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1.
Burns ; 50(4): 797-807, 2024 May.
Artículo en Inglés | MEDLINE | ID: mdl-38307765

RESUMEN

BACKGROUND: The disruption to the immune system and profound metabolic response to burn injury gives rise to a unique susceptibility to infection. Indeed, infection is one of the most frequently encountered post-burns complications placing significant burden on patients and healthcare system. Advancements in burn care have led to marked improvements in burn-related mortality and morbidity; however, scarce hospital resources hamper adequate burn-related care, and patient length of stay (LOS) in hospital is an important drain on such resources. The aim of this review was to assess and evaluate the existing literature relating to the impact of infections on LOS in hospitalised, adult burn patients. METHODS: Electronic searches were performed in Medline and Embase. Eligible studies were those reporting on LOS and infection in adult burn populations. Articles published before 2000 were excluded to ensure that the analysis was focused on contemporary literature that reflects current, clinical management of burn patients. RESULTS: Nineteen studies (54,397 burn patients) were included in the review. All studies were retrospective, with the majority undertaken in North America (14 studies). The mean age range was 38-67 years and the majority of patients were male. Inhalation injury was recorded in eleven studies. The most common types of infection included pneumonia, blood stream infections (BSI) and burn wound infections. Overall, there was a trend towards a positive association between infection and LOS. CONCLUSION: The results of this scoping review provide an overview of the existing literature on the relationship between infection and LOS in adult burn populations. However, significant gaps remain in knowledge which call for further high-quality research. Standardised definitions for the collection of infection data and the use of burns specific infection control guidelines are also critical to understanding and improving patient outcomes.


Asunto(s)
Quemaduras , Tiempo de Internación , Infección de Heridas , Humanos , Quemaduras/terapia , Quemaduras/complicaciones , Tiempo de Internación/estadística & datos numéricos , Infección de Heridas/epidemiología , Neumonía/epidemiología , Bacteriemia/epidemiología , Quemaduras por Inhalación/terapia , Adulto , Lesión por Inhalación de Humo/terapia
2.
J Burn Care Res ; 45(3): 796-800, 2024 05 06.
Artículo en Inglés | MEDLINE | ID: mdl-38367208

RESUMEN

INTRODUCTION: Inhalation injury is a major risk factor for mortality in burn patients via 3 primary mechanisms: airway edema and obstruction, hypoxemic respiratory failure, and pneumonia. Currently, the mainstay of treatment is supportive care to include early intubation, lung-protective or high-frequency-percussive mechanical ventilation, nebulized heparin, and aggressive pulmonary toilet. Despite these treatments, a subset of these patients progress to severe acute respiratory distress syndrome (ARDS) for which rescue options are limited. CASE PRESENTATION: A 31-year-old woman was found down in a house fire. On admission to the burn intensive care unit, she was diagnosed with grade 3 smoke inhalation injury. Cutaneous thermal injury was absent. By hospital day 2, she developed worsening hypoxemia and hypercapnia despite maximal ventilatory support. She was placed on veno-venous extracorporeal membrane oxygenation (ECMO). She received an average of 2.2 hours of direct rehabilitation a day and completed out-of-bed modalities over 90% of total hospital days. After 159 hours, she was decannulated, and by hospital day 18, she was discharged home on supplemental oxygen. CONCLUSION: Current literature regarding ECMO in inhalation injury is limited, but a growing body of evidence suggests that treatment of severe smoke inhalation injury should include ECMO for those who fail conventional therapy.


Asunto(s)
Oxigenación por Membrana Extracorpórea , Lesión por Inhalación de Humo , Humanos , Femenino , Adulto , Lesión por Inhalación de Humo/terapia , Síndrome de Dificultad Respiratoria/terapia , Síndrome de Dificultad Respiratoria/etiología , Grupo de Atención al Paciente
3.
MedEdPORTAL ; 20: 11383, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38414645

RESUMEN

Introduction: Pediatric trauma has long been one of the primary contributors to pediatric mortality. There are multiple cases in the literature involving cyanide (CN) toxicity, carbon monoxide (CO) toxicity, and smoke inhalation with thermal injury, but none in combination with mechanical trauma. Methods: In this 45-minute simulation case, emergency medicine residents and fellows were asked to manage a pediatric patient with multiple life-threatening traumatic and metabolic concerns after being extracted from a van accident with a resulting fire. Providers were expected to identify and manage the patient's airway, burns, hemoperitoneum, and CO and CN toxicities. Results: Forty learners participated in this simulation, the majority of whom had little prior clinical experience managing the concepts highlighted in it. All agreed or strongly agreed that the case was relevant to their work. After participation, learner confidence in the ability to manage each of the learning objectives was high. One hundred percent of learners felt confident or very confident in managing CO toxicity and completing primary and secondary surveys, while 97% were similarly confident in identifying smoke inhalation injury, preparing for a difficult airway, and managing CN toxicity. Discussion: This case was a well-received teaching tool for the management of pediatric trauma and metabolic derangements related to fire injuries. While this specific case represents a rare clinical experience, it is within the scope of expected knowledge for emergency medicine providers and offers the opportunity to practice managing multisystem trauma.


Asunto(s)
Medicina de Emergencia , Incendios , Traumatismo Múltiple , Lesión por Inhalación de Humo , Humanos , Niño , Medicina de Emergencia/educación , Lesión por Inhalación de Humo/diagnóstico , Lesión por Inhalación de Humo/terapia
4.
Front Immunol ; 14: 1227751, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-37520569

RESUMEN

Acute respiratory distress syndrome (ARDS) is a leading cause of morbidity and mortality in polytrauma patients. Pharmacological treatments of ARDS are lacking, and ARDS patients rely on supportive care. Accurate diagnosis of ARDS is vital for early intervention and improved outcomes but is presently delayed up to days. The use of biomarkers for early identification of ARDS development is a potential solution. Inflammatory mediators high-mobility group box 1 (HMGB1), syndecan-1 (SDC-1), and C3a have been previously proposed as potential biomarkers. For this study, we analyzed these biomarkers in animals undergoing smoke inhalation and 40% total body surface area burns, followed by intensive care for 72 h post-injury (PI) to determine their association with ARDS and mortality. We found that the levels of inflammatory mediators in serum were affected, as well as the degree of HMGB1 and Toll-like receptor 4 (TLR4) signal activation in the lung. The results showed significantly increased HMGB1 expression levels in animals that developed ARDS compared with those that did not. Receiver operating characteristic (ROC) analysis showed that HMGB1 levels at 6 h PI were significantly associated with ARDS development (AUROC=0.77) and mortality (AUROC=0.82). Logistic regression analysis revealed that levels of HMGB1 ≥24.10 ng/ml are associated with a 13-fold higher incidence of ARDS [OR:13.57 (2.76-104.3)], whereas the levels of HMGB1 ≥31.39 ng/ml are associated with a 12-fold increase in mortality [OR: 12.00 (2.36-93.47)]. In addition, we found that mesenchymal stem cell (MSC) therapeutic treatment led to a significant decrease in systemic HMGB1 elevation but failed to block SDC-1 and C3a increases. Immunohistochemistry analyses showed that smoke inhalation and burn injury induced the expression of HMGB1 and TLR4 and stimulated co-localization of HMGB1 and TLR4 in the lung. Interestingly, MSC treatment reduced the presence of HMGB1, TLR4, and the HMGB1-TLR4 co-localization. These results show that serum HMGB1 is a prognostic biomarker for predicting the incidence of ARDS and mortality in swine with smoke inhalation and burn injury. Therapeutically blocking HMGB1 signal activation might be an effective approach for attenuating ARDS development in combat casualties or civilian patients.


Asunto(s)
Quemaduras , Proteína HMGB1 , Síndrome de Dificultad Respiratoria , Lesión por Inhalación de Humo , Porcinos , Animales , Receptor Toll-Like 4 , Pronóstico , Proteína HMGB1/metabolismo , Síndrome de Dificultad Respiratoria/terapia , Lesión por Inhalación de Humo/complicaciones , Lesión por Inhalación de Humo/terapia , Quemaduras/complicaciones , Biomarcadores , Humo
5.
Int Immunopharmacol ; 123: 110638, 2023 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-37494838

RESUMEN

INTRODUCTION: Treatment of ARDS caused by smoke inhalation is challenging with no specific therapies available. The aim of this study was to test the efficacy of nebulized adipose-derived mesenchymal stem cells (ASCs) in a well-characterized, clinically relevant ovine model of smoke inhalation injury. MATERIAL AND METHODS: Fourteen female Merino sheep were surgically instrumented 5-7 days prior to study. After induction of acute lung injury (ALI) by cooled cotton smoke insufflation into the lungs (under anesthesia and analgesia), sheep were placed on a mechanical ventilator for 48 hrs and monitored for cardiopulmonary hemodynamics in a conscious state. ASCs were isolated from ovine adipose tissue. Sheep were randomly allocated to two groups after smoke injury: 1) ASCs group (n = 6): 10 million ASCs were nebulized into the airway at 1 hr post-injury; and 2) Control group (n = 8): Nebulized with saline into the airways at 1 hr post-injury. ASCs were labeled with green fluorescent protein (GFP) to trace cells within the lung. ASCs viability was determined in bronchoalveolar lavage fluid (BALF). RESULTS: PaO2/FiO2 in the ASCs group was significantly higher than in the control group (p = 0.001) at 24 hrs. Oxygenation index: (mean airway pressure × FiO2/PaO2) was significantly lower in the ASCs group at 36 hr (p = 0.003). Pulmonary shunt fraction tended to be lower in the ASCs group as compared to the control group. GFP-labelled ASCs were found on the surface of trachea epithelium 48 hrs after injury. The viability of ASCs in BALF was significantly lower than those exposed to the control vehicle solution. CONCLUSION: Nebulized ASCs moderately improved pulmonary function and delayed the onset of ARDS.


Asunto(s)
Lesión Pulmonar Aguda , Células Madre Mesenquimatosas , Síndrome de Dificultad Respiratoria , Lesión por Inhalación de Humo , Ovinos , Animales , Femenino , Lesión por Inhalación de Humo/terapia , Lesión por Inhalación de Humo/complicaciones , Intercambio Gaseoso Pulmonar , Pulmón , Lesión Pulmonar Aguda/terapia , Lesión Pulmonar Aguda/complicaciones , Humo/efectos adversos , Síndrome de Dificultad Respiratoria/etiología , Modelos Animales de Enfermedad
6.
Burns ; 49(7): 1643-1653, 2023 11.
Artículo en Inglés | MEDLINE | ID: mdl-37270393

RESUMEN

BACKGROUND: Burns of the chest region constitute a common burn and develops skin contractures around the thorax region. Inhalation of toxic gases and chemical irritants during the fire leads to Acute Respiratory Distress Syndrome (ARDS). Breathing exercises are painful but are needed to help counteract contractures and increase lung capacity. These patients are usually in pain and extremely anxious about chest physiotherapy. Virtual reality distraction is one such technique that is gaining immense popularity when compared to other pain distraction techniques. However, studies examining the efficacy of the virtual reality distraction technique in this population are lacking. OBJECTIVES: To find and compare the effects of the virtual reality distraction technique as a pain alleviation tool for reducing pain during chest physiotherapy in chest burns patients with ARDS in middle-aged adults. METHODS: A randomized controlled study was conducted at the physiotherapy department between 1st Sep 2020 and 30th Dec 2022. The eligible sixty subjects were randomized into two groups: The virtual reality distraction group (n = 30) received virtual reality distraction technique and the control group (n = 30) received progressive relaxation technique before chest physiotherapy as a pain distraction technique. All the participants received chest physiotherapy as a common treatment (treatment as usual). Primary (Visual Analogue Scale - VAS) and secondary (forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), FEV1/FVC, peak expiratory flow (PEF), residual volume (RV), functional residual capacity (FRC), total lung capacity (TLC), RV/TLC, and diffusing capacity for carbon monoxide of the lungs (DLCO) outcome measures were measured at baseline, after four weeks, eight weeks and at six months follow up. The effects between the two groups were analyzed using the independent t-test and chi-square test. The intra-group effect was analyzed with a repeated measure ANOVA test. RESULTS: Baseline demographic characters and study variables show homogenous distribution between the groups (p > 0.05). Four weeks following two different training protocols virtual reality distraction group shows more significant changes in pain intensity, FVC, FEV1, FEV1/FVC, PEF, RV, FRC, TLC, RV/TLC, and DLCO (p = 0.001) but not in RV (p = 0.541). The similar improvements were noted in the 8 weeks and 6 months follow up. CONCLUSION: The reports of the study concluded that virtual reality distraction is an effective and useful technique in reducing pain and increasing lung capacity in chest burn patient with ARDS following smoke inhalation in community-dwelling middle-aged adults. In the virtual reality distraction group, the patients reported significantly less pain and clinically meaningful changes in pulmonary functions as compared to the control group (physiotherapy + relaxation).


Asunto(s)
Quemaduras , Contractura , Síndrome de Dificultad Respiratoria , Lesión por Inhalación de Humo , Realidad Virtual , Persona de Mediana Edad , Adulto , Humanos , Quemaduras/complicaciones , Quemaduras/terapia , Lesión por Inhalación de Humo/complicaciones , Lesión por Inhalación de Humo/terapia , Dolor , Tórax , Humo
7.
Surg Clin North Am ; 103(3): 369-376, 2023 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-37149374

RESUMEN

Since the first burn units were established following World War II, great advances in understanding and treating burn shock, smoke inhalation injury, pneumonia, and invasive burn wound infections, and in achieving early burn-wound closure, have greatly decreased postburn morbidity and mortality. These advances were the result of closely integrated multidisciplinary teams of clinicians and researchers. The team approach to burns is a model for success in the care of any challenging clinical problem.


Asunto(s)
Neumonía , Lesión por Inhalación de Humo , Humanos , Lesión por Inhalación de Humo/terapia , Grupo de Atención al Paciente
9.
Int J Artif Organs ; 46(3): 182-187, 2023 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-36800906

RESUMEN

A systematic review of the role of extracorporeal life support (ECLS) in pediatric patients with burn and smoke inhalation injury was undertaken. A systematic search of the literature according to a specific combination of keywords to ascertain the effectiveness of this treatment strategy was conducted. A total of 14 articles out of 266 were considered suitable for the analysis in pediatric patients. The PICOS approach and PRISMA flow chart were followed for the purpose of this review. Despite the limited number of studies on the subject, ECMO in burn and smoke inhalation injury provides an additional level of support in pediatric patients leading to positive outcomes. V-V ECMO demonstrated the best overall survival of all configurations, with similar outcomes to non-burned patients. Prolonged mechanical ventilation prior to ECMO decreases survival and increases mortality by 12% with each additional day off ECMO. Good outcomes have been described for scald burns, dressing changes, and pre-ECMO cardiac arrest.


Asunto(s)
Quemaduras , Oxigenación por Membrana Extracorpórea , Paro Cardíaco , Lesión por Inhalación de Humo , Humanos , Niño , Oxigenación por Membrana Extracorpórea/efectos adversos , Lesión por Inhalación de Humo/etiología , Lesión por Inhalación de Humo/terapia , Quemaduras/terapia , Respiración Artificial , Estudios Retrospectivos
10.
BMC Cardiovasc Disord ; 22(1): 570, 2022 12 27.
Artículo en Inglés | MEDLINE | ID: mdl-36575398

RESUMEN

BACKGROUND: Carbon monoxide intoxication and smoke inhalation injury can lead to severe disorders, and the current literature has elaborated on the importance of major cardiopulmonary impairment. Exercise intolerance has seldom been discussed, particular in patient with low cardiovascular risk. CASE PRESENTATION: Two young male fire survivors who presented with exercise intolerance after CO intoxication and smoke inhalation injury. Both received bronchodilator and glucocorticoid therapy, high-flow oxygen therapy, and hyperbaric oxygen therapy for airway edema and CO intoxication during acute care. Serum carboxyhemoglobin levels improved after treatment (8.2-3.9% in Case A and 14.8-0.8% in Case B). However, subjective exercise intolerance was noted after discharge. Cardiopulmonary exercise testing revealed exercise-induced myocardial ischemia during peak exercise (significant ST-segment depression on exercise electrocardiogram). They were instructed to exercise with precaution by setting the intensity threshold according to the ischemic threshold. Their symptoms improved, and no cardiopulmonary events were reported in the 6-month follow-up. CONCLUSION: The present case report raised the attention that exercise intolerance after carbon monoxide intoxication and smoke inhalation injury in low cardiovascular risk population may be underestimated. Cardiopulmonary exercise testing help physician to discover exercise-induced myocardial ischemia and set up the cardiac rehabilitation program accordingly.


Asunto(s)
Intoxicación por Monóxido de Carbono , Enfermedad de la Arteria Coronaria , Incendios , Isquemia Miocárdica , Lesión por Inhalación de Humo , Masculino , Humanos , Lesión por Inhalación de Humo/complicaciones , Lesión por Inhalación de Humo/diagnóstico , Lesión por Inhalación de Humo/terapia , Monóxido de Carbono , Intoxicación por Monóxido de Carbono/complicaciones , Intoxicación por Monóxido de Carbono/diagnóstico , Intoxicación por Monóxido de Carbono/terapia
11.
Rev. cir. (Impr.) ; 74(1): 48-52, feb. 2022. tab, graf
Artículo en Español | LILACS | ID: biblio-1388918

RESUMEN

Resumen Introducción: Existen distintos scores pronósticos para determinar probabilidad de muerte en pacientes quemados. El Índice de Garcés (IG) utilizado en Chile, no es aceptado mundialmente. Objetivo: Decidimos evaluar la correlación entre IG y Abbreviated Burn Severity Index (ABSI), de uso generalizado. Materiales y Método Estudio descriptivo analítico transversal de pacientes quemados subidos a la plataforma online "Registro Nacional de Quemados" y luego ingresados a nuestro centro entre julio de 2017 y julio de 2018. Se calculó coeficiente de correlación de Pearson entre IG y ABSI. Se normalizan ambas variables para hacerlas comparables y se calculó concordancia entre estas con coeficiente de correlación de Lin. Con análisis de regresión logística se calculó probabilidad de fallecer asociada para ambas variables y se compararon áreas de las curvas ROC de ambos scores. Resultados: De 141 pacientes, 15 fallecieron durante hospitalización, con medias de IG de 104 ± 49 puntos y ABSI 7 ± 2. El coeficiente de correlación de Pearson entre IG y ABSI demostró ser muy alto con un valor de 0,928. El coeficiente de correlación de Lin entregó concordancia moderada con un valor de 0,93. Al comprobar cuál de las dos puntuaciones predice mejor la probabilidad de muerte mediante análisis de sensibilidad y especificidad, la curva ROC cubre más área en IG (0,82 vs. 0,83), sin ser estadísticamente significativo. Conclusiones: Ambos índices, IG y ABSI, son muy similares para predecir la probabilidad de muerte, por lo cual son equiparables a la hora de compartir resultados de estudios científicos.


Introduction: There are different prognostic scores to determine the probability of death in burned patients. The Garces Index (GI) used in Chile is not accepted worldwide. Aim: We decided to evaluate the correlation between IG and Abbreviated Burn Severity Index (ABSI), which is widely used. Materials and Method: Cross-sectional analytical and descriptive study of burned patients uploaded to the online platform "National Burns Registry" and then admitted to our center between July 2017 and July 2018. Pearson's correlation coefficient between IG and ABSI was calculated. Both variables were normalized to be able to make them comparable and the agreement between them was calculated with Lin's correlation coefficient. With logistic regression analysis, the associated probability of death was calculated for both variables and areas of the ROC curves of both scores were compared. Results: Of 141 patients, 15 died during hospitalization, with a mean GI 104 ± 49 and ABSI 7 ± 2. Pearson's correlation coefficient between GI and ABSI showed a very high correlation with a value of 0.928. Lin's correlation coefficient gave moderate agreement with a value of 0.93. When checking which of the two scores best predicts the probability of death through sensitivity and specificity analysis, the ROC curve covers more area in IG (0.82 vs 0.83) without being statistically significant. Conclusions: Both scores, IG and ABSI, are very similar when it comes to predicting the probability of death, which is why they are comparable at the time of sharing the results in scientific studies.


Asunto(s)
Humanos , Quemaduras/mortalidad , Lesión por Inhalación de Humo/complicaciones , Pronóstico , Lesión por Inhalación de Humo/terapia , Índices de Gravedad del Trauma , Epidemiología Descriptiva , Mortalidad
12.
Undersea Hyperb Med ; 48(2): 157-168, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33975406

RESUMEN

Introduction: Safe administration of critical care hyperbaric medicine requires specialized equipment and advanced training. Equipment must be tested in order to evaluate function in the hyperbaric environment. High-frequency percussive ventilation (HFPV) has been used in intensive care settings effectively, but it has never been tested in a hyperbaric chamber. Methods: Following a modified U.S. Navy testing protocol used to evaluate hyperbaric ventilators, we evaluated an HFPV transport ventilator in a multiplace hyperbaric chamber at 1.0, 1.9, and 2.8 atmospheres absolute (ATA). We used a test lung with analytical software for data collection. The ventilator uses simultaneous cyclic pressure-controlled ventilation at a pulsatile flow rate (PFR)/oscillatory continuous positive airway pressure (oCPAP) ratio of 30/10 with a high-frequency oscillation percussive rate of 500 beats per minute. Inspiratory and expiratory times were maintained at two seconds throughout each breathing cycle. Results: During manned studies, the PFR/oCPAP ratios were 26/6, 22/7, and 22.5/8 at an airway resistance of 20cm H2O/L/second and 18/9, 15.2/8.5, and 13.6/7 at an airway resistance of 50 cm/H2O/L/second at 1, 1.9, and 2.8 ATA. The resulting release volumes were 800, 547, and 513 mL at airway resistance of 20 cm H2O/L/sec and 400, 253, and 180 mL at airway resistance of 50 cm/H2O/L/sec at 1, 1.9, and 2.8 ATA. Unmanned testing showed similar changes. The mean airway pressure (MAP) remained stable throughout all test conditions; theoretically, supporting adequate lung recruitment and gas exchange. A case where HFPV was used to treat a patient for CO poisoning was presented to illustrate that HFPV worked well under HBO2 conditions and no complications occurred during HBO2 treatment. Conclusion: The HFPV transport ventilator performed adequately under hyperbaric conditions and should be considered a viable option for hyperbaric critical care. This ventilator has atypical terminology and produces unique pulmonary physiology, thus requiring specialized training prior to use.


Asunto(s)
Ventilación de Alta Frecuencia/instrumentación , Oxigenoterapia Hiperbárica/instrumentación , Lesión por Inhalación de Humo/terapia , Ventiladores Mecánicos , Acidosis/etiología , Anciano , Resistencia de las Vías Respiratorias , Presión Atmosférica , Intoxicación por Monóxido de Carbono/complicaciones , Femenino , Ventilación de Alta Frecuencia/métodos , Humanos , Oxigenoterapia Hiperbárica/métodos , Pulmón/fisiología , Respiración con Presión Positiva/instrumentación , Respiración con Presión Positiva/métodos , Intercambio Gaseoso Pulmonar/fisiología , Flujo Pulsátil , Valores de Referencia , Respiración
13.
J Burn Care Res ; 42(6): 1168-1175, 2021 11 24.
Artículo en Inglés | MEDLINE | ID: mdl-33560337

RESUMEN

Inhalation injury is associated with high inpatient mortality, but the impact of inhalation injury after discharge and on non-mortality outcomes is poorly characterized. To address this gap, we evaluated the effect of inhalation injury on postdischarge morbidity, mortality, and hospital readmissions among patients who sustained burn injury, as well as on in-hospital outcomes for context. This was a retrospective cohort study of patients with cutaneous fire/flame burns admitted to a burn center intensive care unit from January 1, 2009 to December 31, 2015, with or without inhalation injury. Records were linked to statewide hospital admission and vital statistics databases to assess postdischarge outcomes. Mixed-effects Poisson regression was used to assess mortality, complications, and readmissions. The overall cohort included 830 patients with cutaneous burns; of these, 201 patients had inhalation injury. In-hospital mortality was 31% among inhalation injury patients vs 6% in patients without inhalation injury (adjusted OR 2.35; 95% CI 1.66-3.31). Inhalation injury was also associated with an increased risk of in-hospital pneumonia and tracheostomy (P < .05 for all). Inhalation injury was not associated with greater postdischarge mortality, all-cause readmission, readmission for pulmonary diagnosis, or readmission requiring intubation. Among the subset of patients with bronchoscopy-confirmed inhalation injury (n = 124; 62% of inhalation injuries), a higher injury grade was not associated with greater inpatient or postdischarge mortality. Inhalation injury was associated with increased early morbidity and mortality, but did not contribute to postdischarge mortality or readmission. These findings have implications for shared decision making with patients and families and for estimating healthcare utilization after initial hospitalization.


Asunto(s)
Enfermedad Crítica/mortalidad , Enfermedad Crítica/terapia , Alta del Paciente/estadística & datos numéricos , Lesión por Inhalación de Humo/mortalidad , Lesión por Inhalación de Humo/terapia , Sobrevivientes/estadística & datos numéricos , Cuidados Posteriores/normas , Superficie Corporal , Quemaduras/mortalidad , Quemaduras/terapia , Humanos , Pacientes Internos/estadística & datos numéricos , Tiempo de Internación/estadística & datos numéricos , Insuficiencia Multiorgánica/mortalidad , Estudios Retrospectivos , Factores de Riesgo , Resultado del Tratamiento
14.
J Burn Care Res ; 42(2): 300-304, 2021 03 04.
Artículo en Inglés | MEDLINE | ID: mdl-32860696

RESUMEN

Smoke inhalation results in bronchospasm of the trachea, increasing secretion of mucus, casts formation, and improvement of blood flow of the airway. High frequency chest wall oscillation is a common modality used for clearing mucus secretion in patients suffering from hypersecretion of thick mucus and used also to help cough clearance. This study aimed to detect the effect of high frequency chest wall oscillation in improving pulmonary function in burn patients suffering from smoke inhalation. Sixty smoke inhalation injury patients were randomly distributed into two groups of equal size. Group A: received high frequency chest wall oscillation and conventional chest physical therapy (breathing exercises, early ambulation, and cough training) thrice per week for 8 weeks. Group B: received traditional chest physical therapy (breathing exercises, early ambulation, and cough training) thrice per week for 8 weeks. Pulmonary function test (forced vital capacity, forced expiratory volume in the first second and peak expiratory flow rate) was measured at enrollment and after 8 weeks by using spirometer. Pulmonary function increased significantly posttreatment when compared with that pretreatment in groups A and B (P > .001). Also, they increased significantly in group A compared with that of group B posttreatment (P > .05). High-frequency chest wall oscillation have an impact on improving pulmonary function and should be handled to be a part of the pulmonary rehabilitation plan for smoke inhalation injury patients.


Asunto(s)
Quemaduras/terapia , Oscilación de la Pared Torácica/métodos , Consumo de Oxígeno/fisiología , Lesión por Inhalación de Humo/terapia , Adulto , Quemaduras/complicaciones , Estudios de Seguimiento , Humanos , Masculino , Pruebas de Función Respiratoria , Lesión por Inhalación de Humo/etiología , Volumen de Ventilación Pulmonar , Resultado del Tratamiento
15.
Mil Med ; 186(5-6): e474-e479, 2021 05 03.
Artículo en Inglés | MEDLINE | ID: mdl-33169135

RESUMEN

INTRODUCTION: The Committee on Tactical Combat Casualty Care and Capabilities Development and Integration Directorate cite airway burn injuries as an indication for prehospital cricothyrotomy. We sought to build on previously published data by describing for the first time the incidence of prehospital airway interventions in combat casualties who received airway management in the setting of inhalational injuries.15,26 We hypothesized that (1) airway interventions in combat casualties who suffered inhalational injury would have a higher mortality rate than those without airway intervention and (2) prehospital cricothyrotomy was used with greater incidence than endotracheal intubation. MATERIALS AND METHODS: Using a previously described Department of Defense Trauma Registry dataset from January 2007 to August 2016, unique casualties with documented inhalational injury were identified. RESULTS: Our predefined search codes captured 28,222 (72.8% of all encounters in the registry) of those subjects. A total of 347 (1.2%) casualties had a documented inhalational injury, 27 (7.8%) of those with at least 1 prehospital airway intervention inhalational injuries (0.09% of our dataset [n = 28,222]). Within the subset of patients with an inhalation injury, 23 underwent intubation, 2 underwent cricothyrotomy, 3 had placement of an airway adjunct not otherwise specifically listed, and 1 casualty had both a cricothyrotomy and intubation documented. No casualties had a supraglottic, nasopharyngeal, or oropharyngeal airway listed. Contrary to our hypotheses, of those with an airway intervention, 74.0% survived to hospital discharge. In multivariable regression models, when adjusting for confounders, there was no difference in survival to discharge in those with an airway intervention compared to those without. CONCLUSIONS: Casualties undergoing airway intervention for inhalation injuries had similar survival adjusting for injury severity, supporting its role when indicated. Without case-specific data on airway status and interventions, it is challenging to determine if the low rate of cricothyrotomy in this population was a result of rapid transport to a more advanced provider capable of performing intubation or cricothyrotomy may not be meeting the needs of the medics.


Asunto(s)
Servicios Médicos de Urgencia , Lesión por Inhalación de Humo , Heridas y Lesiones , Manejo de la Vía Aérea , Humanos , Intubación Intratraqueal , Sistema de Registros , Lesión por Inhalación de Humo/terapia
16.
Curr Opin Anaesthesiol ; 33(6): 774-780, 2020 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-33060384

RESUMEN

PURPOSE OF REVIEW: Airway management, mechanical ventilation, and treatment of systemic poisoning in burn patients with inhalation injury remains challenging. This review summarizes new concepts as well as open questions. RECENT FINDINGS: Several life-threatening complications, such as airway patency impairment and respiratory insufficiency, can arise in burn patients and require adequate and timely airway management. However, unnecessary endotracheal intubation should be avoided. Direct visual inspection via nasolaryngoscopy can guide appropriate airway management decisions. In cases of lower airway injury, bronchoscopy is recommended to remove casts and estimate the extent of the injury in intubated patients. Several mechanical ventilation strategies have been studied. An interesting modality might be high-frequency percussive ventilation. However, to date, there is no sound evidence that patients with inhalation injury should be ventilated with modes other than those applied to non-burn patients. In all burn patients exposed to enclosed fire, carbon monoxide as well as cyanide poisoning should be suspected. Carbon monoxide poisoning should be treated with an inspiratory oxygen fraction of 100%, whereas cyanide poisoning should be treated with hydroxocobalamin. SUMMARY: Burn patients need specialized care that requires specific knowledge about airway management, mechanical ventilation, and carbon monoxide and cyanide poisoning.


Asunto(s)
Manejo de la Vía Aérea/tendencias , Quemaduras por Inhalación/terapia , Respiración Artificial/tendencias , Lesión por Inhalación de Humo/terapia , Manejo de la Vía Aérea/métodos , Quemaduras/terapia , Intoxicación por Monóxido de Carbono/terapia , Incendios , Humanos , Respiración Artificial/métodos , Terapia Respiratoria , Lesión por Inhalación de Humo/complicaciones
17.
Burns ; 46(6): 1297-1301, 2020 09.
Artículo en Inglés | MEDLINE | ID: mdl-32600936

RESUMEN

INTRODUCTION: The use of oxygen is a key component of acute burn resuscitation, particularly when there is concern for carbon monoxide toxicity or inhalation injury. Prior studies of critically-ill patients have shown an association between early hyperoxia and increased mortality. There are no studies to date evaluating outcomes related to excessive oxygen administration in burn patients. METHODS: We conducted a retrospective analysis of 219 severely burned patients to quantify the average amount of oxygen given during initial resuscitation, the level of carbon monoxide exposure, and to determine if early exposure to supratherapeutic oxygen was associated with increased hospital mortality or ventilator-associated pneumonia (VAP). The models were adjusted for inhalation injury and total body surface area (TBSA) burned. RESULTS: Early hyperoxia in severely burn patients is common and possibly associated with increased overall mortality, although the results were inconclusive and after adjusting for burn-specific scoring systems, we found a negative correlation between hyperoxia and mortality. Confirmed carbon monoxide poisoning was relatively uncommon, but also associated with increased mortality. Patients with elevated carboxyhemoglobin did not receive more oxygen compared to others within the cohort. CONCLUSIONS: Burn patients are exposed to higher concentrations of pure oxygen compared to other critically-ill patients, presumably for empiric treatment of carbon monoxide poisoning. Our data showed a liberal use of oxygen therapy across all patients. Considering the potentially negative effects of hyperoxia, this study exposes either a gap in clinical research or need for clearer indications.


Asunto(s)
Quemaduras/terapia , Mortalidad Hospitalaria , Hiperoxia/epidemiología , Adulto , Superficie Corporal , Quemaduras/mortalidad , Quemaduras/patología , Intoxicación por Monóxido de Carbono/terapia , Femenino , Humanos , Hiperoxia/etiología , Masculino , Persona de Mediana Edad , Oxígeno , Terapia por Inhalación de Oxígeno/efectos adversos , Presión Parcial , Neumonía Asociada al Ventilador/epidemiología , Lesión por Inhalación de Humo/terapia
18.
Life Sci ; 257: 118042, 2020 Sep 15.
Artículo en Inglés | MEDLINE | ID: mdl-32621926

RESUMEN

AIMS: To investigate the role of bone marrow mesenchymal stem cell (BMSC)-derived exosomes in smoke inhalation lung injury. MAIN METHODS: In this study, we initially isolated exosomes from BMSCs and identified them by western blot and transmission electron microscopy. BMSC-derived exosomes were then used to treat in vitro and in vivo models of smoke inhalation lung injury. Pathologic alterations in lung tissue, the levels of inflammatory factors and apoptosis-related factors, and the expression of HMGB1 and NF-κB were determined to evaluate the therapeutic effect of BMSC-derived exosomes. KEY FINDINGS: We found that BMSC-derived exosomes could alleviate the injury caused by smoke inhalation. Smoke inhalation increased the levels of inflammatory factors and apoptosis-related factors and the expression of HMGB1 and NF-κB, and these increases were reversed by BMSC-derived exosomes. HMGB1 overexpression abrogated the exosome-induced decreases in inflammatory factors, apoptosis-related factors and NF-κB. SIGNIFICANCE: Collectively, these results indicate that BMSC-derived exosomes can effectively alleviate smoke inhalation lung injury by inhibiting the HMGB1/NF-κB pathway, suggesting that exosome, a noncellular therapy, is a potential therapeutic strategy for inhalation lung injury.


Asunto(s)
Exosomas/metabolismo , Células Madre Mesenquimatosas/metabolismo , Lesión por Inhalación de Humo/metabolismo , Animales , Apoptosis/efectos de los fármacos , Proteína HMGB1/metabolismo , Inflamación/patología , Lesión Pulmonar/metabolismo , Masculino , Trasplante de Células Madre Mesenquimatosas/métodos , FN-kappa B/metabolismo , Ratas , Ratas Sprague-Dawley , Transducción de Señal , Humo/efectos adversos , Lesión por Inhalación de Humo/terapia
19.
Anaesth Intensive Care ; 48(2): 114-122, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32316738

RESUMEN

Smoke inhalation resulting in acute lung injury is a common challenge facing critical care practitioners caring for patients with severe burns, contributing significantly to morbidity and mortality. The intention of this review is to critically evaluate the published literature and trends in the diagnosis, management, implications and novel therapies in caring for patients with inhalation injury.


Asunto(s)
Quemaduras , Incendios , Lesión por Inhalación de Humo , Quemaduras/terapia , Humanos , Humo , Lesión por Inhalación de Humo/terapia
20.
Arch Pediatr ; 27(4): 196-201, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32331913

RESUMEN

AIM: The literature includes few reports on the prehospital care of pediatric casualties of urban house fires. Here we aimed to describe the epidemiology of pediatric fire victims, focusing on their injuries, prehospital care, and survival. METHODS: This retrospective study included children under 15 years of age who were victims of urban house fires and who received care from prehospital medical teams. The variables analyzed included epidemiology, specific care provided by prehospital emergency services, the number of cardiac arrests, and survival rates. RESULTS: Over the 15-month study period, 365 house fires required the presence of at least one prehospital medical team. Casualties of these fires included 121 pediatric victims (median age, 4 years [interquartile range: 2-9 years]). All children were initially treated by a prehospital medical team that was not specialized in pediatrics. Six children (4.9%) received secondary treatment from a pediatric support team. Of the 121 children, 114 (94.2%) suffered from smoke inhalation and seven (5.8%) from burns. Two patients who were in cardiac arrest at their initial medical care did not survive. CONCLUSION: Pediatric fire casualties were initially managed by prehospital medical teams that were not specialized in pediatrics. As in adults, the main injuries were secondary to smoke inhalation, but this has increased toxicity in children. Prehospital teams not specialized in pediatrics can optimize their practice via the sharing of experiences, team training, and cognitive aid checklist for pediatric fire victims.


Asunto(s)
Quemaduras/epidemiología , Quemaduras/terapia , Servicios Médicos de Urgencia/métodos , Incendios , Adolescente , Quemaduras/complicaciones , Niño , Preescolar , Servicios Médicos de Urgencia/estadística & datos numéricos , Femenino , Paro Cardíaco/epidemiología , Paro Cardíaco/etiología , Paro Cardíaco/terapia , Humanos , Lactante , Recién Nacido , Masculino , Paris/epidemiología , Estudios Retrospectivos , Lesión por Inhalación de Humo/complicaciones , Lesión por Inhalación de Humo/epidemiología , Lesión por Inhalación de Humo/terapia , Salud Suburbana/estadística & datos numéricos , Análisis de Supervivencia , Salud Urbana/estadística & datos numéricos , Adulto Joven
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