The Role of Inhalation Injury in Burn Trauma A Canadian Experience

Tredget, Edward E.; Shankowsky, Heather A.; Taerum, Terry; Moysa, Gerald L.; Alton, John

doi:10.1097/00000658-199012000-00011

Cited by 135 publications

(50 citation statements)

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“…Potential survivability for those children who were incinerated is obviously zero, and for those with more than 60 per cent of surface area burnt who also sustained some inhalational injury, survivability is estimated at less than 20 per cent. [10][11][12][13][14] Evidence of airway obstruction was present in 61 (81 per cent) of the 68 children for whom this factor was recorded at post mortem. Seven of the 82 children (8 per cent) survived their injuries for one d ay or more.…”

Section: Resultsmentioning

confidence: 99%

“…The reason for this low figure is the life-threatening influence of tracheal and pulmonary burns sustained by an entrapped victim breathing hot gases. 4,11,12,24 Adult data have indicated that smoke inhaled by an entrapped victim results in 62 per cent mortality. 25 Intubation and airway control is the urgent resuscitation measure for all children who are rescued from house fires and from motor vehicle conflagrations.…”

Section: Discussionmentioning

confidence: 99%

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Facial burns in children: A series analysis with implications for resuscitation and forensic odontology

Acton

Nixon

Pearn

et al. 1999

Australian Dental Journal

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This study comprises a continuous (1981–1995) unselected series of all children who died from thermal injuries in teh state of Queensland, Australia. One hundred and six children, so identified, died from incineration (35 per cent), respiratory burns with smoke or carbon monoxide inhalaton (33 per cent), body surface area burns comprising greater than 60 per cent (9 per cent) and electrocution (20 per cent). The burn fatality rate electrocution (20 percent). The burn fatality rate was 0.98 per hundred thousand children (0–14 years) per year, with no secular trend and, specifically, no reduction in the annual rate of such fatalities. Eighty‐two children (49 males) had concomitant facial injuries, both thermal and nonthermal; of whom 55 per cent were under the age of five years. Sixty (73 per cent) child burn victims died in house fires. Forensic odontology is important in confirming the age of such victims in single incinerations but is of limited value wen larger numbers of children are incinerte, because of the relative lack of dental restorations in teh infant and pre‐school age group. Of the 82 children with facial and airway injuries, 12 per cent had only mild or superficial facial damage and only seven (8 per cent) were alive or resuscitatable at teh time of rescue from teh conflagration or burning injury. Child deaths from burns contributed an annual loss rate of 506 years of potential life lost (YPLL) in a population of 3 milllion of whom 21.5 per cent were children under the age of 15 years. Airway management and resuscitation, in the context of managing surviving burn victims of any age with facial injuries, pose special difficulties. Inhalational burns (smoke and the grass of conflagration) result in a mortality greater than 60 per cent. Although 81 per cent of children showed evidence of airway obstruction, analysis of current data indicates that a maximum of 8 per cent could have survived with airway maintenance and protection. Inhalational burns (to both upper and lower airway) grossly reduce survivability. Primary prevention would seem vital and thus remains a major challenge to reduce the incidence of such deaths. Some strategies include advocacy to promote the compulsory installation of smoke alarms, family drills to practise escape and the teaching of ‘first aid for all’.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Facial burns in children: A series analysis with implications for resuscitation and forensic odontology

Acton

Nixon

Pearn

et al. 1999

Australian Dental Journal

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“…When combined with cutaneous burns, inhalation injury increases fluid requirements for resuscitation, [1] the incidence of pulmonary complications, [2] and the mortality rate. [2][3][4] Inhalation injury is produced by either thermal or chemical irritation due to inspiration of smoke, burning embers, steam, or other irritant or cytotoxic materials in the form of fumes, mists, particulates, or gases. [3,5,6] The damage can be the result of direct cytotoxic effects of the aspirated materials or a consequence of the inflammatory response.…”

Section: Methodsmentioning

confidence: 99%

Management of Inhalation Injury and Respiratory Complications in Burns Intensive Care Unit

Kabalak

Yastı²

2012

Ulus Travma Acil Cerrahi Derg

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AMAÇİnhalasyon yaralanması yüksek mortalite oranlarına sahiptir ve belirgin kalıcı pulmoner fonksiyon bozukluğu riski taşımaktadır. İnhalasyon yaralanması ve sonuçları, klinik yönetiminde ana rol oynayan solunum terapistlerine, hemşirelere ve doktorlara ciddi zorluklar oluşturur. Çalış-mamızda inhalasyon yaralanmalı hasta serimizdeki klinik tecrübelerimizi ve noninvazif mekanik ventilatör (NIMV) desteğinin rolünü bildirmeyi amaçladık. GEREÇ VE YÖNTEMAnkara Numune Eğitim ve Araştırma Hastanesi Yanık Yoğun Bakım Ünitesi'nde Mart 2009 -Mart 2011 yılları arasında yatarak tedavi alan hastalardan inhalasyon hasarı nedeniyle solunum desteğine ihtiyaç duyanlar çalışma-ya alındı. BULGULARBu hastaların 37'sinde inhalasyon yaralanması vardı, mortalite oranı %13,5 olarak bulundu, hastaların 16'sında zorunlu entübasyon uygulanırken (altı hastada ilk 6 saatte ve 10 hastada klinik seyir sürecinde) diğer hastalara sadece (%67,8) NIMV desteği uygulandı. SONUÇNIMV desteğinin uygun modlarda uygulanması, inhalasyon yaralanmalı olgularda invaziv yöntemlerin gerekliliği-ni azaltmaktadır. NIMV desteğinin inhalasyon yaralanmalı yanık hastalarında uygulanmasını önermekteyiz.Anahtar Sözcükler: İnhalasyon yaralanması; medikal tedavi; solunum yönetimi; ventilatör desteği. BACKGROUNDInhalation injury has high mortality and carries a significant risk of permanent pulmonary dysfunction. Inhalation injury and its consequences impose difficulties for the respiratory therapists, nurses and doctors who play a central role in its clinical management. In this study, we aimed to report our clinical experience and the role of non-invasive mechanic ventilatory (NIMV) support in a series of inhalation-injured patients. METHODSPatients hospitalized at Ankara Numune Training and Research Hospital's Burns Intensive Care Unit between March 2009 and March 2011 was reviewed, and patients with required respiratory support due to inhalation injury were included in the study. RESULTSAmong the patients, 37 had inhalation injury, and their mortality was 13.5%. Of the 37 patients, 16 had mandatory intubation (6 in the first 6 hours and 10 in the clinical course); however, others (67.8%) had only NIMV support. CONCLUSIONApplication of NIMV support with proper modes decreases the need for invasive procedures in inhalation-injured patients. Based on our results, we propose the application of NIMV support in inhalation-injured burn patients.

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“…Among annual reported injuries in USA two million are ranked in burn category (US fact sheet 2000). The mortality in South Asia extended over 10/100,000 burn injuries (Tredget et al, 1990). In biggest city of Pakistan, Karachi the adult mortality rate due to burns was, 6.8/100,000 for men and 14.1/100,000 for women, respectively in the year of 2002 (World Health Organization ;.…”

Section: Mortality Rate Associated With Hospital Acquired Infectionsmentioning

confidence: 99%

Mortality rate associated with hospital acquired infections among burn patients

et al. 2016

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Abstract-Introduction:Hospital acquired infections (HAIs) are the major contributors of mortality associated with burn injuries. The aim of this research was to document the antecedents affiliated with major burn injuries, hospitalization and mortality in burn patients. Methods: We performed a single center prospective study of patients admitted during 3 months period (April-June 2014) in burn wards of government hospital. There were 100 patients in this investigation which were observed weekly. The inclusion criterion was based on the shifting of patients from emergency to the wards after initial treatment of more than 24 h. Variables included were age and gender of the patient, the percent total body surface area (%TBSA) burn, the cause of the burn. Results: Mean age of patients was 30.29 years. More females (55.67%) were admitted than males (44.32%). The total body surface area (%TBSA) burnt were from 15%-95% respectively moreover children were more sensitive to hospital acquired infections (HAIs) and mortality rate was 34% in children with mean age of 5 years and disability of body parts were 42% among 75% were females. Whereas the most common (HAIs) were primary bloodstream (PBS) with mean value of 30.50, wound infections (WIS) were at second prevalence with mean value of 27.50, followed by sepsis (S) and pneumonia (P) 10.33, eye infections (EIs) 4.833 and urinary tract infections (UTIs) 2.667. Factors significantly (p-value= 0.000) associated with increased duration of hospitalization caught HAIs mortality include the age and gender of the patient, the cause of burn, inhalation injury, the region affected and %TBSA burnt. Conclusion: It concluded that the mortality was very much dependent on age and gender of the patient, burn causes, affected area as well as % TBSA burnt are considerable factors in determining the relationship of HAIs and whether the patients will survive or knuckle to injuries. Better compliance techniques, stricter control over disinfection and sterilization practices and usage of broad spectrum antibiotics, and reduction of the environmental contamination are required to reduce the HAIs rates among burn patients.

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The Role of Inhalation Injury in Burn Trauma A Canadian Experience

Cited by 135 publications

References 20 publications

Facial burns in children: A series analysis with implications for resuscitation and forensic odontology

Facial burns in children: A series analysis with implications for resuscitation and forensic odontology

Management of Inhalation Injury and Respiratory Complications in Burns Intensive Care Unit

Mortality rate associated with hospital acquired infections among burn patients

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