Successful Management With Continuous Negative Abdominal Pressure Therapy in a Severely Obese Patient With Inhalation Burn-Induced Severe Respiratory Failure Requiring Veno-Venous Extracorporeal Membrane Oxygenation: A Case Report.

Continuous negative abdominal pressure (CNAP) therapy effectively provides respiratory support in patients with respiratory failure and severe obesity; however, its use in clinical practice remains limited. In this case, we report a significant improvement in the respiratory condition of a patient with severe obesity and inhalation burns following the application of CNAP in addition to venovenous extracorporeal membrane oxygenation (V-V ECMO) and mechanical ventilation. The patient was able to wean off these devices successfully. This case highlights the potential of CNAP therapy as an adjunct treatment for severe respiratory failure, particularly in obese patients for whom conventional interventions are insufficient.

Voice Recovery in a Patient with Inhaled Laryngeal Burns.

INTRODUCTION: Laryngeal burns cause long-term voice disorders due to mucosal changes of the vocal folds. Inhalation injuries affect voice production and result in changes in the mucosal thickness and voice quality. CASE REPORT: A 47-year-old woman was transferred to our department with laryngeal burns sustained during a house fire. On laryngoscopic examination, mucosal waves of both vocal folds were not visualized due to the injury caused by inhalation of high-temperature toxic smoke. Hence, voice analysis, laryngoscopic examinations, and high-speed videoendoscopy (HSV) were performed to evaluate vocal fold vibrations. An absence of mucosal waves and a breathy and strained voice with a severe grade were noted. We report that voice quality was recovered to close to the normal state through multiple treatments such as medication, voice therapy, and counseling. CONCLUSION: This paper presents the unique case of a patient with laryngeal burns, in which vibrations of the vocal folds were observed using laryngoscopic examination and HSV. Voice samples before and after treatment were also analyzed. By observing the vibration pattern of the injured vocal fold, it is expected that appropriate diagnosis and treatment planning can be established in clinical practice.

Pre-burn centre management of the airway in patients with face burns.

Face burns expose patients to a higher respiratory risk, and early prophylactic intubation before they enter the burn unit might be life-saving. However, unnecessary intubation may compromise their clinical evolution. Hence, the decision to perform pre-burn centre endotracheal intubation remains a clinical challenge. A retrospective study was developed to characterize the experience of the tertiary burn unit of the Hospital da Prelada with face burn patients arriving endotracheally-intubated between January 2009 and September 2013. Specific goals included assessment of whether these intubations were clinically appropriate and if these procedures determined significant changes in clinical course and outcome. A total of 136 patients were admitted to our burn centre with facial burns. 38.2% (n=52) of them arrived endotracheally-intubated, with 75% (n=39) intubated at the scene of the burn injury and 25% (n=13) in the emergency room because of the suspicion of smoke inhalation injury. In only 23% of the cases (n=12) was the lesion confirmed by bronchoscopy. The overall mortality rate was 12.5% (n=17): 3.6% (n=3) were patients who had not been subjected to pre-burn centre intubation, and 27% (n=14) were in the group of patients arriving intubated. A face burn is a warning sign of a possible upper airway injury, and pre-burn centre prophylactic intubation might be life-saving. However, unnecessary intubation may impair clinical evolution. Therefore, it is imperative that updated practice guidelines for pre-burn centre airway management are adhered to, and that these guidelines are subject to revision in order to improve airway management in burn patients.

Les brûlures de la face exposent le patient à un risque respiratoire important et l'intubation « prophylactique ¼, avant l'hospitalisation en CTB, peut lui sauver la vie. Cependant, une intubation inutile peut retentir défavorablement sur l'évolution. De ce fait, la décision de réaliser ou non une intubation en préhospitalier reste un défi pour le clinicien. Une étude rétrospective a été conduite, afin de caractériser les patients brûlés de la face arrivant intubés dans le CTB de l'hôpital da Prelada, entre janvier 2009 et septembre 2013. Il s'agissait de définir si l'intubation était nécessaire et si elle impactait l'évolution du patient. Cent trente six patient ont été admis avec une brûlure faciale. Cinquante deux (38,2%) étaient intubés, dont 39 (75%) sur site et 13 (25%) aux urgences, en raison de la suspicion de lésions d'inhalation, qui n'a été confirmée (par bronchoscopie) que 12 fois (23%). La mortalité globale a été de 12,5% (n=17). Elle était de 3,6% chez les patients non intubés (n=3) et de 27% (n= 14) chez ceux arrivant intubés. Une brûlure de la face est un signe d'alerte de lésion des voies aériennes supérieures, et une intubation préhospitalière peut être vitale. Cependant, une intubation inutile peut obérer l'évolution. De ce fait, il est impératif de rédiger et maintenir à jour des protocoles de gestion préhospitalière des voies aériennes chez les patients brûlés, afin d'optimiser la prise en charge des brûlés de la face.

Prediction of mortality in pediatric burn injuries: R-baux score to be applied in children (pediatrics-baux score).

OBJECTIVE: R-Baux score has obtained an acceptable validity and accuracy in predicting burn-related mortality. However, its usage and efficacy among pediatric burn patients has not been well documented. The aim of this study was to employ Pediatrics-Baux (P-Buax) score as modified version of R-Baux score in these patients to determine how it could be applicable in this population. METHODS: Through a prospective study, 870 pediatric burn patients were enrolled. P-Baux and R-Baux scores were calculated for each patient and they were categorized to different groups according to these scores. Mortality and further death probability were measured for each subject and then analyzed by logistic regression model to reveal how they change in relation with age in pediatric burn patients. FINDINGS: R-Baux score for 95% probability of death revealed a mean of 73 among patients of this study. Also P-Baux score was measured in these patients with inhalation injury which showed to be 55 for 95% probability of death. Results showed that age had a positive prognostic value in contrast to the negative prognostic value of Total Body Surface Area (TBSA) and inhalation injury. CONCLUSION: Our analysis showed that in children under the age of 15 years, age has a positive prognostic value while TBSA and inhalation injuries had negative prognostic values in relation to mortality. Hence, in contrast to the adult population, burn injury related mortality may be predicted by modified R-Baux score as (TBSA - age + [18×R]) which could be named as P-Baux score.