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Rech TH, Boniatti MM, Franke CA, Lisboa T, Wawrzeniak IC, Teixeira C, Maccari JG, Schaich F, Sauthier A, Schifelbain LM, Riveiro DFM, da Fonseca DLO, Berto PP, Marques L, Dos Santos MC, de Oliveira VM, Dornelles CFD, Vieira SRR. Inhalation injury after exposure to indoor fire and smoke: The Brazilian disaster experience. Burns 2016; 42:884-90. [PMID: 26975698 DOI: 10.1016/j.burns.2016.02.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2015] [Revised: 01/14/2016] [Accepted: 02/18/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To describe the pre-hospital, emergency department, and intensive care unit (ICU) care and prognosis of patients with inhalation injury after exposure to indoor fire and smoke. MATERIALS AND METHODS This is a prospective observational cohort study that includes patients admitted to seven ICUs after a fire disaster. The following data were collected: demographic characteristics; use of fiberoptic bronchoscopy; degree of inhalation injury; percentage of burned body surface area; mechanical ventilation parameters; and subsequent events during ICU stay. Patients were followed to determine the ICU and hospital mortality rates. RESULTS Within 24h of the incident, 68 patients were admitted to seven ICUs. The patients were young and had no comorbidities. Most patients (n=35; 51.5%) only had an inhalation injury. The mean ventilator-free days for patients with an inhalation injury degree of 0 or I was 12.5±8.1 days. For patients with an inhalation injury degree of II or III, the mean ventilator-free days was 9.4±5.8 days (p=0.12). In terms of the length of ICU stay for patients with degrees 0 or I, and patients with degrees II or III, the median was 7.0 days (5.0-8.0 days) and 12.0 days (8.0-23.0 days) (p<0.001), respectively. In addition, patients with a larger percentage of burned surface areas also had a longer ICU stay; however, no association with ventilator-free days was found. The patients with <10% of burned body surface area showed a mean of 9.2±5.4 ventilator-free days. The mean ventilator-free days for patients who had >10% burned body surface area was 11.9±9.5 (p=0.26). The length of ICU stay for the <10% and >10% burned body surface area patients was 7.0 days (5.0-10.0 days) and 23.0 days (11.5-25.5 days) (p<0.001), respectively. CONCLUSIONS We conclude that burn patients with inhalation injuries have different courses of disease, which are mainly determined by the percentage of burned body surface area.
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Affiliation(s)
- Tatiana Helena Rech
- Department of Intensive Care Medicine, Hospital de Clínicas de Porto Alegre, Ramiro Barcelos, 2350, Porto Alegre, Brazil
| | - Márcio Manozzo Boniatti
- Department of Intensive Care Medicine, Hospital de Clínicas de Porto Alegre, Ramiro Barcelos, 2350, Porto Alegre, Brazil.
| | - Cristiano Augusto Franke
- Department of Intensive Care Medicine, Hospital de Clínicas de Porto Alegre, Ramiro Barcelos, 2350, Porto Alegre, Brazil
| | - Thiago Lisboa
- Department of Intensive Care Medicine, Hospital de Clínicas de Porto Alegre, Ramiro Barcelos, 2350, Porto Alegre, Brazil
| | - Iuri Christmann Wawrzeniak
- Department of Intensive Care Medicine, Hospital de Clínicas de Porto Alegre, Ramiro Barcelos, 2350, Porto Alegre, Brazil
| | - Cassiano Teixeira
- Department of Intensive Care Medicine, Hospital Moinhos de Vento, Ramiro Barcelos, 910, Porto Alegre, Brazil
| | - Juçara Gasparetto Maccari
- Department of Intensive Care Medicine, Hospital Moinhos de Vento, Ramiro Barcelos, 910, Porto Alegre, Brazil
| | - Felipe Schaich
- Department of Intensive Care Medicine, Hospital Moinhos de Vento, Ramiro Barcelos, 910, Porto Alegre, Brazil
| | - Angelica Sauthier
- Department of Intensive Care Medicine, Hospital de Pronto Socorro de Porto Alegre, Largo Teodoro Herzl, Porto Alegre, Brazil
| | - Luciele Medianeira Schifelbain
- Department of Intensive Care Medicine, Hospital de Caridade Dr. Astrogildo de Azevedo, Presidente Vargas, 2291, Santa Maria, Brazil
| | | | | | - Paula Pinheiro Berto
- Department of Intensive Care Medicine, Santa Casa de Misericórdia, Professor Annes Dias, 295, Porto Alegre, Brazil
| | - Leonardo Marques
- Department of Intensive Care Medicine, Santa Casa de Misericórdia, Professor Annes Dias, 295, Porto Alegre, Brazil
| | - Moreno Calcagnotto Dos Santos
- Department of Intensive Care Medicine, Hospital Nossa Senhora da Conceição, Francisco Trein, 596, Porto Alegre, Brazil
| | - Vanessa Martins de Oliveira
- Department of Intensive Care Medicine, Hospital Nossa Senhora da Conceição, Francisco Trein, 596, Porto Alegre, Brazil
| | | | - Sílvia Regina Rios Vieira
- Department of Intensive Care Medicine, Hospital de Clínicas de Porto Alegre, Ramiro Barcelos, 2350, Porto Alegre, Brazil
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Lung [(18)F]fluorodeoxyglucose uptake and ventilation-perfusion mismatch in the early stage of experimental acute smoke inhalation. Anesthesiology 2014; 120:683-93. [PMID: 24051392 DOI: 10.1097/01.anes.0000435742.04859.e8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Acute lung injury occurs in a third of patients with smoke inhalation injury. Its clinical manifestations usually do not appear until 48-72 h after inhalation. Identifying inflammatory changes that occur in pulmonary parenchyma earlier than that could provide insight into the pathogenesis of smoke-induced acute lung injury. Furthermore, noninvasive measurement of such changes might lead to earlier diagnosis and treatment. Because glucose is the main source of energy for pulmonary inflammatory cells, the authors hypothesized that its pulmonary metabolism is increased shortly after smoke inhalation, when classic manifestations of acute lung injury are not yet expected. METHODS In five sheep, the authors induced unilateral injury with 48 breaths of cotton smoke while the contralateral lung served as control. The authors used positron emission tomography with: (1) [F]fluorodeoxyglucose to measure metabolic activity of pulmonary inflammatory cells; and (2) [N]nitrogen in saline to measure shunt and ventilation-perfusion distributions separately in the smoke-exposed and control lungs. RESULTS The pulmonary [F]fluorodeoxyglucose uptake rate was increased at 4 h after smoke inhalation (mean ± SD: 0.0031 ± 0.0013 vs. 0.0026 ± 0.0010 min; P < 0.05) mainly as a result of increased glucose phosphorylation. At this stage, there was no worsening in lung aeration or shunt. However, there was a shift of perfusion toward units with lower ventilation-to-perfusion ratio (mean ratio ± SD: 0.82 ± 0.10 vs. 1.12 ± 0.02; P < 0.05) and increased heterogeneity of the ventilation-perfusion distribution (mean ± SD: 0.21 ± 0.07 vs. 0.13 ± 0.01; P < 0 .05). CONCLUSION Using noninvasive imaging, the authors demonstrated that increased pulmonary [F]fluorodeoxyglucose uptake and ventilation-perfusion mismatch occur early after smoke inhalation.
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