RESUMO
This study aimed to evaluate pulmonary function measurements and respiratory muscle parameters in patients with major burn injury and smoke inhalation. The inclusion criteria included patients who were diagnosed with a smoke inhalation burn or a major burn of more than 20% of total body surface area (TBSA). All subjects underwent a pulmonary function test, respiratory muscle strength test, peak cough flow and fluoroscopic diaphragmatic movement measurement, and 6-minute walk test before starting pulmonary rehabilitation. Evaluations were conducted on the 88th day after the injury, the average time of admission to the Department of the Rehabilitation Medicine for burn rehabilitation after the completion of the acute treatment. The average degree of burns of the total 67 patients was 34.6% TBSA. All parameters in the patient group were significantly lower than the healthy controls, and a mild restrictive pattern of impairment with a reduction in diffusing capacity and more reduced expiratory muscle, than inspiratory muscle strength were observed. Peak cough flow, respiratory muscle strength, and forced vital capacity in the patient group with inhalation burn were significantly lower than in those without inhalation burn. The conditions of the majority of patients with major burn and inhalation injury were consistent with restrictive impairment and significant reduction in diffusion capacity. The patients had expiratory muscle weakness, decreased diaphragmatic movement, and exercise capacity impairment.
Assuntos
Queimaduras/fisiopatologia , Lesão por Inalação de Fumaça/fisiopatologia , Adulto , Queimaduras/reabilitação , Estudos de Casos e Controles , Tosse/fisiopatologia , Diafragma/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Debilidade Muscular/fisiopatologia , Estudos Prospectivos , Testes de Função Respiratória , Músculos Respiratórios/fisiopatologia , Lesão por Inalação de Fumaça/reabilitação , Teste de CaminhadaRESUMO
BACKGROUND: Dysphagia following severe burns can be significant and protracted, yet there is little evidence describing the rehabilitation principles, process or outcomes. PURPOSE: Outline current evidence and detail the clinical outcomes of two cases who underwent a multifaceted intensive treatment programme aimed at rehabilitating dysphagia by strengthening swallow function and minimising orofacial contractures after severe head and neck burns. METHODS: Two men (54 and 18 years) with full-thickness head and neck burns and inhalation injury underwent intensive orofacial scar management and dysphagia rehabilitation. Therapy was prescribed, consisting of scar stretching, splinting and pharyngeal swallow tasks. Horizontal and vertical range of movement (HROM; VROM), physiological swallow features, functional swallowing outcomes and related distress, were collected at baseline and routinely until dysphagia resolution and scar stabilisation. RESULTS: At presentation, both cases demonstrated severely reduced HROM and VROM, profound dysphagia and moderate dysphagia related distress. Therapy adherence was high. Resolution of dysphagia to full oral diet, nil physiological swallowing impairment, and nil dysphagia related distress was achieved by 222 and 77 days post injury respectively. VROM and HROM achieved normal range by 237 and 204 days. CONCLUSION: Active rehabilitation achieved full functional outcomes for swallowing and orofacial range of movement. A protracted duration of therapy can be anticipated in this complex population.
Assuntos
Queimaduras/reabilitação , Cicatriz/reabilitação , Contratura/reabilitação , Transtornos de Deglutição/reabilitação , Traumatismos Faciais/reabilitação , Doenças da Boca/reabilitação , Lesões do Pescoço/reabilitação , Lesão por Inalação de Fumaça/reabilitação , Adolescente , Queimaduras/complicações , Cicatriz/etiologia , Contratura/etiologia , Transtornos de Deglutição/etiologia , Terapia por Exercício , Traumatismos Faciais/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Doenças da Boca/etiologia , Lesões do Pescoço/complicações , Modalidades de Fisioterapia , Projetos Piloto , Amplitude de Movimento Articular , Lesão por Inalação de Fumaça/complicaçõesRESUMO
Firing smoke candle, on reaction of pyrotechnic mixture of zinc oxide and hexachloroethane, releases of white smoke, which can damage the pulmonary parenchyma. Presented case illustrates the effects of such an inhalation injury that has led to acute respiratory distress syndrome (ARDS). The use of mechanical ventilation and administration of antibiotics and corticosteroids give the possibility to obtain clinical improvement. The resulting changes in the lung parenchyma shown on imaging studies resulted in significant impairment of breathing.
Assuntos
Pulmão/diagnóstico por imagem , Síndrome do Desconforto Respiratório/diagnóstico por imagem , Síndrome do Desconforto Respiratório/etiologia , Lesão por Inalação de Fumaça/diagnóstico por imagem , Fumaça/efeitos adversos , Adulto , Etano/análogos & derivados , Etano/química , Humanos , Hidrocarbonetos Clorados/química , Masculino , Militares , Radiografia , Respiração Artificial , Síndrome do Desconforto Respiratório/reabilitação , Lesão por Inalação de Fumaça/reabilitação , Resultado do Tratamento , Óxido de Zinco/químicaAssuntos
Intoxicação por Monóxido de Carbono/reabilitação , Incêndios , Cianeto de Hidrogênio/intoxicação , Modalidades de Fisioterapia , Lesão por Inalação de Fumaça/reabilitação , Brasil , Intoxicação por Monóxido de Carbono/mortalidade , Humanos , Atividades de Lazer , Lesão por Inalação de Fumaça/mortalidadeAssuntos
Acidentes de Trabalho , Incêndios , Gases/toxicidade , Pneumopatias/induzido quimicamente , Lesão por Inalação de Fumaça/induzido quimicamente , Adulto , Humanos , Assistência de Longa Duração , Pneumopatias/fisiopatologia , Pneumopatias/reabilitação , Masculino , Pessoa de Meia-Idade , Polineuropatias/induzido quimicamente , Respiração Artificial , Testes de Função Respiratória , Lesão por Inalação de Fumaça/fisiopatologia , Lesão por Inalação de Fumaça/reabilitaçãoRESUMO
67 patients with inhalation trauma of 90 patients with acute thermal trauma and 23 healthy controls participated in the trial. External respiration function was assessed on the spirograph SPIROSIFT-3000 (Fukuda Densy, Japan). The injured patients have undergone chest vibromassage (n = 23), vibromassage of Zakhariin-Head zones (trachea-bronchi-lungs) (n = 22), manual chest massage (n = 22). Improvement of clinical and external respiration parameters was more significant in patients exposed to vibromassage of the trachea-bronchi-lungs zones.
Assuntos
Massagem/métodos , Lesão por Inalação de Fumaça/reabilitação , Broncoscopia , Terapia Combinada , Quimioterapia Combinada , Volume Expiratório Forçado , Hospitais , Humanos , Medidas de Volume Pulmonar , Ventilação Voluntária Máxima , Radiografia , Lesão por Inalação de Fumaça/diagnóstico , Lesão por Inalação de Fumaça/fisiopatologia , Resultado do Tratamento , VibraçãoRESUMO
The share of total hospital Canadian burn care provided by 17 of Canada's 27 present burn units increased marginally to 18.3% in 1991 from 17.0% in 1981 (p = 0.0506), and the mortality rate decreased from 5.6% in 1981 to 3.5% in 1991 (p < 0.05). In 10 units providing serial data, patients with burns undergoing ventilation therapy for a concomitant smoke inhalation injury increased from 6.3% (n = 58) of 1981 admissions to 11.1% (n = 73) of 1991 admissions (p < 0.05). In 1991 Canada's 27 burn units treated 32.4% of Canada's hospitalized patients with burns and provided 50.6% of hospital burn care days. Although the total number of patients with burns hospitalized in Canada decreased by 35% from 7923 in 1981 to 5161 in 1991 (32.6 to 18.9 per 100,000 population), with a proportional decrease in patients treated in burn units, the requirement for intensive care unit capability to treat patients undergoing ventilation therapy has remained the same or is greater and must be preserved as burn units shrink.