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Ahmadi Z, Björk J, Gilljam H, Gogineni M, Gustafsson T, Runold M, Ringbæk T, Wahlberg J, Wendel L, Ekström M. Smoking and home oxygen therapy: a review and consensus statement from a multidisciplinary Swedish taskforce. Eur Respir Rev 2024; 33:230194. [PMID: 38296345 PMCID: PMC10828833 DOI: 10.1183/16000617.0194-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 12/02/2023] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND Home oxygen therapy (HOT) improves survival in patients with hypoxaemic chronic respiratory disease. Most patients evaluated for HOT are former or active smokers. Oxygen accelerates combustion and smoking may increase the risk of burn injuries and fire hazards; therefore, it is considered a contraindication for HOT in many countries. However, there is variability in the practices and policies regarding this matter. This multidisciplinary Swedish taskforce aimed to review the potential benefits and risks of smoking in relation to HOT, including medical, practical, legal and ethical considerations. METHODS The taskforce of the Swedish Respiratory Society comprises 15 members across respiratory medicine, nursing, medical law and ethics. HOT effectiveness and adverse risks related to smoking, as well as practical, legal and ethical considerations, were reviewed, resulting in five general questions and four PICO (population-intervention-comparator-outcome) questions. The strength of each recommendation was rated according to the GRADE (grading of recommendation assessment, development and evaluation) methodology. RESULTS General questions about the practical, legal and ethical aspects of HOT were discussed and summarised in the document. The PICO questions resulted in recommendations about assessment, management and follow-up of smoking when considering HOT, if HOT should be offered to people that meet the eligibility criteria but who continue to smoke, if a specific length of time of smoking cessation should be considered before assessing eligibility for HOT, and identification of areas for further research. CONCLUSIONS Multiple factors need to be considered in the benefit/risk evaluation of HOT in active smokers. A systematic approach is suggested to guide healthcare professionals in evaluating HOT in relation to smoking.
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Affiliation(s)
- Zainab Ahmadi
- Department of Clinical Sciences Lund, Respiratory Medicine, Allergology and Palliative Medicine, Lund University, Lund, Sweden
| | - Joar Björk
- Centre for Research Ethics and Bioethics (CRB), Uppsala University, Uppsala, Sweden
- Stockholm Centre for Healthcare Ethics (CHE), LIME, Karolinska Institute, Stockholm, Sweden
| | - Hans Gilljam
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - Madhuri Gogineni
- Stockholms Sjukhem, Palliative Home Care and Hospice Wards, Stockholm, Sweden
| | - Torbjörn Gustafsson
- Department of Respiratory Medicine and Allergy, University Hospital of Umeå, Umeå, Sweden
| | - Michael Runold
- Department of Respiratory Medicine and Allergy, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine Solna, Respiratory Medicine Unit, Karolinska Institute, Stockholm, Sweden
| | | | | | - Lotta Wendel
- Faculty of Health and Society, Malmö University, Malmö, Sweden
| | - Magnus Ekström
- Department of Clinical Sciences Lund, Respiratory Medicine, Allergology and Palliative Medicine, Lund University, Lund, Sweden
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Yoon JS, Khoo KH, Puthumana JS, Pérez Rivera LR, Keller PR, Lagziel T, Cox CA, Caffrey J, Galiatsatos P, Hultman CS. Outcomes of Patients with Burns Associated with Home Oxygen Therapy: An Institutional Retrospective Review. J Burn Care Res 2022; 43:1024-1031. [DOI: 10.1093/jbcr/irac090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Home oxygen therapy (HOT) burns carry high morbidity and mortality. Many patients are active smokers, which is the most frequent cause of oxygen ignition. We conducted a retrospective review at our institution to characterize demographics and outcomes in this patient population. An IRB-approved single-institution retrospective review was conducted for home oxygen therapy burn patients between July 2016 and January 2021. Demographic and clinical outcome data were compared between groups. We identified 100 patients with oxygen therapy burns. Mean age was 66.6 years with a male to female ratio of 1.3:1 and median burn surface area of 1%. In these patients, 97% were on oxygen for COPD and smoking caused 83% of burns. Thirteen were discharged from the emergency department, 35 observed for less than 24 hours, and 52 admitted. For admitted patients, 69.2% were admitted to the ICU, 37% required intubation, and 11.5% required debridement and grafting. Inhalational injury was found in 26.9% of patients, 3.9% underwent tracheostomy, and 17.3% experienced hospital complications. In-hospital mortality was 9.6% and 7.7% were discharged to hospice. 13.5% required readmission within 30 days. Admitted patients had significantly higher rates of admission to the ICU, intubation, and inhalational injury compared to those that were not admitted (p < .01). Most HOT-related burns are caused by smoking and can result in significant morbidity and mortality. Efforts to educate and encourage smoking cessation with more judicious HOT allocation would assist in preventing these unnecessary highly morbid injuries.
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Affiliation(s)
- Joshua S Yoon
- Division of Plastic, Reconstructive & Maxillofacial Surgery, R Adams Cowley Shock Trauma Center , Baltimore, MD USA
- Department of Surgery, George Washington University Hospital , Washington, DC USA
| | - Kimberly H Khoo
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University , Baltimore, MD USA
| | - Joseph S Puthumana
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University , Baltimore, MD USA
| | | | - Patrick R Keller
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University , Baltimore, MD USA
| | - Tomer Lagziel
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University , Baltimore, MD USA
| | - Carrie A Cox
- Adult Burn Center, Johns Hopkins University Bayview Medical Center , Baltimore, MD USA
| | - Julie Caffrey
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University , Baltimore, MD USA
- Adult Burn Center, Johns Hopkins University Bayview Medical Center , Baltimore, MD USA
| | - Panagis Galiatsatos
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University , Baltimore, MD USA
| | - C Scott Hultman
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University , Baltimore, MD USA
- Adult Burn Center, Johns Hopkins University Bayview Medical Center , Baltimore, MD USA
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Care of the Critically Injured Burn Patient. Ann Am Thorac Soc 2022; 19:880-889. [PMID: 35507538 DOI: 10.1513/annalsats.202110-1099cme] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Care of the critically injured burn patient presents unique challenges to the intensivist. Certified burn centers are rare and geographically sparse, necessitating that much of the initial management of patients with severe burn injuries must happen in the pre-burn center setting.1 Severe burn injuries often lead to a wide range of complications that extend beyond the loss of skin integrity and require specialized care. As such, medical intensivists are often called upon to stabilize these critically injured patients. This focused review outlines the clinical care of these medically complex patients, including airway management, post-burn complications, volume resuscitation, nutrition, and end-of-life care.
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Daniels M, Stromps JP, Heitzmann W, Schiefer J, Fuchs PC, Seyhan H. Nexobrid Treatment for Burn Injuries in Patients With Chronic Obstructive Pulmonary Disease and Home Oxygen Therapy. J Burn Care Res 2021; 44:693-697. [PMID: 34197585 DOI: 10.1093/jbcr/irab127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Indexed: 11/13/2022]
Abstract
There is an increased risk for burn injuries associated with home oxygen therapy of patients with chronic obstructive pulmonary disease since 10 to 50 % of these patients continue to smoke. Enzymatic eschar removal of facial burns is gaining popularity but intubation of this specific patient group often leads to prolonged weaning and can require tracheostomy. This study dealt with the question if enzymatic debridement in these patients can also be performed in analgosedation. A selective review of the literature regarding burn trauma associated with home oxygen use in patients with COPD was performed, as well as a retrospective analysis of all patients with burn injuries associated with home oxygen use and chronic obstructive pulmonary disease that were admitted to the study clinic. In the literature 1746 patients with burns associated with home oxygen use are described, but none of them received enzymatic debridement. In this study seventeen patients were included. All three patients in this study with facial full-thickness burn injuries received enzymatic debridement. The mortality rate in this cohort was 17.6 % (3/17). Up to date, there is limited experience performing regional anesthesia debridement in patients with COPD. This is the first manuscript describing the use of enzymatic debridement in patients with COPD and home oxygen therapy. We could confirm other studies that intubation of these patients leads to prolonged ventilation hours and increases the probability for poor prognosis. Therefore, we described the treatment of enzymatic debridement in analgosedation without intubation.
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Affiliation(s)
- Marc Daniels
- Clinic of Plastic, Reconstructive, Hand and Burn Surgery, Hospital Cologne Merheim, University of Witten-Herdecke, Germany
| | - Jan Philipp Stromps
- Clinic of Plastic, Reconstructive, Hand and Burn Surgery, Hospital Cologne Merheim, University of Witten-Herdecke, Germany
| | - Wolfram Heitzmann
- Clinic of Plastic, Reconstructive, Hand and Burn Surgery, Hospital Cologne Merheim, University of Witten-Herdecke, Germany
| | - Jennifer Schiefer
- Clinic of Plastic, Reconstructive, Hand and Burn Surgery, Hospital Cologne Merheim, University of Witten-Herdecke, Germany
| | - Paul Christian Fuchs
- Clinic of Plastic, Reconstructive, Hand and Burn Surgery, Hospital Cologne Merheim, University of Witten-Herdecke, Germany
| | - Harun Seyhan
- Clinic of Plastic, Reconstructive, Hand and Burn Surgery, Hospital Cologne Merheim, University of Witten-Herdecke, Germany
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Tang JA, Amadio G, Nagappan L, Schmalbach CE, Dion GR. Laryngeal inhalational injuries: A systematic review. Burns 2021; 48:23-33. [PMID: 33814215 DOI: 10.1016/j.burns.2021.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 12/19/2020] [Accepted: 02/05/2021] [Indexed: 02/07/2023]
Abstract
Laryngeal inhalation injury carries a significant increase in mortality rate and often indicates immediate airway evaluation. This may be difficult in the setting of clinical deterioration necessitating immediate intubation, which itself can synergistically cause mucosal damage. Prior studies do not encompass predictive factors or long-term outcomes for the laryngotracheal complex. This systemic review of PubMed, Embase, and Cochrane identified studies investigating inhalational injuries of the upper airway. Demographic data as well as presentation, physical findings, and delayed sequelae were documented. Laryngotracheal burn patients were divided into two cohorts based on timing of laryngeal injury diagnosis (before- versus after-airway intervention). 1051 papers met initial search criteria and 43 studies were ultimately included. Airway stenosis was more common in patients that were intubated immediately (50.0%, n = 18 versus 5.2%, n = 13; p = 0.57). Posterior glottic involvement was only identified in patients intubated prior to airway evaluation (71.4%, n = 15). All studies reported a closed space setting for those patients in whom airway intervention preceded laryngeal evaluation. Laryngeal inhalational injuries are a distinct subset that can have a variety of minor to severe laryngotracheal delayed sequelae, particularly for thermal injuries occurring within enclosed spaces. Given these findings, early otolaryngology referral may mitigate or treat these effects.
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Affiliation(s)
- Jessica A Tang
- Department of Otolaryngology, Head and Neck Surgery, Temple University Hospital, Philadelphia, PA, USA
| | - Grace Amadio
- Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Lavanya Nagappan
- Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Cecelia E Schmalbach
- Department of Otolaryngology, Head and Neck Surgery, Temple University Hospital, Philadelphia, PA, USA; Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA; Temple Head and Neck Institute, Philadelphia, PA, USA
| | - Gregory R Dion
- US Army Institute of Surgical Research, Joint Base San Antonio, Fort Sam Houston, TX, USA.
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Klifto KM, Yesantharao PS, Dellon AL, Hultman CS, Lifchez SD. Chronic Neuropathic Pain Following Hand Burns: Etiology, Treatment, and Long-Term Outcomes. J Hand Surg Am 2021; 46:67.e1-67.e9. [PMID: 32855013 DOI: 10.1016/j.jhsa.2020.07.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 05/16/2020] [Accepted: 07/13/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE Chronic neuropathic pain (CNP) after burn injury to the hand/upper extremity is relatively common, but not well described in the literature. This study characterizes patients with CNP after hand/upper extremity burns to help guide risk stratification and treatment strategies. We hypothesize that multiple risk factors contribute to the development of CNP and refractory responses to treatment. METHODS Patients older than 15 years admitted to the burn center after hand/upper extremity burns, from January 1, 2014, through January 1, 2019, were included. Chronic neuropathic pain was defined as self-described pain for longer than 6 months after burn injury, not including pain due to preexisting illness/medications. Two analyses were undertaken: (1) determining risk factors for developing CNP among patients with hand/upper extremity burns, and (2) determining risk factors for developing refractory pain (ie, nonresponsive to treatment) among hand/upper extremity burn patients with CNP. RESULTS Of the 914 patients who met the inclusion criteria, 55 (6%) developed CNP after hand/upper extremity burns. Twenty-nine of these patients (53%) had refractory CNP. Significant risk factors for developing CNP after hand/upper extremity burns included history of substance abuse and tobacco use. Among CNP patients, significant risk factors for developing refractory pain included symptoms of burning sensations. In all CNP patients, gabapentin and ascorbic acid were associated with significant decreases in pain scores on follow-up. CONCLUSIONS Substance abuse and tobacco use may contribute to the development of CNP after hand/upper extremity burns. Those who developed refractory CNP were more likely to use the pain descriptor, burning sensations. Pharmacological pain management with gabapentin or pregabalin and ascorbic acid may provide the most relief of CNP symptoms. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Kevin M Klifto
- Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Pooja S Yesantharao
- Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - A Lee Dellon
- Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - C Scott Hultman
- Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Scott D Lifchez
- Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD; Department of Orthopedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD.
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Klifto KM, Shetty PN, Slavin BR, Gurno CF, Seal SM, Asif M, Hultman CS. Impact of nicotine/smoking, alcohol, and illicit substance use on outcomes and complications of burn patients requiring hospital admission: systematic review and meta-analysis. Burns 2020; 46:1498-1524. [DOI: 10.1016/j.burns.2019.08.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Revised: 06/04/2019] [Accepted: 08/10/2019] [Indexed: 11/25/2022]
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Moslander C, Lat T, Giri B, Pattison R, Coppin JD, Bhat UM. Long-Term Oxygen Therapy and Risk of Fire-Related Events. Fed Pract 2020; 37:442-446. [PMID: 33132681 DOI: 10.12788/fp.0048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Introduction Two large major trials showed that long-term oxygen therapy (LTOT) improved mortality in patients with chronic obstructive pulmonary disease (COPD) and hypoxemia. Although oxygen accelerates combustion and is an obvious fire hazard, LTOT has traditionally been prescribed to veterans who are actively smoking. Methods We conducted a retrospective chart review of all veterans with COPD at a single center who were prescribed new LTOT between October 2010 and September 2015. Of the 158 patients who met the study criteria, 152 were male. Bayesian logistic regression was used to model the outcome variable fire-related incident with the predictors smoking status, age, race, depression, posttraumatic stress disorder, and type of oxygen used. Results The mean age of the 158 patients with COPD in the study was 71.3 years in nonsmokers and 65.9 years in smokers. The model-estimated odds (SD) of a fire-related incident occurring in a smoker were 31.6 (5.1-372.7) times the odds of a fire-related incident occurring in a nonsmoker. Conclusions Patients who smoke and remain on LTOT put themselves at greater risk of having a fire-related incident than do nonsmokers.
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Affiliation(s)
- Conner Moslander
- is a Resident in the Department of Internal Medicine; is Faculty and is a Fellow, both in the Division of Pulmonary/Critical Care Medicine; all at Baylor Scott & White in Temple, Texas. is an Assistant Professor at Virginia Tech Carilion School of Medicine in the Pulmonary, Critical Care and Sleep Medicine Carilion Clinic in Roanoke, Virginia. is a Statistician in the Department of Research, and is Associate Program Director for the Pulmonary and Critical Care Fellowship Program, both at Central Texas Veterans Health Care System. Udaya Bhat is Chief, Pulmonary/Critical Care Section and Assistant Professor of Medicine at Texas A&M University in College Station
| | - Tasnim Lat
- is a Resident in the Department of Internal Medicine; is Faculty and is a Fellow, both in the Division of Pulmonary/Critical Care Medicine; all at Baylor Scott & White in Temple, Texas. is an Assistant Professor at Virginia Tech Carilion School of Medicine in the Pulmonary, Critical Care and Sleep Medicine Carilion Clinic in Roanoke, Virginia. is a Statistician in the Department of Research, and is Associate Program Director for the Pulmonary and Critical Care Fellowship Program, both at Central Texas Veterans Health Care System. Udaya Bhat is Chief, Pulmonary/Critical Care Section and Assistant Professor of Medicine at Texas A&M University in College Station
| | - Badri Giri
- is a Resident in the Department of Internal Medicine; is Faculty and is a Fellow, both in the Division of Pulmonary/Critical Care Medicine; all at Baylor Scott & White in Temple, Texas. is an Assistant Professor at Virginia Tech Carilion School of Medicine in the Pulmonary, Critical Care and Sleep Medicine Carilion Clinic in Roanoke, Virginia. is a Statistician in the Department of Research, and is Associate Program Director for the Pulmonary and Critical Care Fellowship Program, both at Central Texas Veterans Health Care System. Udaya Bhat is Chief, Pulmonary/Critical Care Section and Assistant Professor of Medicine at Texas A&M University in College Station
| | - Rachael Pattison
- is a Resident in the Department of Internal Medicine; is Faculty and is a Fellow, both in the Division of Pulmonary/Critical Care Medicine; all at Baylor Scott & White in Temple, Texas. is an Assistant Professor at Virginia Tech Carilion School of Medicine in the Pulmonary, Critical Care and Sleep Medicine Carilion Clinic in Roanoke, Virginia. is a Statistician in the Department of Research, and is Associate Program Director for the Pulmonary and Critical Care Fellowship Program, both at Central Texas Veterans Health Care System. Udaya Bhat is Chief, Pulmonary/Critical Care Section and Assistant Professor of Medicine at Texas A&M University in College Station
| | - John D Coppin
- is a Resident in the Department of Internal Medicine; is Faculty and is a Fellow, both in the Division of Pulmonary/Critical Care Medicine; all at Baylor Scott & White in Temple, Texas. is an Assistant Professor at Virginia Tech Carilion School of Medicine in the Pulmonary, Critical Care and Sleep Medicine Carilion Clinic in Roanoke, Virginia. is a Statistician in the Department of Research, and is Associate Program Director for the Pulmonary and Critical Care Fellowship Program, both at Central Texas Veterans Health Care System. Udaya Bhat is Chief, Pulmonary/Critical Care Section and Assistant Professor of Medicine at Texas A&M University in College Station
| | - Udaya M Bhat
- is a Resident in the Department of Internal Medicine; is Faculty and is a Fellow, both in the Division of Pulmonary/Critical Care Medicine; all at Baylor Scott & White in Temple, Texas. is an Assistant Professor at Virginia Tech Carilion School of Medicine in the Pulmonary, Critical Care and Sleep Medicine Carilion Clinic in Roanoke, Virginia. is a Statistician in the Department of Research, and is Associate Program Director for the Pulmonary and Critical Care Fellowship Program, both at Central Texas Veterans Health Care System. Udaya Bhat is Chief, Pulmonary/Critical Care Section and Assistant Professor of Medicine at Texas A&M University in College Station
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Knowlin LT, Stanford LB, Cairns BA, Charles AG. The effect of preexisting respiratory co-morbidities on burn outcomes. Burns 2017; 43:366-373. [PMID: 28341260 PMCID: PMC5918311 DOI: 10.1016/j.burns.2016.08.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 08/12/2016] [Accepted: 08/27/2016] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Burns cause physiologic changes in multiple organ systems in the body. Burn mortality is usually attributable to pulmonary complications, which can occur in up to 41% of patients admitted to the hospital after burn. Patients with preexisting comorbidities such as chronic lung diseases may be more susceptible. We therefore sought to examine the impact of preexisting respiratory disease on burn outcomes. METHODS A retrospective analysis of patients admitted to a regional burn center from 2002-2012. Independent variables analyzed included basic demographics, burn mechanism, presence of inhalation injury, TBSA, pre-existing comorbidities, smoker status, length of hospital stay, and days of mechanical ventilation. Bivariate analysis was performed and Cox regression modeling using significant variables was utilized to estimate hazard of progression to mechanical ventilation and mortality. RESULTS There were a total of 7640 patients over the study period. Overall survival rate was 96%. 8% (n=672) had a preexisting respiratory disease. Chronic lung disease patients had a higher mortality rate (7%) compared to those without lung disease (4%, p<0.01). The adjusted Cox regression model to estimate the hazard of progression to mechanical ventilation in patients with respiratory disease was 21% higher compared to those without respiratory disease (HR=1.21, 95% CI=1.01-1.44). The hazard of progression to mortality is 56% higher (HR=1.56, 95% CI=1.10-2.19) for patients with pre-existing respiratory disease compared to those without respiratory disease after controlling for patient demographics and injury characteristics. CONCLUSION Preexisting chronic respiratory disease significantly increases the hazard of progression to mechanical ventilation and mortality in patients following burn. Given the increasing number of Americans with chronic respiratory diseases, there will likely be a greater number of individuals at risk for worse outcomes following burn.
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Affiliation(s)
- Laquanda T Knowlin
- Department of Surgery, University of North Carolina at Chapel Hill, North Carolina Jaycee Burn Center, United States
| | - Lindsay B Stanford
- Department of Surgery, University of North Carolina at Chapel Hill, North Carolina Jaycee Burn Center, United States
| | - Bruce A Cairns
- Department of Surgery, University of North Carolina at Chapel Hill, North Carolina Jaycee Burn Center, United States
| | - Anthony G Charles
- Department of Surgery, University of North Carolina at Chapel Hill, North Carolina Jaycee Burn Center, United States.
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Tanash HA, Ringbaek T, Huss F, Ekström M. Burn injury during long-term oxygen therapy in Denmark and Sweden: the potential role of smoking. Int J Chron Obstruct Pulmon Dis 2017; 12:193-197. [PMID: 28123292 PMCID: PMC5230731 DOI: 10.2147/copd.s119949] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Long-term oxygen therapy (LTOT) increases life expectancy in patients with COPD and severe hypoxemia. Smoking is the main cause of burn injury during LTOT. Policy regarding smoking while on LTOT varies between countries. In this study, we compare the incidence of burn injury that required contact with a health care specialist, between Sweden (a country with a strict policy regarding smoking while on LTOT) and Denmark (a country with less strict smoking policy). Methods This was a population-based, cohort study of patients initiating LTOT due to any cause in Sweden and Denmark. Data on diagnoses, external causes, and procedures were obtained from the Swedish and Danish National Patient Registers for inpatient and outpatient care. Patients were followed from January 1, 2000, until the first of the following: LTOT withdrawal, death, or study end (December 31, 2009). The primary end point was burn injury during LTOT. Results A total of 23,741 patients received LTOT in Denmark and 7,754 patients in Sweden. Most patients started LTOT due to COPD, both in Sweden (74%) and in Denmark (62%). The rate of burn injury while on LTOT was higher in Denmark than in Sweden; 170 (95% confidence interval [CI], 126–225) vs 85 (95% CI, 44–148) per 100,000 person-years; rate ratio 2.0 (95% CI, 1.0–4.1). The risk remained higher after adjustment for gender, age, and diagnosis in multivariate Cox regression, hazard ratio 1.8 (95% CI, 1.0−3.5). Thirty-day mortality after burn injury was 8% in both countries. Conclusion Compared to Sweden, the rate of burn injury was twice as high in Denmark where smoking is not a contraindication for prescribing LTOT.
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Affiliation(s)
- Hanan A Tanash
- Department of Respiratory Medicine, Skåne University Hospital, Lund University, Lund, Sweden
| | - Thomas Ringbaek
- Respiratory Department, Hvidovre Hospital, Copenhagen, Denmark
| | - Fredrik Huss
- Department of Surgical Sciences, Plastic Surgery; Department of Plastic and Maxillofacial Surgery, Burn Center, Uppsala University Hospital, Uppsala, Sweden
| | - Magnus Ekström
- Department of Respiratory Medicine, Skåne University Hospital, Lund University, Lund, Sweden
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High K, Johnson MK. A 62-Year-Old Man with Home Oxygen Therapy Facial Burns. J Emerg Nurs 2016; 42:522-523. [DOI: 10.1016/j.jen.2016.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 01/20/2016] [Accepted: 01/21/2016] [Indexed: 10/22/2022]
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Wolff KB, Soncrant C, Mills PD, Hemphill RR. Flash Burns While on Home Oxygen Therapy: Tracking Trends and Identifying Areas for Improvement. Am J Med Qual 2016; 32:445-452. [DOI: 10.1177/1062860616658343] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The objective was to analyze reported flash burns experienced by patients on home oxygen therapy (HOT) in the Veterans Health Administration (VHA) using a qualitative, retrospective review of VHA root cause analysis reports between January 2009 and November 2015. Of 123 cases of reported adverse events related to flash burns, 100 cases (81%) resulted in injury, and 23 (19%) resulted in death. Although 89% of veterans claimed to have quit smoking (n = 109), 92% (n = 113) of burns occurred as a result of smoking. The most common root cause was risk identification issues. Recommended actions were standardized risk assessment policies, patient education, and the adoption of fire stop valves. Patients with a history of smoking who are on HOT should be considered for fire stop valves and offered consistent counseling and follow-up using a combination of harm reduction and shared decision-making techniques. Standardization of risk identification and documentation is recommended.
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Affiliation(s)
- Kristina B. Wolff
- VA National Center for Patient Safety Field Office (NCPS), White River Junction, VT
| | - Christina Soncrant
- VA National Center for Patient Safety Field Office (NCPS), White River Junction, VT
| | - Peter D. Mills
- VA National Center for Patient Safety Field Office (NCPS), White River Junction, VT
- The Geisel School of Medicine at Dartmouth College, Hanover, NH
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Carlos WG, Baker MS, McPherson KA, Bosslet GT, Sood R, Torke AM. Smoking-Related Home Oxygen Burn Injuries: Continued Cause for Alarm. Respiration 2016; 91:151-5. [PMID: 26812246 DOI: 10.1159/000443798] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 01/04/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Home oxygen therapy is a mainstay of treatment for patients with various cardiopulmonary diseases. In spite of warnings against smoking while using home oxygen, many patients sustain burn injuries. OBJECTIVES We aimed to quantify the morbidity and mortality of such patients admitted to our regional burn unit over a 6-year period. METHODS A retrospective chart review of all patients admitted to a regional burn center from 2008 through 2013 was completed. Admitted patients sustaining burns secondary to smoking while using home oxygen therapy were selected as the study population to determine morbidity. RESULTS Fifty-five subjects were admitted to the burn unit for smoking-related home oxygen injuries. The age range was 40-84 years. Almost all subjects were on home oxygen for chronic obstructive pulmonary disease (96%). Seventy-two percent of burns involved <5% of the total body surface area, 51% of patients were intubated, and of those 33% had evidence of inhalation injury. The hospital mortality rate was 14.5%. The mean length of hospital stay was 8.6 days, and 54.5% were discharged to a nursing home or another advanced facility. Finally, concomitant substance abuse was found in 27%, and a previous history of injury from smoking while on home oxygen was discovered in 14.5%. CONCLUSIONS This single-center analysis is one of the largest describing burn injuries stemming from smoking while using home oxygen therapy. We identified the morbidity and mortality associated with these injuries. Ongoing education and careful consideration of prescribing home oxygen therapy for known smokers is highly encouraged.
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Affiliation(s)
- William G Carlos
- Division of Pulmonary/Critical Care/Allergy and Occupational Medicine, Department of Medicine, Indiana University School of Medicine, Indianapolis, Ind., USA
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Sharma G, Meena R, Goodwin JS, Zhang W, Kuo YF, Duarte AG. Burn injury associated with home oxygen use in patients with chronic obstructive pulmonary disease. Mayo Clin Proc 2015; 90:492-9. [PMID: 25837866 PMCID: PMC4743653 DOI: 10.1016/j.mayocp.2014.12.024] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Revised: 10/27/2014] [Accepted: 12/19/2014] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To quantify the risk of burn injury associated with home oxygen use and to examine the risk factors associated with the development of this injury. PATIENTS AND METHODS We used a nested case-control and a retrospective cohort design to study enrollment and claims data from a national sample of Medicare beneficiaries 66 years and older with a diagnosis of chronic obstructive pulmonary disease (COPD) from January 1, 2001, through December 31, 2010. The primary outcome was burn injury in patients with COPD prescribed home oxygen. RESULTS In the nested case-control method, patients with burn injury were twice (odds ratio, 2.43; 95% CI, 1.57-3.78) as likely to be prescribed oxygen in the preceding 90 days compared with those without burn injury. In the retrospective cohort study, the absolute risk of burn injury in patients prescribed oxygen therapy was 2.98 per 1000 patients compared with 1.69 per 1000 patients not prescribed oxygen during a 22-month period. The excess risk of a burn injury associated with oxygen was 0.704 per 1000 patients per year, and the number needed to harm was 1421. In multivariable analysis, factors associated with burn injury included male sex, low socioeconomic status, oxygen therapy use, and the presence of 3 or more comorbidities. CONCLUSION The benefits of oxygen therapy in patients with COPD outweigh the modest risk of burn injury associated with home oxygen use. However, with the increasing number of patients being prescribed oxygen, health care professionals must educate and counsel patients regarding the potential risk of burn injury.
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