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At least 19 recordsLinked to original sources
PubMed1989

Treatment of combined subglottic and critically low tracheal stenoses secondary to burn inhalation injury.

We report a case of combined severe subglottic and lower tracheobronchial stenoses after an inhalation burn injury. The patient was successfully treated by the insertion of a bifurcated silicone rubber stent. The proximal limb of the silicone tube was used to stent the subglottic stenosis after it had been resected, a treatment option not previously reported. It is speculated that the diffuse airway damage resulted from a combination of thermal injury, mechanical trauma and infection. The relatively late symptomatic presentation of the lower tracheal stricture is stressed and the treatment options discussed.

Burns, Inhalation↗
PubMed1997

[Inhalation burns: apropos of 198 cases. Incidence of laryngotracheal involvement].

Inhalation burns and laryngotracheal involvement were studied in a retrospective series of 635 patients hospitalized for skin burns at the Center for Burn Treatment from January 1993 to January 1997. Inhalation burns were observed in 31.1% of the cases. Exclusive laryngeal involvement occurred in 19.6% of the inhalation burns. Both tracheobronchial and laryngeal burns were observed in 27.2%. Patients with inhalation burns also had facial burns (90.9%) and extensive (> 50%) or severe (UBS > 200) skin burns in 39.8% and 29.7% of the cases respectively. Mortality of skin burns was increased six-fold to 19.1% in patients who also had inhalation burns. Intubation was used alone in 60.1% and was followed by tracheotomy in 27.2%. The decision for tracheotomy was essentially based on the probable duration of ventilatory assistance. Tracheotomy was required in case of severe inhalation burns and the predictable duration of intubation was over 8 days. Laryngotracheal stenosis occurring after inhalation burns is complex and extensive, with great variability over time. Laryngotracheal calibration is indicated as first intention therapy.

Burns, Inhalation↗
PubMed1985

The role of carbon monoxide poisoning in the production of inhalation burns.

Because heat and many poisonous chemicals are generated in a fire, studies of inhalation burns have tended to focus on injury by heat and irritative chemicals. In view of the frequent carbon monoxide (CO) poisoning associated with burn deaths and in patients with inhalation burns, however, nonirritative poisonous gases such as CO cannot be disregarded as possible causative factors involved in the production of inhalation burns. Accordingly, we attempted to clarify in animals the effect of nonlethal CO poisoning on inhalation burns due to heated air. The experimental results indicate that inhaling an amount of moderately heated dry air that alone could not cause pulmonary injury produces severe pulmonary injury in the presence of CO. This seems to occur because CO poisoning causes hyperventilation and thus allows a massive amount of heat to reach the lung.

Animals↗
PubMed1999

Inhalation burns in children.

Survival from serious burns in children has improved substantially in recent years. Mortality is predominantly determined by the total body surface area burned and the often unrecognised inhalation injury. A retrospective review of 4,451 consecutive children with thermal injuries over a 10-year period was undertaken to determine the incidence, clinical presentation, and pathology of inhalation injury and its contribution to morbidity and mortality. Inhalation burns were diagnosed clinically and confirmed endoscopically and post-mortem in 97 (2.2%) children; 77 sustained fire burns (mean age 4 years) and 20 hot-water burns (mean age 18 months). The Moylan classification stratified them into upper-airway burns in 59 children, major-airway burns in 29, and parenchymal burns in 44. Major-airway burns were always seen in conjunction with either upper-airway or parenchymal injury. Stridor and acute progressive respiratory distress were the two main symptoms, the onset of which was occasionally delayed for up to 72 h. Endoscopy was most helpful in confirming the diagnosis and determining airway management. Endotracheal intubation was needed in more than 50% of children, usually for less than 5 days, and was converted to tracheostomy in only 6. Persistent laryngeal and tracheal damage was identified in 4. Secondary pneumonia occurred in 41.5% of children with fire burns and 55% with hot-water burns. Extensive surface burns, parenchymal injury, and secondary pneumonia all contributed to the significant mortality. Post-mortem findings corroborated clinical and endoscopic evidence. This study suggests that inhalation burns were often not recognised, could present late, and usually had significant consequences. Early clinical diagnosis, supported by endoscopic findings and appropriate management, is essential if the high morbidity and mortality amongst these children is to be improved.

Burns, Inhalation↗
PubMed1992

Mass ammonia inhalational burns--experience in the management of 12 patients.

Twelve Korean crew members of a deep sea fishing vessel were admitted to the Burns Centre, Singapore General Hospital following exposure to ammonia gas. The injuries sustained were primarily respiratory burns with minor cutaneous and corneal burns. They were divided into three grades of severity based on the admission findings and subsequent clinical course. Management was according to a standard respiratory burns protocol. Eight patients were intubated. Ten of the patients with mild and moderate involvement of the respiratory tract recovered without complication. Of the two patients with severe respiratory burns, one died while another progressed to chronic debilitating airway disease.

Accidents, Occupational↗
PubMed2001

Successful reconstruction of extensive laryngotracheal strictures after inhalation burn injury: report of a case.

We report a rare case of long segmental laryngotracheal stenosis following inhalation burn injury. The patient presented 2 months after his injury with progressive stridor and dyspnea necessitating tracheostomy. A computed tomographic scan of the neck revealed stenosis extending from the vocal cords to the top of the sternum. Repair was successfully carried out with multiple surgical procedures employing hinge-flap closure tented with autogenous tissue.

Adult↗
PubMed1997

[Bronchoscopy in inhalation burns].

The treatment of burns of various depth and location which are combined with thermoinhalation affections of the respiratory organs is a serious problem during the entire course of burn disease. Despite advances in modern treatment of burns, the death rate of pulmonary complications is still high. Pulmonary disorders encountered in inhalation of chemical toxic products of burning, smoke and its finely divided components increase the fatal outcomes by 30-100% in different periods of the burn disease. Until recently, thermoinhalation affections were not often taken into account in analysis of the causes of death of patients with burns, and the diagnosis was based on scanty historical data and late clinical symptoms. In works published from the beginning of the eighties, bronchoscopy was assigned secondary significance. Evaluation of the character of the lesion, the extent and depth of pathological changes in the tracheobronchial tree in thermoinhalation affections is based in most cases on the post-mortem findings. The purpose of this work was to evaluate clinically and by laboratory studies the role and significance of bronchoscopy in establishing the diagnosis in individuals with burns and thermoinhalation damage during life, in the treatment and prevention of the expected complications in the respiratory organs, and to promote wide use of a bronchoscope in this category of seriously ill patients. On the basis of the study, the authors revealed a close correlation between respiratory insufficiency of various degree and extent and the depth of the affection of the tracheobronchial tree. They also substantiated indications for systemic bronchoscopic treatment of thermoinhalation lesions.

Adolescent↗
PubMed1993

Salvage of a patient with burn inhalation injury and pancreatitis.

A multidisciplinary approach by the staffs of the Emergency Department and the Regional Burn Center saved the life of a burn patient with an inhalation injury and pancreatitis. This successful treatment is attributed to ventilatory management using fibreoptic bronchoscopy in the Emergency Department, followed by burn eschar excision with coverage by cultured skin and non-operative management of an enlarging pseudocyst by percutaneous transgastric drainage.

Adult↗
PubMed1980

Inhalation injury in burns.

(1) Inhalation injury usually occurs in persons with large flame burns indoors, frequently followed by respiratory failure and death. (2) fiberoptic bronchoscopy accurately verifies the diagnosis. (3) Assessment of pulmonary capillary integrity plus bronchoscopy can predict early respiratory failure. (4) Surfactant deficiency may promote late respiratory failure. (5) Corticosteroids probably are beneficial.

Adolescent↗
PubMed1994

Effect of inhalation injury, burn size, and age on mortality: a study of 1447 consecutive burn patients.

The relative impact of inhalation injury, burn size, and age on overall outcome following burn injury was examined in 1447 consecutive burn patients over a five and a half year period. The overall mortality for all patients was 9.5% (138 of 1447). The presence of inhalation injury, increasing burn size, and advancing age were all associated with an increased mortality (p < 0.01). The incidence of inhalation injury was 19.6% (284 of 1447) and correlated with increasing percent total body surface area (%TBSA) burn (r = 0.41, p < 0.01) and advancing age (r = 0.15, p < 0.01). The overall mortality for patients with inhalation injury was 31% (88 of 284) compared with 4.3% (50 of 1163) for those without inhalation injury. Using multivariate analysis inhalation injury was found to be an important variable in determining outcome, but the most important factor in predicting mortality was %TBSA burn (accuracy = 92.8%) or a combination of %TBSA burn and patient age (accuracy = 93.0%). Adding inhalation injury only slightly improved the ability to predict mortality (accuracy = 93.3%). The presence of inhalation injury is significantly associated with mortality after thermal injury but adds little to the prediction of mortality using %TBSA and age alone.

Adolescent↗
PubMed2016

Early leukocyte gene expression associated with age, burn size, and inhalation injury in severely burned adults.

BACKGROUND: In the patient with burn injury, older age, larger percentage of total body surface area (TBS) burned, and inhalation injury are established risk factors for death, which typically results from multisystem organ failure and sepsis, implicating burn-induced immune dysregulation as a contributory mechanism. We sought to identify early transcriptomic changes in circulating leukocytes underlying increased mortality associated with these three risk factors. METHODS: We performed a retrospective analysis of the Glue Grant database. From 2003 to 2010, 324 adults with 20% or greater TBS burned were prospectively enrolled at five US burn centers, and 112 provided blood samples within 1 week after burn. RNA was extracted from pooled leukocytes for hybridization onto Affymetrix HU133 Plus 2.0 GeneChips. A multivariate regression model was constructed to determine risk factors for mortality. Testing for differential gene association associated with age, burn size, and inhalation injury was based on linear models using a fold change threshold of 1.5 and false discovery rate of 0.05. RESULTS: After adjusting for potential confounders, age greater than 60 years (relative risk [RR], 4.53; 95% confidence interval [CI], 2.93-6.99), burn size greater than 40% TBS (RR, 4.24; 95% CI, 2.61-6.91), and inhalation injury (RR, 2.08; 95% CI, 1.35-3.21) were independently associated with mortality. No genes were differentially expressed in association with age greater than 60 years or inhalation injury. Fifty-one probe sets representing 39 unique genes were differentially expressed in leukocytes from patients with burn size greater than 40% TBS; these genes were associated with platelet activation and degranulation/exocytosis, and gene-set enrichment analysis suggested increased cellular proliferation and down-regulation of proinflammatory cytokines. CONCLUSION: Among adults with large burns, older age, increasing burn size, and inhalation injury have a modest effect on the leukocyte transcriptome in the context of the "genomic storm" induced by a 20% or greater than TBS burned. The 39-gene signature we identified may provide novel targets for the development of therapies to reduce morbidity and mortality associated with burns greater than 40% TBS. LEVEL OF EVIDENCE: Epidemiologic study, level III.

Adult↗
PubMed1982

The Parkland formula in patients with burns and inhalation injury.

Clinical concern over the fluid status of patients with burns and inhalation injury led us to review the course of 101 consecutive adult patients with large (20%-60% BSA) burns, all resuscitated with the Parkland formula. The results indicate that this regimen may have resulted in unnecessarily large fluid loads in patients with inhalation injury. In order to avoid the highly significant excess amount of fluid over the calculated estimate, patients with burns and inhalation injury should be resuscitated with substantially less than formula predictions, with acceptance of urine output in the range of 0.3-0.5 ml/kg/hr.

Adult↗
PubMed1991

Alveolar macrophage chemotaxis in fire victims with smoke inhalation and burns injury.

In vitro migration of alveolar macrophages was studied in 24 fire victims and 19 controls; all subjects were cigarette smokers. Unstimulated (P = 0.01) and stimulated migration towards casein-(P = 0.01) and zymosan-activated serum (P = 0.002) of macrophages from smoke inhalation patients (SI) (n = 19) was increased when compared to control subjects (CS). Migration of alveolar macrophages from patients with burns without smoke inhalation (burns only, BO) was not increased. Patients with smoke inhalation and no burns (smoke only, SO) (n = 9) had increased migration when compared to controls but this was not statistically significant. Patients with smoke inhalation and burns (SB) (n = 10) had increased unstimulated migration (P = 0.01) and increased migration towards casein (P less than 0.005), ZAS (P less than 0.002) and F-met-leu-phe (P less than 0.05) when compared to controls (CS). Lavage fluid from the fire victims displayed chemotactic activity towards normal human neutrophils and its analysis for the components of the complement cascade proved positive (Clq, Clr, Factor B and C3). These data suggest that activation of alveolar macrophages may contribute to the development of pathophysiological changes in patients with smoke inhalation (SI) and particularly those with smoke inhalation and burns (SB).

Burns↗