ABSTRACT
The purpose of this study is to determine the incidence of sinusitis in mechanically ventilated burn victims and to examine if the presence of inhalational injury increases the likelihood of developing sinusitis. The authors hypothesize that the incidence of sinusitis will be increased in burn victims who have concomitant inhalational injury. A retrospective chart analysis was performed on all patients who were admitted to the Nathan Speare Regional Burn Treatment Center over a 24-month time frame. Patients who were mechanically ventilated for greater than 24 hours were then selected, resulting in a total of 137 patients for analysis. Multiple variables including number of days on mechanical ventilation, presence of confirmed inhalational injury by bronchoscopy, and method of diagnosis were examined. Of 137 patients, a diagnosis of sinusitis was made in 32 patients (23%). In patients with sinusitis, 87.5% had inhalational injury confirmed with bronchoscopy, compared with only 33.3% of patients without sinusitis (P < .01). Rates of nasotracheal/nasogastric intubation, nasoenteric feeding, and length of mechanical ventilation before sinusitis diagnosis were not significantly different. Patients with sinusitis were found to have suffered inhalational injury at a significantly higher rate than those who did not develop sinusitis. This suggests that inhalational injury is a significant risk factor for developing sinusitis.
Subject(s)
Burns, Inhalation/complications , Sinusitis/epidemiology , Adult , Bronchoscopy , Burns, Inhalation/diagnosis , Burns, Inhalation/therapy , Female , Humans , Incidence , Male , Middle Aged , Respiration, Artificial , Retrospective Studies , Risk Factors , Sinusitis/diagnosisABSTRACT
Objetivo: Identificar as características dos pacientes que apresentaram queimaduras de face no Centro de Tratamento de Queimados do Hospital Metropolitano de Urgência e Emergência. Método: Estudo de abordagem quantitativa, do tipo observacional, retrospectivo e descritivo. Foram consultados 47 prontuários de internações de agosto de 2010 a maio de 2012 e coletados dados por meio de ficha contendo dados referentes a identificação, história da doença, exames complementares e tempo de internação. Os dados foram analisados por meio de médias, frequência e tabulação das variáveis de interesse. Resultados: O sexo masculino foi o mais acometido, entre a faixa etária de 18 a 40 anos, sendo que 40,4% apresentaram lesão inalatória e a exposição a líquidos inflamáveis como principal agente causador, acarretando em sua maioria lesões de 2º grau e apenas 32% realizaram broncoscopia. A média de internação foi menor que 30 dias, havendo 46 altas e apenas um óbito. Conclusão: Identificou-se que 51% da amostra sofreu lesão inalatória associada à queimadura de face, sendo os adultos jovens do sexo masculino o grupo mais acometido. Tais dados são importantes para o conhecimento da comunidade científica e para que sejam difundidos programas de prevenção a grupos de risco para este tipo de lesão, já que esta é a melhor forma de evitar as queimaduras e suas complicações.
Objective: To identify the characteristics of patients with facial burns at the Burns Treatment Center of the Hospital Metropolitano de Urgência e Emergência. Method: The study was a quantitative approach, observational, retrospective and descriptive. Analyzed 47 medical records during the period from August 2010 to May 2012. Data were collected related to identification, history of the disease, laboratory tests and length of stay, among others. Data were analyzed using mean, frequency and tabulation of the variables of interest. Results: Males were the most affected, between the age group of 18 to 40 years, and 40.4% had inhalation injury having as the main causative agent exposure to flammable liquids, resulting mostly injury 2nd degree and only 32% underwent bronchoscopy. The average hospital stay was less than 30 days, with 46 discharge and only one death. Conclusion: These data are important for understanding the scientific community and that prevention programs are broadcast to risk groups for this type of injury, identified as males, aged 18-45 years, mostly suffered second degree injuries, generating an average hospital stay less than 30 days, with only one death.
Objetivo: Identificar las características de los pacientes con quemaduras del rostro en el Centro de Tratamiento de Quemados del Hospital Metropolitano de Urgência e Emergência. Método: Estudio de abordaje cuantitativo, de tipo observacional, retrospectivo y descriptivo. Fueron analizados 47 archivos médicos de pacientes atendidos entre agosto de 2010 a mayo de 2012, a través de un formulario en el que se recogieron los datos relativos a la identificación, la historia de la enfermedad, las pruebas de laboratorio y tiempo estancia hospitalaria. Realizados análisis descriptivos de media, frecuencia y la tabulación de las variables de interés. Resultados: Los hombres fueron los más afectados, entre el grupo de edad de 18 a 40 años y 40,4% tuvieron lesiones por inhalación después de exposición a líquidos inflamables, siendo este el principal agente causal, lo que resulta sobre todo en lesiones segundo en grado; e sólo el 32% tuvieron que realizar broncoscopía. La estancia media hospitalaria fue de menos de 30 días, con 46 altas y apenas una muerte. Conclusión: Se identificó que el 51% de la muestra sufrió lesiones por inhalación asociado con quemaduras faciales, siendo los adultos jovenes del sexo masculino los más afectados. Estos datos son importantes para la comprensión de la comunidad científica y para que sean difundidos programas de prevención para grupos de riesgo para este tipo de lesiones, ya que esta es la mejor forma de evitar as quemaduras y sus complicaciones.
Subject(s)
Humans , Male , Female , Adolescent , Young Adult , Burns, Inhalation/diagnosis , Smoke Inhalation Injury , Facial Injuries/therapy , Brazil , Burn Units/standardsABSTRACT
La mayoría de las muertes tempranas por accidentes con fuego son provocadas por la inhalación de gases más que por las lesiones causadas por llamas, debido principalmente al compromiso ventilatorio que esto produce. Por lo anterior debe existir un alto grado de sospecha de compromiso de vía aérea en aquellos pacientes que presenten quemaduras faciales, en espacios cerrados, vibrisas chamuscadas, compromiso respiratorio progresivo, esputo carbonáceo o que se encuentren en estado de inconciencia. Sin embargo, la presencia de estos hallazgos no es patognomónica de daño en el árbol bronquial ni su ausencia lo descarta. El principal método de diagnóstico es la fibrobroncoscopía, que permite observar directamente las lesiones y además lavar y remover restos que puedan encontrarse en la vía aérea, pero lamentablemente no se encuentra disponible en todos los servicios de urgencia.(AU)
Most of the early deaths from accidents with are fire mainly caused by compromise of the ventilation due to gas inhalation rather thand by injuries caused by flames. Therefore there must be a high degree of suspicion of air compromise for patients presenting facial burns indoors, burnt hair of the nasal cavity, progressive respiratory compromise, carbonaceous sputum or unconsciousness. However, neither is the presence of these findings pathognomonic of damage to the bronchial tree nor does their discharge it. The main method is the fibrobroncoscopy diagnosis, which allows direct observation of the injuries and also the washing and removal of debris that can be found in the airways. Unfortunately, this is method is not available in all amergency services.(AU)
Subject(s)
Humans , Airway Obstruction/diagnosis , Airway Obstruction/etiology , Airway Obstruction/physiopathology , Airway Obstruction/therapy , Burns, Inhalation/diagnosis , Burns, Inhalation/physiopathology , Burns, Inhalation/therapy , Smoke Inhalation Injury/complications , Carbon Monoxide/adverse effectsABSTRACT
La mayoría de las muertes tempranas por accidentes con fuego son provocadas por la inhalación de gases más que por las lesiones causadas por llamas, debido principalmente al compromiso ventilatorio que esto produce. Por lo anterior debe existir un alto grado de sospecha de compromiso de vía aérea en aquellos pacientes que presenten quemaduras faciales, en espacios cerrados, vibrisas chamuscadas, compromiso respiratorio progresivo, esputo carbonáceo o que se encuentren en estado de inconciencia. Sin embargo, la presencia de estos hallazgos no es patognomónica de daño en el árbol bronquial ni su ausencia lo descarta. El principal método de diagnóstico es la fibrobroncoscopía, que permite observar directamente las lesiones y además lavar y remover restos que puedan encontrarse en la vía aérea, pero lamentablemente no se encuentra disponible en todos los servicios de urgencia.
Most of the early deaths from accidents with are fire mainly caused by compromise of the ventilation due to gas inhalation rather thand by injuries caused by flames. Therefore there must be a high degree of suspicion of air compromise for patients presenting facial burns indoors, burnt hair of the nasal cavity, progressive respiratory compromise, carbonaceous sputum or unconsciousness. However, neither is the presence of these findings pathognomonic of damage to the bronchial tree nor does their discharge it. The main method is the fibrobroncoscopy diagnosis, which allows direct observation of the injuries and also the washing and removal of debris that can be found in the airways. Unfortunately, this is method is not available in all amergency services.
Subject(s)
Humans , Airway Obstruction/diagnosis , Airway Obstruction/etiology , Airway Obstruction/physiopathology , Airway Obstruction/therapy , Burns, Inhalation/diagnosis , Burns, Inhalation/physiopathology , Burns, Inhalation/therapy , Smoke Inhalation Injury/complications , Carbon Monoxide/adverse effectsABSTRACT
Every year almost three thousand people get burned in Chile. In this group, about 40 percent of the critical burned patients also suffer inhalation injury. This number is expected to grow bigger among the adult population in the next few years. Inhalation injury significantly increases mortality in burned patients. The prevalence, pathophysiology, clinical characteristics, treatment, and prognosis of this pathology have not been incorporated in the undergraduate curses of Chilean medical schools. Therefore, this subject is pooly known by most of our physicians. Because this disease will be included in the explicit warranties health plan of the public health care system in Chile, we decide to write this review about this pathological condition.
Cada año casi tres mil personas sufren quemaduras en Chile. En la población adulta se estima que este número se incrementará en los próximos años. En este grupo, cerca del 40 por ciento de las quemaduras graves se asocian a injuria inhalatoria. la injuria inhalatoria aumenta significativamente la mortalidad en los pacientes quemados. la prevalencia, fisiopatologia, cuadro clínico, manejo y pronóstico de esta patología no han sido incorporados en los estudios de pregrado de las escuelas de medicina y son temas desconocidos para la mayoría de los médicos. En el contexto de la próxima incorporación de este tipo de dolencias en el plan de garantías explícitas en la salud chilena hemos realizado una actualización del tema.