INHALATION INJURY
Inhalation injury ; resulting from inhalation of smoke or chemical products of combustion; is associated with significant morbidity and mortality.(1) A lot of patients that I had three months ago were electrical burns with a concomitant inhalation injury.
The classic paper describing the effects of inhalation injury, and its principle complication, pneumonia, on mortality in burn patients comes from Shirani, Pruitt, Mason, and the U.S. Army Institute of Surgical Research in San Antonio, Texas [2]. A review of over 1,000 patients was conducted, in which data were gathered on status of inhalation injury on admission and development of pneumonia during hospitalization.
Two other papers support the observations of Shirani and coworkers. A more recent meta-analysis on prognostic factors in burn injury with smoke inhalation reveals that overall mortality increased dramatically with inhalation injury (27.6% versus 13.9%). Extent of burn size and age were predictive of mortality. Another study included a predictive model of outcome with cutaneous injury plus smoke inhalation.(3-5)
In our patients, bronchoscopy in not available. Instead of the bronchoscope we are using a fiber optic laryngoscope but it only goes as far as the upperpart of the larynx. But we can get good results too. What it cannot do is go as far as the bronchi where we can do a wash if needed. A wash is when we need plain NSS to into the bronchoscopy go deep into the bronchi. We need to wash the bronchi area for carbonaceous sputum and to check for irregularities and take tissue samples.
Because almost half of intubated burn patients admitted to burn centers develop acute respiratory distress syndrome, and ventricular dysrhythmias may be provoked in some patients with exposure to certain types of hydrocarbons by bronchodilators. For patients with evidence of significant airflow obstruction, supplemental therapy with corticosteroids is recommended to reduce inflammation, Antibiotics should be used only in patients with clinical evidence of infection.(1)
BIBLIOGRAPHY
- Park GY, Park JW, Jeong DH, Jeong SW: Prolonged airway and systemic inflammatory reactions after smoke inhalation. Chest 2003, 123:475–480.
- Shirani KZ, Pruitt BA Jr, Mason AD Jr: The influence of inhalation injury and pneumonia on burn mortality. Ann Surg 1987, 205:82–87.
- Sen S, Greenhalgh D, Palmieri T: Review of burn research for the year 2010. J Burn Care Res 2012, 33:577–586.
- Colohan SM: Predicting prognosis in thermal burns with associated inhalational injury: a systematic review of prognostic factors in adult burn victims. J Burn Care Res 2010, 31:529–539.
- Hassan Z, Wong JK, Bush J, Bayat A, Dunn KW: Assessing the severity of inhalation injuries in adults. Burns 2010, 36:212–216.
Michelle Marie P. Aportadera M.D.
Plastic Surgery
Diplomate in General Surgery
Master of the Arts Hospital Administration
Administrator, RD Aportadera MD SPMC BURN CENTER
