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Severe burn injury is a serious systemic insult that can lead to life threatening secondary infections. Immunosuppression, inhalation injury and prolonged length of hospital stay are factors which predispose patients to severe respiratory tract infections. Furthermore, evidence shows that burns can put one at risk of infection long after the original injury. Currently in the United Kingdom, the annual National Flu Immunisation programme outlines guidance for groups who are deemed high risk and therefore eligible for the influenza vaccine. At present, no guidance exists for administration of the influenza vaccine in burn injured patients, despite knowledge of immunosuppression. The aim of this literature review is to examine the evidence for associations between burn injury and influenza and where available, evaluate efficacy of influenza vaccines in this cohort. In addition, literature was searched for the effectiveness of the influenza vaccine in patients 65 years and above, and in patients admitted to the intensive care unit (ICU); two domains common to patients with severe burns. Three papers were found to suggest increased susceptibility to influenza following burn injury, however no papers studying the effectiveness of the influenza vaccine in this group were found. Several studies demonstrated improved outcomes in patients over 65 years and patients admitted to ICU. Following evaluation of the evidence, this review advocates for the consideration of hospitalized burn patients for the influenza vaccine. We suggest avoidance of vaccine administration in the acute burn phase. Further prospective clinical trials would be required to validate these findings.

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Respiratory Morbidity After Childhood Burns: A 10-Year Follow-up Study

Abstract: These findings demonstrated increased respiratory infection admissions after burns. These outcomes suggest that immune changes triggered by a burn injury may persist in some children for at least 10 years after wound healing.

Cited by 12 publications

References 43 publications

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

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

Non-severe burn injury increases cancer incidence in mice and has long-term impacts on the activation and function of T cells

Recommendations for Influenza Vaccination in Burns Patients Based on a Systematic Review of the Evidence

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