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Dou Z, Zhou X, Jiang H, Zhao X, Wen C, Zhang GA. Protection of laryngeal mucosa and function in laryngeal burns by heat absorption of perilaryngeal tissue. Eur Arch Otorhinolaryngol 2023; 280:4531-4542. [PMID: 37219683 DOI: 10.1007/s00405-023-08030-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 05/15/2023] [Indexed: 05/24/2023]
Abstract
OBJECTIVE The laryngeal tissue carries most of the heat during inhalation injury. This study aims to explore the heat transfer process and the severity of injury inside laryngeal tissue by horizontally studying the temperature rise process at various anatomical layers of the larynx and observing the thermal damage in various parts of the upper respiratory tract. METHODS The 12 healthy adult beagles were randomly divided into four groups, and inhaled room temperature air (control group), dry hot air of 80 °C (group I), 160 °C (group II), and 320 °C (group III) for 20 min, respectively. The temperature changes of the glottic mucosal surface, the inner surface of the thyroid cartilage, the external surface of the thyroid cartilage, and subcutaneous tissue were measured every minute. All animals were immediately sacrificed after injury, and pathological changes in various parts of laryngeal tissue were observed and evaluated under a microscope. RESULTS After inhaling hot air of 80 °C, 160 °C and 320 °C, the increase of laryngeal temperature in each group was ΔT = 3.57 ± 0.25 °C, 7.83 ± 0.15 °C, 11.93 ± 0.21 °C. The tissue temperature was approximately uniformly distributed, and the difference was not statistically significant. The average laryngeal temperature-time curve showed that the laryngeal tissue temperature in group I and group II showed a trend of "first decrease and then increase", except that the temperature of group III directly increased with time. The prominent pathological changes after thermal burns mainly concluded necrosis of epithelial cells, loss of the mucosal layer, atrophy of submucosal glands, vasodilatation, erythrocytes exudation, and degeneration of chondrocytes. Mild degeneration of cartilage and muscle layers was also observed in mild thermal injury. Pathological scores indicated that the pathological severity of laryngeal burns increased significantly with the increase of temperature, and all layers of laryngeal tissue were seriously damaged by 320 °C hot air. CONCLUSIONS The high efficiency of tissue heat conduction enabled the larynx to quickly transfer heat to the laryngeal periphery, and the heat-bearing capacity of perilaryngeal tissue has a certain degree of protective effect on laryngeal mucosa and function in mild to moderate inhalation injury. The laryngeal temperature distribution was in accordance with the pathological severity, and the pathological changes of laryngeal burns provided a theoretical basis for the early clinical manifestations and treatment of inhalation injury.
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Affiliation(s)
- Zhe Dou
- Peking University Fourth School of Clinical Medicine, Beijing, 100035, People's Republic of China
- Department of Burns, Beijing Jishuitan Hospital, Xinjiekoudongjie Street 31, Xicheng District, Beijing, 100035, People's Republic of China
| | - Xiaocheng Zhou
- Department of Dermatology, The First Hospital of Tsinghua University, Beijing, 100016, People's Republic of China
| | - Huihao Jiang
- Department of Burns, Beijing Jishuitan Hospital, Xinjiekoudongjie Street 31, Xicheng District, Beijing, 100035, People's Republic of China
| | - Xiaozhuo Zhao
- Department of Burns, Beijing Jishuitan Hospital, Xinjiekoudongjie Street 31, Xicheng District, Beijing, 100035, People's Republic of China
| | - Chunquan Wen
- Department of Burns, Beijing Jishuitan Hospital, Xinjiekoudongjie Street 31, Xicheng District, Beijing, 100035, People's Republic of China
| | - Guo-An Zhang
- Department of Burns, Beijing Jishuitan Hospital, Xinjiekoudongjie Street 31, Xicheng District, Beijing, 100035, People's Republic of China.
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Shamohammadi H, Mehrabi S, Sadrizadeh S, Yaghoubi M, Abouali O. 3D numerical simulation of hot airflow in the human nasal cavity and trachea. Comput Biol Med 2022; 147:105702. [DOI: 10.1016/j.compbiomed.2022.105702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 05/17/2022] [Accepted: 06/04/2022] [Indexed: 11/30/2022]
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3
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Aijaz A, Vinaik R, Jeschke MG. Large animal models of thermal injury. Methods Cell Biol 2022; 168:191-219. [PMID: 35366983 DOI: 10.1016/bs.mcb.2021.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Burn injury results in a triad of inter-related adaptive responses: a systemic inflammatory response, a stress response, and a consequent hypermetabolic state which supports the former two. These pathological responses extend beyond the site of injury to affect distant organs and influence long-term outcomes in the patient. Animal models have proven valuable in advancing our understanding of mechanisms underlying the multifactorial manifestations of burn injury. While rodent models have been unprecedented in providing insights into signaling pathways, metabolic responses, protein turnover, cellular and molecular changes; small animal models do not replicate hypermetabolism, hyperinflammation, and wound healing after a burn injury as seen in humans. Herein, we provide a concise review of preferred large animal models utilized to understand burn pathophysiology based on organ systems and associated dysfunction. Additionally, we present a detailed protocol of contact burn injury in the Yorkshire pig model with a focus on preoperative care, anesthesia, analgesia, wound excision and grafting, dressing application, and frequency of dressing changes.
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Affiliation(s)
- Ayesha Aijaz
- Sunnybrook Research Institute, Toronto, ON, Canada
| | - Roohi Vinaik
- Sunnybrook Research Institute, Toronto, ON, Canada
| | - Marc G Jeschke
- Sunnybrook Research Institute, Toronto, ON, Canada; Department of Surgery, Division of Plastic Surgery, University of Toronto, Toronto, ON, Canada; Department of Immunology, University of Toronto, Toronto, ON, Canada; Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
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4
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Lowery AS, Dion G, Thompson C, Weavind L, Shinn J, McGrane S, Summitt B, Gelbard A. Incidence of Laryngotracheal Stenosis after Thermal Inhalation Airway Injury. J Burn Care Res 2020; 40:961-965. [PMID: 31332446 DOI: 10.1093/jbcr/irz133] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Inhalation injury is independently associated with burn mortality, yet little information is available on the incidence, risk factors, or functional outcomes of thermal injury to the airway. In patients with thermal inhalation injury, we sought to define the incidence of laryngotracheal stenosis (LTS), delineate risk factors associated with LTS development, and assess long-term tracheostomy dependence as a proxy for laryngeal function. Retrospective cohort study of adult patients treated for thermal inhalation injury at a single institution burn critical care unit from 2012 to 2017. Eligible patients' records were assessed for LTS (laryngeal, subglottic, or tracheal stenosis). Patient characteristics, burn injury characteristics, and treatment-specific covariates were assessed. Descriptive statistics, Mann-Whitney U-tests, odds ratio, and chi-square tests compared LTS versus non-LTS groups. Of 129 patients with thermal inhalation injury during the study period, 8 (6.2%) developed LTS. When compared with the non-LTS group, patients with LTS had greater mean TBSA (mean 30.3, Interquartile Range 7-57.5 vs 10.5, Interquartile Range 0-15.12, P = .01), higher grade of inhalation injury (mean 2.63 vs 1.80, P = .05), longer duration of intubation (12.63 vs 5.44; P < .001), and greater inflammatory response (mean white blood cell count on presentation 25.8 vs 14.9, P = .02, mean hyperglycemia on presentation 176.4 vs 136.9, P = .01). LTS patients had a significantly higher rate of tracheostomy dependence at last follow-up (50 vs 1.7%, P < .001). Six percent of patients with thermal inhalation injury develop LTS. LTS was associated with more severe thermal airway injury, longer duration of intubation, and more severe initial host inflammation. Patients with inhalation injury and LTS are at high risk for tracheostomy dependence. In burn patients with thermal inhalation injury, laryngeal evaluation and directed therapy should be incorporated early into multispecialty pathways of care.
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Affiliation(s)
- Anne Sun Lowery
- Department of Otolaryngology, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Greg Dion
- Department of Otolaryngology and Head and Neck Surgery, Brooke Army Medical Center, Fort Sam Houston, Houston, Texas
| | - Callie Thompson
- Division of Trauma and Surgical Critical Care, Vanderbilt University Medical Center
| | - Liza Weavind
- Division of Anesthesiology Critical Care Medicine, Vanderbilt University Medical Center
| | - Justin Shinn
- Department of Otolaryngology and Head and Neck Surgery, Vanderbilt University Medical Center
| | - Stuart McGrane
- Division of Anesthesiology Critical Care Medicine, Vanderbilt University Medical Center
| | - Blair Summitt
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Alexander Gelbard
- Division of Trauma and Surgical Critical Care, Vanderbilt University Medical Center
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5
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Rosati T, Burkitt JM, Watson KD, Jandrey KE, Osborne LG, Sinnott DM, Epstein SE. Obstructive Tracheal Necrosis in a Dog Secondary to Smoke Inhalation Injury-Case Report. Front Vet Sci 2020; 7:409. [PMID: 32793644 PMCID: PMC7385375 DOI: 10.3389/fvets.2020.00409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 06/08/2020] [Indexed: 11/13/2022] Open
Abstract
A 4-year-old Siberian Husky mix was referred to the emergency service of the University of California Davis Veterinary Medical Teaching Hospital after being found unconscious in a housefire. Upon arrival, the dog was conscious and panting with normal breathing effort. The dog was initially treated with oxygen therapy to minimize the risk of carbon monoxide toxicosis. Progressive agitation with paroxysmal episodes of increased respiratory effort and increased upper airway sounds were noted ~48 h after presentation. Hypoxemia was then documented. Clinical signs continued to progress despite supportive measures, and five days after initial presentation mechanical ventilation was deemed indicated. Following anesthetic induction, endotracheal intubation was performed. Capnography and peak inspiratory pressures recorded on the mechanical ventilator were consistent with airway obstruction. Diffuse intraluminal tracheal obstruction with grossly necrotic tracheal tissue was confirmed using fiber optic tracheoscopy. The patient was humanely euthanized due to grave prognosis. At necropsy, the tracheal lumen was obstructed by sloughed, necrotic tracheal mucosa. This is the first report describing a severe delayed intrathoracic large airway complication secondary to smoke inhalation in a dog.
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Affiliation(s)
- Tommaso Rosati
- William R. Pritchard Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
| | - Jamie M Burkitt
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
| | - Katherine D Watson
- California Animal Health and Food Safety Laboratory, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
| | - Karl E Jandrey
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
| | - Laura G Osborne
- Western Veterinary Specialist and Emergency Centre, Calgary, AB, Canada
| | - Devinn M Sinnott
- California Animal Health and Food Safety Laboratory, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
| | - Steven E Epstein
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
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6
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Sosnowski TR, Jabłczyńska K, Odziomek M, Schlage WK, Kuczaj AK. Physicochemical studies of direct interactions between lung surfactant and components of electronic cigarettes liquid mixtures. Inhal Toxicol 2018; 30:159-168. [PMID: 29932004 DOI: 10.1080/08958378.2018.1478916] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Direct physicochemical interactions between the major components of electronic cigarette liquids (e-liquids): glycerol (VG) and propylene glycol (PG), and lung surfactant (LS) were studied by determining the dynamic surface tension under a simulated breathing cycle using drop shape method. The studies were performed for a wide range of concentrations based on estimated doses of e-liquid aerosols (up to 2500 × the expected nominal concentrations) and for various VG/PG ratios. The results are discussed as relationships among mean surface tension, surface tension amplitude, and surface rheological properties (dilatational elasticity and viscosity) versus concentration and composition of e-liquid. The results showed that high local concentrations (>200 × higher than the estimated average dose after a single puffing session) may induce measurable changes in biophysical activity of LS; however, only ultra-high e-liquid concentrations inactivated the surfactant. Physiochemical characterization of e-liquids provide additional insights for the safety assessment of electronic nicotine delivery systems (ENDS).
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Affiliation(s)
- Tomasz R Sosnowski
- a Faculty of Chemical and Process Engineering , Warsaw University of Technology , Warsaw , Poland
| | - Katarzyna Jabłczyńska
- a Faculty of Chemical and Process Engineering , Warsaw University of Technology , Warsaw , Poland
| | - Marcin Odziomek
- a Faculty of Chemical and Process Engineering , Warsaw University of Technology , Warsaw , Poland
| | - Walter K Schlage
- b Philip Morris International R&D, Philip Morris Products S.A. (part of Philip Morris International group of companies) , Neuchâtel, Switzerland
| | - Arkadiusz K Kuczaj
- b Philip Morris International R&D, Philip Morris Products S.A. (part of Philip Morris International group of companies) , Neuchâtel, Switzerland.,c Department of Applied Mathematics, Faculty EEMCS , University of Twente , Enschede , The Netherlands
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7
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Gupta K, Mehrotra M, Kumar P, Gogia AR, Prasad A, Fisher JA. Smoke Inhalation Injury: Etiopathogenesis, Diagnosis, and Management. Indian J Crit Care Med 2018; 22:180-188. [PMID: 29657376 PMCID: PMC5879861 DOI: 10.4103/ijccm.ijccm_460_17] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Smoke inhalation injury is a major determinant of morbidity and mortality in fire victims. It is a complex multifaceted injury affecting initially the airway; however, in short time, it can become a complex life-threatening systemic disease affecting every organ in the body. In this review, we provide a summary of the underlying pathophysiology of organ dysfunction and provide an up-to-date survey of the various critical care modalities that have been found beneficial in caring for these patients. Major pathophysiological change is development of edema in the respiratory tract. The tracheobronchial tree is injured by steam and toxic chemicals, leading to bronchoconstriction. Lung parenchyma is damaged by the release of proteolytic elastases, leading to release of inflammatory mediators, increase in transvascular flux of fluids, and development of pulmonary edema and atelectasis. Decreased levels of surfactant and immunomodulators such as interleukins and tumor-necrosis-factor-α accentuate the injury. A primary survey is conducted at the site of fire, to ensure adequate airway, breathing, and circulation. A good intravenous access is obtained for the administration of resuscitation fluids. Early intubation, preferably with fiberoptic bronchoscope, is prudent before development of airway edema. Bronchial hygiene is maintained, which involves therapeutic coughing, chest physiotherapy, deep breathing exercises, and early ambulation. Pharmacological agents such as beta-2 agonists, racemic epinephrine, N-acetyl cysteine, and aerosolized heparin are used for improving oxygenation of lungs. Newer agents being tested are perfluorohexane, porcine pulmonary surfactant, and ClearMate. Early diagnosis and treatment of smoke inhalation injury are the keys for better outcome.
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Affiliation(s)
- Kapil Gupta
- Department of Anaesthesia, Vardhaman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
| | - Mayank Mehrotra
- Department of Anesthesia, Integral Institute of Medical Sciences, Lucknow, India
| | - Parul Kumar
- Department of Emergency Medicine, Sinai Health Systems, Chicago, USA
| | - Anoop Raj Gogia
- Department of Anaesthesia, Vardhaman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
| | - Arun Prasad
- Department of Anaesthesia, University Health Network, and University of Toronto, Toronto, Canada
| | - Joseph Arnold Fisher
- Department of Anaesthesia, University Health Network, and University of Toronto, Toronto, Canada
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8
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Xu X, Ni S, Fu M, Zheng X, Luo N, Weng W. Numerical investigation of airflow, heat transfer and particle deposition for oral breathing in a realistic human upper airway model. J Therm Biol 2017; 70:53-63. [DOI: 10.1016/j.jtherbio.2017.05.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Revised: 04/30/2017] [Accepted: 05/17/2017] [Indexed: 11/26/2022]
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9
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Hogg G, Goswamy J, Khwaja S, Khwaja N. Laryngeal Trauma Following an Inhalation Injury: A Review and Case Report. J Voice 2016; 31:388.e27-388.e31. [PMID: 27884557 DOI: 10.1016/j.jvoice.2016.09.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 09/13/2016] [Indexed: 11/26/2022]
Abstract
The primary concern when managing a patient with inhalation injury is security of the airway. Airflow may be impeded by both edema of the upper airway and reduction of oxygen delivery to the lower respiratory tract. Although there has been much discussion regarding management of the latter, the focus of this article is the management of the former. This review aimed to determine the optimum management in burn victims with upper airway inhalation injury as an attempt to prevent laryngeal trauma leading to long-term voice disorders and upper airway dyspnea. We describe the case of a 57-year-old woman with significant inhalation injury and discuss the natural progression of her injuries and the laryngeal controversies surrounding her care. We conclude with advice on the optimal management of this condition based on our experience, combined with current best evidence.
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Affiliation(s)
- Gemma Hogg
- Department of Otolaryngology, University Hospital of South Manchester, Manchester, UK; Department of Plastics and Burns, University Hospital of South Manchester, Manchester, UK.
| | - Jay Goswamy
- Department of Otolaryngology, University Hospital of South Manchester, Manchester, UK; Department of Plastics and Burns, University Hospital of South Manchester, Manchester, UK
| | - Sadie Khwaja
- Department of Otolaryngology, University Hospital of South Manchester, Manchester, UK; Department of Plastics and Burns, University Hospital of South Manchester, Manchester, UK
| | - Nadeem Khwaja
- Department of Otolaryngology, University Hospital of South Manchester, Manchester, UK; Department of Plastics and Burns, University Hospital of South Manchester, Manchester, UK
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10
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Enkhbaatar P, Pruitt BA, Suman O, Mlcak R, Wolf SE, Sakurai H, Herndon DN. Pathophysiology, research challenges, and clinical management of smoke inhalation injury. Lancet 2016; 388:1437-1446. [PMID: 27707500 PMCID: PMC5241273 DOI: 10.1016/s0140-6736(16)31458-1] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 08/11/2016] [Accepted: 08/16/2016] [Indexed: 01/02/2023]
Abstract
Smoke inhalation injury is a serious medical problem that increases morbidity and mortality after severe burns. However, relatively little attention has been paid to this devastating condition, and the bulk of research is limited to preclinical basic science studies. Moreover, no worldwide consensus criteria exist for its diagnosis, severity grading, and prognosis. Therapeutic approaches are highly variable depending on the country and burn centre or hospital. In this Series paper, we discuss understanding of the pathophysiology of smoke inhalation injury, the best evidence-based treatments, and challenges and future directions in diagnostics and management.
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Affiliation(s)
- Perenlei Enkhbaatar
- Department of Anesthesiology, University of Texas Medical Branch, Galveston, TX, USA.
| | - Basil A Pruitt
- Department of Surgery, Division of Trauma, University of Texas Health Science Center, San Antonio, TX, USA
| | - Oscar Suman
- Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA; Shriners Hospitals for Children, Galveston, TX, USA
| | - Ronald Mlcak
- Shriners Hospitals for Children, Galveston, TX, USA; Department of Respiratory Care, School of Health Professions, University of Texas Medical Branch, Galveston, TX, USA
| | - Steven E Wolf
- Department of Surgery, University of Texas, Southwestern Medical Center, Dallas, TX, USA
| | - Hiroyuki Sakurai
- Department of Plastic and Reconstructive Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - David N Herndon
- Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA; Shriners Hospitals for Children, Galveston, TX, USA
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11
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Mucosal fluid evaporation is not the method of heat dissipation from fourth-degree laryngopharyngeal burns. Sci Rep 2016; 6:28772. [PMID: 27349685 PMCID: PMC4923872 DOI: 10.1038/srep28772] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 06/10/2016] [Indexed: 11/08/2022] Open
Abstract
This study was designed to explore whether mucosal fluid evaporation represents a method of heat dissipation from thermal air inhalation injury and to assess laryngopharyngeal tissue damage according to heat quantity changes of dry air and vapour. Fifteen adult male beagles were divided into five groups to inhale heated air or vapour for 10 min as follows: control group (ordinary air), group I (91–110 °C heated air), group II (148–175 °C heated air), group III (209–227 °C heated air), and group IV (96 °C saturated vapour). The heat quantity changes of the dry air and vapour were calculated via thermodynamic formulas. The macroscopic and histological features of the laryngopharynxes were examined and assessed by various tissue damage grading systems. Group IV exhibited the most serious laryngopharyngeal damage, including cilia exfoliation, submucosal thrombosis, glandular atrophy, and chondrocyte degeneration, which is indicative of fourth-degree injury. The quality, heat quantity, and proportional reduction of heat quantity of vapour in group IV were all higher than those in the other groups. Furthermore, we found that mucosal fluid evaporation is not the method of heat dissipation from thermal air inhalation injury used by the airways. Laryngopharyngeal tissue damage depends chiefly on the heat quantity of vapour in the air.
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12
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Wan J, Zhang G, Qiu Y, Wen C, Fu T. Heat dissipation by blood circulation and airway tissue heat absorption in a canine model of inhalational thermal injury. Burns 2016; 42:548-55. [DOI: 10.1016/j.burns.2015.11.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 10/30/2015] [Accepted: 11/05/2015] [Indexed: 11/15/2022]
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13
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Goodarzi-Ardakani V, Taeibi-Rahni M, Salimi MR, Ahmadi G. Computational simulation of temperature and velocity distribution in human upper respiratory airway during inhalation of hot air. Respir Physiol Neurobiol 2016; 223:49-58. [PMID: 26777422 DOI: 10.1016/j.resp.2016.01.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 12/14/2015] [Accepted: 01/03/2016] [Indexed: 11/16/2022]
Abstract
The present study provides an accurate simulation of velocity and temperature distributions of inhalation thermal injury in a human upper airway, including vestibule, nasal cavity, paranasal sinuses, nasopharynx, oropharynx, larynx, and upper part of main bronchus. To this end, a series of CT scan images, taken from an adult woman, was used to construct a three dimensional model. The airway walls temperature was adjusted according to existing in vivo temperature measurements. Also, in order to cover all breathing activities, five different breathing flow rates (10, 15, 20, 30, and 40 l/min) and different ambient air temperatures (100, 200, 300, 400, and 500 °C) were studied. Different flow regimes, including laminar, transitional, and turbulence were considered and the simulations were validated using reliable experimental data. The results show that nostrils, vestibule, and nasal cavity are damaged more than other part of airway. Finally, In order to obtain the heat flux through the walls, correlations for Nusselt number for each individual parts of airway (vestibule, main upper airway, nasopharynx etc.,) are proposed.
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Affiliation(s)
- V Goodarzi-Ardakani
- Department of Aerospace Engineering, Sharif University of Technology, Tehran, Iran.
| | - M Taeibi-Rahni
- Department of Aerospace Engineering, Sharif University of Technology, Tehran, Iran
| | - M R Salimi
- Department of Aerospace Engineering, Sharif University of Technology, Tehran, Iran
| | - G Ahmadi
- Mechanical and Aeronautical Engineering Department, Clarkson University, Potsdam, NY, USA
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14
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Dong ZW, Chen J, Ruan YC, Zhou T, Chen Y, Chen Y, Tsang LL, Chan HC, Peng YZ. CFTR-regulated MAPK/NF-κB signaling in pulmonary inflammation in thermal inhalation injury. Sci Rep 2015; 5:15946. [PMID: 26515683 PMCID: PMC4626762 DOI: 10.1038/srep15946] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 09/30/2015] [Indexed: 12/17/2022] Open
Abstract
The mechanism underlying pulmonary inflammation in thermal inhalation injury remains elusive. Cystic fibrosis, also hallmarked with pulmonary inflammation, is caused by mutations in CFTR, the expression of which is temperature-sensitive. We investigated whether CFTR is involved in heat-induced pulmonary inflammation. We applied heat-treatment in 16HBE14o- cells with CFTR knockdown or overexpression and heat-inhalation in rats in vivo. Heat-treatment caused significant reduction in CFTR and, reciprocally, increase in COX-2 at early stages both in vitro and in vivo. Activation of ERK/JNK, NF-κB and COX-2/PGE2 were detected in heat-treated cells, which were mimicked by knockdown, and reversed by overexpression of CFTR or VX-809, a reported CFTR mutation corrector. JNK/ERK inhibition reversed heat-/CFTR-knockdown-induced NF-κB activation, whereas NF-κB inhibitor showed no effect on JNK/ERK. IL-8 was augmented by heat-treatment or CFTR-knockdown, which was abolished by inhibition of NF-κB, JNK/ERK or COX-2. Moreover, in vitro or in vivo treatment with curcumin, a natural phenolic compound, significantly enhanced CFTR expression and reversed the heat-induced increases in COX-2/PGE2/IL-8, neutrophil infiltration and tissue damage in the airway. These results have revealed a CFTR-regulated MAPK/NF-κB pathway leading to COX-2/PGE2/IL-8 activation in thermal inhalation injury, and demonstrated therapeutic potential of curcumin for alleviating heat-induced pulmonary inflammation.
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Affiliation(s)
- Zhi Wei Dong
- State Key Laboratory of Trauma, Burns and Combined Injury, Chongqing Key Laboratory for Proteomics Disease, Institute of Burn Research, Southwest Hospital, the Third Military Medical University, Chongqing, China
| | - Jing Chen
- State Key Laboratory of Trauma, Burns and Combined Injury, Chongqing Key Laboratory for Proteomics Disease, Institute of Burn Research, Southwest Hospital, the Third Military Medical University, Chongqing, China
| | - Ye Chun Ruan
- Epithelial Cell Biology Research Center, School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - Tao Zhou
- State Key Laboratory of Trauma, Burns and Combined Injury, Chongqing Key Laboratory for Proteomics Disease, Institute of Burn Research, Southwest Hospital, the Third Military Medical University, Chongqing, China
| | - Yu Chen
- State Key Laboratory of Trauma, Burns and Combined Injury, Chongqing Key Laboratory for Proteomics Disease, Institute of Burn Research, Southwest Hospital, the Third Military Medical University, Chongqing, China
| | - YaJie Chen
- State Key Laboratory of Trauma, Burns and Combined Injury, Chongqing Key Laboratory for Proteomics Disease, Institute of Burn Research, Southwest Hospital, the Third Military Medical University, Chongqing, China
| | - Lai Ling Tsang
- Epithelial Cell Biology Research Center, School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - Hsiao Chang Chan
- Epithelial Cell Biology Research Center, School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - Yi Zhi Peng
- State Key Laboratory of Trauma, Burns and Combined Injury, Chongqing Key Laboratory for Proteomics Disease, Institute of Burn Research, Southwest Hospital, the Third Military Medical University, Chongqing, China
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15
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Fang-Gang N, Yang C, Yu-Xuan Q, Yan-Hua R, Wei-Li D, Cheng W, Chun-Quan W, Guo-An Z. Laryngeal morphologic changes and epidemiology in patients with inhalation injury: A retrospective study. Burns 2015; 41:1340-6. [DOI: 10.1016/j.burns.2015.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Revised: 01/19/2015] [Accepted: 02/02/2015] [Indexed: 10/23/2022]
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16
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Chang Y, Zhao XZ, Wang C, Ning FG, Zhang GA. Simulation of the Velocity and Temperature Distribution of Inhalation Thermal Injury in a Human Upper Airway Model by Application of Computational Fluid Dynamics. J Burn Care Res 2015; 36:500-8. [DOI: 10.1097/bcr.0000000000000181] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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17
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Cheng W, Ran Z, Wei L, La-na D, Xiao-zhuo Z, Yan-hua R, Fang-gang N, Guo-an Z. Pathological changes of the three clinical types of laryngeal burns based on a canine model. Burns 2014; 40:257-67. [DOI: 10.1016/j.burns.2013.06.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Revised: 03/24/2013] [Accepted: 06/03/2013] [Indexed: 11/17/2022]
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18
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Oscier C, Emerson B, Handy JM. New perspectives on airway management in acutely burned patients. Anaesthesia 2014; 69:105-10. [DOI: 10.1111/anae.12565] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- C. Oscier
- Chelsea and Westminster NHS Foundation Trust; London UK
| | - B. Emerson
- St Andrews Centre for Plastic Surgery and Burns; Mid Essex Hospitals NHS Trust; Chelmsford UK
| | - J. M. Handy
- Chelsea and Westminster NHS Foundation Trust; London UK
- Imperial College London; London UK
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19
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Zhao R, La-na D, Chun-Quan W, Fang-gang N, Guo-an Z. Circulational heat dissipation of upper airway: Canine model of inhalational thermal injury. Burns 2013; 39:1212-20. [DOI: 10.1016/j.burns.2013.01.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Revised: 12/21/2012] [Accepted: 01/04/2013] [Indexed: 11/26/2022]
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20
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Zhao R, Di LN, Zhao XZ, Wang C, Zhang GA. Measuring surface temperature and grading pathological changes of airway tissue in a canine model of inhalational thermal injury. Burns 2013; 39:767-75. [DOI: 10.1016/j.burns.2012.10.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2012] [Revised: 10/24/2012] [Accepted: 10/24/2012] [Indexed: 12/29/2022]
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