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Akın M, Tuncer HB, Akgün AE, Erkılıç E. New Treatment Modality for Burn Injury-Related Acute Respiratory Distress Syndrome: High-Flow Nasal Oxygen Therapy in Major Burns. J Burn Care Res 2024; 45:1060-1065. [PMID: 38630547 DOI: 10.1093/jbcr/irae066] [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] [Received: 01/22/2024] [Indexed: 04/19/2024]
Abstract
Pulmonary insufficiency is the primary cause of death in cases of major burns accompanied by inhalation damage. It is important to consider the impact on the face and neck in flame burns. Early implementation of bronchial hygiene measures and oxygenation treatment in inhalation injury can reduce mortality. This case series presents the effects of high-flow nasal oxygen (HFNO) application on patient outcomes in major burns and inhalation injury. This report discusses 3 different patients. One patient, a 29-year-old male with 35% TBSA burns, received HFNO treatment for inhalation injury on the sixth day after the trauma. After 72 hours of HFNO application, the patient's pulmonary symptoms improved. The second patient had 60% TBSA burns and developed respiratory distress symptoms on the fifth day after the trauma. After 7 days of HFNO application, all symptoms and findings of acute respiratory distress syndrome (ARDS) were resolved. HFNO has been used for the treatment of ARDS related to major burn (60% of burned TBSA) in a 28-year-old patient, and improvement was achieved. The use of HFNO in pulmonary insufficiency among burn patients has not been reported previously. This series of patient cases demonstrates the successful application of HFNO in treating inhalation injury and burn-related ARDS. However, further clinical studies are necessary to increase its clinical utilization.
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Affiliation(s)
- Merve Akın
- General Surgery, Burn Treatment Unit, Ankara City Hospital, Ankara, 06800, Turkey
| | | | - Ali Emre Akgün
- General Surgery, Burn Treatment Unit, Ankara City Hospital, Ankara, 06800, Turkey
| | - Ezgi Erkılıç
- Anesthesiology and Reanimation, Ankara City Hospital, Ankara, 06800, Turkey
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Liu J, Gao J, Wang H, Fan X, Li L, Wang X, Wang X, Lu J, Shi X, Yang P. Acute Neurobehavioral and Glial Responses to Explosion Gas Inhalation in Rats. ENVIRONMENTAL TOXICOLOGY 2024. [PMID: 39092980 DOI: 10.1002/tox.24389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 04/27/2024] [Accepted: 07/03/2024] [Indexed: 08/04/2024]
Abstract
Military personnel, firefighters, and fire survivors exhibit a higher prevalence of mental health conditions such as depression and post-traumatic stress disorder (PTSD) compared to the general population. While numerous studies have examined the neurological impacts of physical trauma and psychological stress, research on acute neurobehavioral effects of gas inhalation from explosions or fires is limited. This study investigates the early-stage neurobehavioral and neuronal consequences of acute explosion gas inhalation in Sprague-Dawley rats. Rats were exposed to simulated explosive gas and subsequently assessed using behavioral tests and neurobiological analyses. The high-dose exposure group demonstrated significant depression-like behaviors, including reduced mobility and exploration. However, neuronal damage was not evident in histological analyses. Immunofluorescence revealed increased density of radial glia and oligodendrocytes in specific brain regions, suggesting hypoxia and axon damage induced by gas inhalation as a potential mechanism for the observed neurobehavioral changes. These findings underscore the acute impact of explosion gas inhalation on mental health, highlighting the habenula and dentate gyrus of hippocampus as the possible target regions. The findings are expected to support early diagnosis and treatment strategies for brain injuries caused by explosion gas, offering insights into early intervention for depression and PTSD in affected populations.
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Affiliation(s)
- Jinren Liu
- Key Laboratory for Disease Prevention and Control and Health Promotion of Shaanxi Province, School of Public Health, Medical Science Center, Xi'an Jiaotong University, Xi'an, China
| | - Junhong Gao
- Xi'an Key Laboratory of Toxicology and Biological Effects, Institute for Hygiene of Ordnance Industry, Xi'an, China
| | - Hong Wang
- Xi'an Key Laboratory of Toxicology and Biological Effects, Institute for Hygiene of Ordnance Industry, Xi'an, China
| | - Xiaolin Fan
- Xi'an Key Laboratory of Toxicology and Biological Effects, Institute for Hygiene of Ordnance Industry, Xi'an, China
| | - Liang Li
- Xi'an Key Laboratory of Toxicology and Biological Effects, Institute for Hygiene of Ordnance Industry, Xi'an, China
| | - Xiangni Wang
- Key Laboratory for Disease Prevention and Control and Health Promotion of Shaanxi Province, School of Public Health, Medical Science Center, Xi'an Jiaotong University, Xi'an, China
| | - Xiying Wang
- Key Laboratory for Disease Prevention and Control and Health Promotion of Shaanxi Province, School of Public Health, Medical Science Center, Xi'an Jiaotong University, Xi'an, China
| | - Jiajia Lu
- Key Laboratory for Disease Prevention and Control and Health Promotion of Shaanxi Province, School of Public Health, Medical Science Center, Xi'an Jiaotong University, Xi'an, China
| | - Xingmin Shi
- Key Laboratory for Disease Prevention and Control and Health Promotion of Shaanxi Province, School of Public Health, Medical Science Center, Xi'an Jiaotong University, Xi'an, China
| | - Pinglin Yang
- The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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Vyklicka K, Gregor P, Lipovy B, Raska F, Kukucka P, Kohoutek J, Pribylova P, Čupr P, Borilova Linhartova P. Polycyclic aromatic hydrocarbons and their metabolites in bronchoalveolar lavage and urine samples from patients with inhalation injury throughout their hospitalization: A prospective pilot study. PLoS One 2024; 19:e0308163. [PMID: 39088550 PMCID: PMC11293749 DOI: 10.1371/journal.pone.0308163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 07/18/2024] [Indexed: 08/03/2024] Open
Abstract
BACKGROUND Specific toxic compounds, such as polycyclic aromatic hydrocarbons (PAHs) and their metabolites, may affect the inhalation injury (INHI) grade, patients' status, and prognosis for recovery. This pilot prospective study aimed to: i) evaluate the suitability of bronchoalveolar lavage (BAL) for determination of PAHs in the LRT and of urine for determination of hydroxylated metabolites (OH-PAHs) in patients with INHI, ii) describe the dynamic changes in the levels of these toxic compounds, and iii) correlate these findings with clinical variables of the patients with INHI. METHODS The BAL and urine samples from 10 patients with INHI were obtained on Days 1, 3, 5, 7, and 14 of hospitalization, if possible, and PAHs (BAL) and OH-PAHs (urine) were analyzed using chromatographic methods (GC-MS and HPLC). RESULTS Concentrations of analyzed PAHs were in most cases and time points below the limit of quantification in BAL samples. Nine OH-PAHs were detected in the urine samples; however, their concentrations sharply decreased within the first three days of the hospitalization. On Day 14, the total amount of OH-PAHs in urine was higher in surviving patients with High-grade INHI (≥3) than in those with Low-grade INHI (<3, p = 0.032). Finally, a significant correlation between certain OH-PAHs and clinical variables (AST/ALT, TBSA, ABSI) from Day 1 of the hospitalization was observed (p<0.05). CONCLUSIONS BAL samples are not suitable for the analysis of PAHs. However, the OH-PAHs levels in urine can be measured reliably and were correlated with several clinical variables. Moreover, High-grade INHI was associated with higher total concentrations of OH-PAHs in urine.
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Affiliation(s)
- Katerina Vyklicka
- RECETOX, Faculty of Science, Masaryk University, Brno, Czech Republic
| | - Petr Gregor
- RECETOX, Faculty of Science, Masaryk University, Brno, Czech Republic
| | - Bretislav Lipovy
- Department of Burns Medicine, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
- Department of Burns and Plastic Surgery, Faculty of Medicine, Masaryk University, Kamenice, Brno, Czech Republic
- Department of Burns and Plastic Surgery, University Hospital Brno, Brno, Czech Republic
| | - Filip Raska
- Department of Burns and Plastic Surgery, Faculty of Medicine, Masaryk University, Kamenice, Brno, Czech Republic
| | - Petr Kukucka
- RECETOX, Faculty of Science, Masaryk University, Brno, Czech Republic
| | - Jiri Kohoutek
- RECETOX, Faculty of Science, Masaryk University, Brno, Czech Republic
| | - Petra Pribylova
- RECETOX, Faculty of Science, Masaryk University, Brno, Czech Republic
| | - Pavel Čupr
- RECETOX, Faculty of Science, Masaryk University, Brno, Czech Republic
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Geringer MR, Stewart L, Shaikh F, Carson ML, Lu D, Cancio LC, Gurney JM, Tribble DR, Kiley JL. Epidemiology and timing of infectious complications from battlefield-related burn injuries. Burns 2024:S0305-4179(24)00204-3. [PMID: 39341778 DOI: 10.1016/j.burns.2024.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 03/28/2024] [Accepted: 07/04/2024] [Indexed: 10/01/2024]
Abstract
BACKGROUND Infections are the most frequent complication and cause of mortality in burn patients. We describe the epidemiology and outcomes of infections among deployed U.S. military personnel with burns. METHODS Military personnel who sustained a burn injury in Iraq or Afghanistan (2009-2014) and were admitted to the Burn Center at U.S. Army Institute of Surgical Research at Brooke Army Medical Center were included in the analysis. RESULTS The study population included 144 patients who were primarily young (median 24 years) males (99 %) with combat-related burns (62 %) sustained via a blast (57 %), resulting in a median total body surface area burned (TBSA) of 6 % (IQR 3-14 %). Twenty-six (18 %) patients developed infections, with pneumonia being the predominant initial infection (= 16), followed by skin and soft-tissue infections (SSTI, = 6), bloodstream infections (BSI, = 3), and intra-abdominal infections (IAI, = 1). Initial infections were diagnosed at a median of 4 days (IQR 3-5) post-injury for pneumonia, 7 days (IQR 4-12) for SSTIs, 7 days (IQR 6-7) for BSI, and 17 days for IAI. Patients with infections were more severely injured with greater TBSA (median 31 % vs 5 %), more inhalation injury (38 % vs 12 %), and longer time to definitive surgical management (median of 34 days vs 9) compared to those who did not develop infections (p < 0.001). Among patients with inhalation injury, a higher proportion developed pneumonia (42 %) compared to those without inhalation injury (5 %; p < 0.001). Five patients developed an invasive fungal infection. Gram-negative bacilli were most frequently recovered, with 32 % of Gram-negative isolates being multidrug-resistant. Four patients died, of whom all had ≥ 4 infections. CONCLUSIONS Military personnel with burn injuries who developed infections were more severely injured with greater TBSA and inhalation injury. Improved understanding of risk factors for burn-related infections in combat casualties is critical for effective management.
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Affiliation(s)
- Matthew R Geringer
- Infectious Disease Service, Brooke Army Medical Center, 3551 Roger Brooke Drive, JBSA Fort Sam Houston, TX 78234, United States.
| | - Laveta Stewart
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, United States; Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., 6720A Rockledge Drive, Bethesda, MD 20817, United States
| | - Faraz Shaikh
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, United States; Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., 6720A Rockledge Drive, Bethesda, MD 20817, United States
| | - M Leigh Carson
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, United States; Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., 6720A Rockledge Drive, Bethesda, MD 20817, United States
| | - Dan Lu
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, United States; Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., 6720A Rockledge Drive, Bethesda, MD 20817, United States
| | - Leopoldo C Cancio
- US. Army Institute of Surgical Research, 3698 Chambers Pass, JBSA Fort Sam Houston, TX 78234, United States
| | - Jennifer M Gurney
- US. Army Institute of Surgical Research, 3698 Chambers Pass, JBSA Fort Sam Houston, TX 78234, United States; Joint Trauma System, 3698 Chambers Pass, JBSA Fort Sam Houston, TX 78234, United States
| | - David R Tribble
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, United States
| | - John L Kiley
- Infectious Disease Service, Brooke Army Medical Center, 3551 Roger Brooke Drive, JBSA Fort Sam Houston, TX 78234, United States
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Bordeanu-Diaconescu EM, Grosu-Bularda A, Frunza A, Andrei GMC, Costache RA, Dumitru CS, Neagu TP, Lascar I, Hariga CS. The Impact of Burns Involving Over 50% of Total Body Surface Area - a Six-Year Retrospective Study. MAEDICA 2024; 19:247-254. [PMID: 39188841 PMCID: PMC11345052 DOI: 10.26574/maedica.2024.19.2.247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/28/2024]
Abstract
BACKGROUND Severe burns pose significant therapeutic challenges due to their complex pathophysiology, the potential for life-threatening complications, long-term sequelae and the need for a multidisciplinary approach. In this retrospective study, we aimed to comprehensively analyze burns involving over 50% of the total body surface area (TBSA) treated in our institution over six years. MATERIALS AND METHODS We performed a retrospective study including 91 patients. The following epidemiological and clinical characteristics were documented: age, sex, comorbidities, admission modality, mechanism of injury, TBSA burned, burn depth, presence of inhalation injury, outcome, length of stay and associated costs. RESULTS In the study group, subjects had a mean age of 54.4 years (24-93), with a male-to-female ratio of 2.5:1. The median percentage of TBSA burned was 70% (50-99%) and 93.4% of patients had third-degree burns. Inhalation injury was present in 71.4% of patients. Flame burns occurred in 90.1% of patients. Prediction scores were assessed, with 60.4% of patients having an ABSI score above 12. Mortality in our study group was 84.61% and 39.5% of patients died in the first week after burn injury. The most frequent systemic complications were respiratory complications (95.6%), followed by cardiocirculatory (93.4%), metabolic (84.6%), hematological (74.7%), renal (64.8%), hepatic (59.3%) and infectious complications (38.4%). CONCLUSIONS Managing major burns is a highly complex process, which requires specialized care and infrastructure to improve outcomes. Extensive burns, especially over 50% TBSA, have high morbidity and mortality, with factors like age, severity and inhalation injury affecting prognosis. A multidisciplinary approach is essential for treatment, addressing not only the burns but also systemic complications to prevent multiple organ dysfunction syndrome and death.
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Affiliation(s)
- Eliza-Maria Bordeanu-Diaconescu
- Department of Plastic Surgery and Reconstructive Microsurgery, "Carol Davila" University of Medicine and Pharmacy Bucharest, 010825 Bucharest, Romania
- Burn Centre, Emergency Clinical Hospital of Bucharest, 014461 Bucharest, Romania
| | - Andreea Grosu-Bularda
- Department of Plastic Surgery and Reconstructive Microsurgery, "Carol Davila" University of Medicine and Pharmacy Bucharest, 010825 Bucharest, Romania
- Burn Centre, Emergency Clinical Hospital of Bucharest, 014461 Bucharest, Romania
| | - Adrian Frunza
- Department of Plastic Surgery and Reconstructive Microsurgery, "Carol Davila" University of Medicine and Pharmacy Bucharest, 010825 Bucharest, Romania
- Burn Centre, Emergency Clinical Hospital of Bucharest, 014461 Bucharest, Romania
| | - Grama Mihaela-Cristina Andrei
- Department of Plastic Surgery and Reconstructive Microsurgery, "Carol Davila" University of Medicine and Pharmacy Bucharest, 010825 Bucharest, Romania
| | - Raducu-Andrei Costache
- Department of Plastic Surgery and Reconstructive Microsurgery, "Carol Davila" University of Medicine and Pharmacy Bucharest, 010825 Bucharest, Romania
| | - Catalina-Stefania Dumitru
- Department of Plastic Surgery and Reconstructive Microsurgery, "Carol Davila" University of Medicine and Pharmacy Bucharest, 010825 Bucharest, Romania
| | - Tiberiu-Paul Neagu
- Department of Plastic Surgery and Reconstructive Microsurgery, "Carol Davila" University of Medicine and Pharmacy Bucharest, 010825 Bucharest, Romania
- Burn Centre, Emergency Clinical Hospital of Bucharest, 014461 Bucharest, Romania
| | - Ioan Lascar
- Department of Plastic Surgery and Reconstructive Microsurgery, "Carol Davila" University of Medicine and Pharmacy Bucharest, 010825 Bucharest, Romania
| | - Cristian-Sorin Hariga
- Department of Plastic Surgery and Reconstructive Microsurgery, "Carol Davila" University of Medicine and Pharmacy Bucharest, 010825 Bucharest, Romania
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Herdy Guerra Avila JE, Aniceto Santana L, Rabelo Suzuki D, Maldaner da Silva VZ, Duarte ML, Mizusaki Imoto A, Ferreira Amorim F. Frequency, complications, and mortality of inhalation injury in burn patients: A systematic review and meta-analysis protocol. PLoS One 2024; 19:e0295318. [PMID: 38652713 PMCID: PMC11037524 DOI: 10.1371/journal.pone.0295318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 11/19/2023] [Indexed: 04/25/2024] Open
Abstract
INTRODUCTION Burns are tissue traumas caused by energy transfer and occur with a variable inflammatory response. The consequences of burns represent a public health problem worldwide. Inhalation injury (II) is a severity factor when associated with burn, leading to a worse prognosis. Its treatment is complex and often involves invasive mechanical ventilation (IMV). The primary purpose of this study will be to assess the evidence regarding the frequency and mortality of II in burn patients. The secondary purposes will be to assess the evidence regarding the association between IIs and respiratory complications (pneumonia, airway obstruction, acute respiratory failure, acute respiratory distress syndrome), need for IMV and complications in other organ systems, and highlight factors associated with IIs in burn patients and prognostic factors associated with acute respiratory failure, need for IMV and mortality of II in burn patients. METHODS This is a systematic literature review and meta-analysis, according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA). PubMed/MEDLINE, Embase, LILACS/VHL, Scopus, Web of Science, and CINAHL databases will be consulted without language restrictions and publication date. Studies presenting incomplete data and patients under 19 years of age will be excluded. Data will be synthesized through continuous (mean and standard deviation) and dichotomous (relative risk) variables and the total number of participants. The means, sample sizes, standard deviations from the mean, and relative risks will be entered into the Review Manager web analysis software (The Cochrane Collaboration). DISCUSSION Despite the extensive experience managing IIs in burn patients, they still represent an important cause of morbidity and mortality. Diagnosis and accurate measurement of its damage are complex, and therapies are essentially based on supportive measures. Considering the challenge, their impact, and their potential severity, IIs represent a promising area for research, needing further studies to understand and contribute to its better evolution. The protocol of this review is registered on the International prospective register of systematic reviews platform of the Center for Revisions and Disclosure of the University of York, United Kingdom (https://www.crd.york.ac.uk/prospero), under number RD42022343944.
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Affiliation(s)
- Juliana Elvira Herdy Guerra Avila
- Culdade de Ciências de Saúde - Universidade de Brasília-UnB, Programa de Pós-Graduação em Ciências da Saúde, FaBrasilia (DF), Brazil
| | - Levy Aniceto Santana
- Programa de Pós-Graduação em Ciências da Saúde, Escola Superior de Ciências da Saúde (ESCS), Brasilia (DF), Brazil
| | - Denise Rabelo Suzuki
- Programa de Pós-Graduação em Ciências da Saúde, Coordenação de Cursos Pós-Graduação Stricto Sensu, Escola Superior de Ciências da Saúde (ESCS), Brasilia (DF), Brazil
| | - Vinícius Zacarias Maldaner da Silva
- Universidade de Brasília, Brasilia (DF), Brazil and Programa de Pós Graduação em Ciências do Movimento Humano e Reabilitação, Universidade Evangélica de Goiás, Goiás, Brazil
| | - Marcio Luís Duarte
- Radiology Professor of Universidade de Ribeirão Preto, Campus Guarujá, Guarujá-SP, Brazil
| | - Aline Mizusaki Imoto
- Programa de Pós-Graduação em Ciências da Saúde, Coordenação de Cursos Pós-Graduação Stricto Sensu, Escola Superior de Ciências da Saúde (ESCS), Brasilia (DF), Brazil
| | - Fábio Ferreira Amorim
- Programa de Pós-Graduação em Ciências da Saúde, Coordenação de Pesquisa e Comunicação Científica, Escola Superior de Ciências da Saúde (ESCS), Brasilia (DF), Brazil
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Velamuri SR, Ali Y, Lanfranco J, Gupta P, Hill DM. Inhalation Injury, Respiratory Failure, and Ventilator Support in Acute Burn Care. Clin Plast Surg 2024; 51:221-232. [PMID: 38429045 DOI: 10.1016/j.cps.2023.11.001] [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: 03/03/2024]
Abstract
Sustaining an inhalation injury increases the risk of severe complications and mortality. Current evidential support to guide treatment of the injury or subsequent complications is lacking, as studies either exclude inhalation injury or design limit inferences that can be made. Conventional ventilator modes are most commonly used, but there is no consensus on optimal strategies. Settings should be customized to patient tolerance and response. Data for pharmacotherapy adjunctive treatments are limited.
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Affiliation(s)
- Sai R Velamuri
- Department of Surgery, College of Medicine, University of Tennessee, Health Science Center, Memphis, TN 38103, USA.
| | - Yasmin Ali
- Department of Surgery, College of Medicine, University of Tennessee Health Science Center, 910 Madison Avenue, 2nd floor Suite 217, Memphis, TN 38103, USA
| | - Julio Lanfranco
- Division of Pulmonary and Critical Care, University of Tennessee Health Science Center, 965 Court Avenue Room H316B, Memphis, TN 38103, USA
| | - Pooja Gupta
- Pulmonary and Critical Care, University of Tennessee Health Science Center, 965 court avenue, Room H316B, Memphis, TN 38103, USA
| | - David M Hill
- Department of Pharmacy, Regional One Health, University of Tennessee, 80 madison avenue, Memphis TN 38103, USA
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Marcus JE, Townsend LC, Rizzo JA, James KA, Markelz AE, Blyth DM. Epidemiology and clinical significance of persistent bacteremia in severely burned patients. Burns 2024; 50:375-380. [PMID: 38042626 DOI: 10.1016/j.burns.2023.11.007] [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] [Received: 05/19/2023] [Revised: 11/09/2023] [Accepted: 11/17/2023] [Indexed: 12/04/2023]
Abstract
BACKGROUND The utility of follow-up blood cultures (FUBC) for gram-negative bloodstream infections (BSIs) are controversial due to low rates of positivity. However, recent studies suggest higher rates of positivity in critically ill patients. The utility of FUBC in gram-negative BSI in patients with severe burn injuries is unknown. METHODS Patients ≥ 18 years old admitted to the US Army Institute of Surgical Research Burn Center for combat-related thermal burns from 1/2003-6/2014 with a monomicrobial BSI were included. FUBC were defined as repeat cultures 1-5 days from index BSI. Persistent BSI (pBSI) was defined as isolation of the same organism from initial and FUBC. The primary endpoint was all-cause in-hospital mortality in patients with gram-negative pBSI. RESULTS Of 126 patients meeting inclusion criteria with BSI, 53 (42%) had pBSI. Compared to patients without persistence, patients with pBSI had more severe burns with median total body surface area (TBSA) burns of 47% ([IQR 34-63] vs. 35.3% [IQR 23.3-56.6], p = 0.02), increased mortality (38 vs. 11%, p = 0.001) compared to those with non-persistent BSI. On multivariate analysis, pBSI was associated with an odds ratio for mortality of 5.3 [95% CI 1.8-15.8, p = 0.003). Amongst gram-negative pathogens, persistence rates were high and associated with increased mortality (41% vs. 11%, p = 0.001) compared to patients without pBSI. CONCLUSION In this cohort of military patients with combat-related severe burns, pBSI was more common than in other hospitalized populations and associated with increased mortality. Given this high frequency of persistence in patients with burn injuries and associated mortality, FUBC are an important diagnostic and prognostic study in this population.
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Affiliation(s)
- Joseph E Marcus
- Infectious Diseases Service, Department of Medicine, Brooke Army Medical Center, Joint Base San Antonio, TX, USA; Department of Medicine, Uniformed Services University, Bethesda, MD, USA.
| | - Lisa C Townsend
- Infectious Diseases Service, Department of Medicine, Brooke Army Medical Center, Joint Base San Antonio, TX, USA; Department of Medicine, Uniformed Services University, Bethesda, MD, USA
| | - Julie A Rizzo
- Department of Trauma, Brooke Army Medical Center, Joint Base San Antonio, TX, USA; Department of Surgery, Uniformed Services University, Bethesda, MD, USA
| | - K Aden James
- Biostatistics, Brooke Army Medical Center, Joint Base San Antonio, TX, USA
| | - Ana E Markelz
- Infectious Diseases Service, Department of Medicine, Brooke Army Medical Center, Joint Base San Antonio, TX, USA; Department of Medicine, Uniformed Services University, Bethesda, MD, USA
| | - Dana M Blyth
- Department of Medicine, Uniformed Services University, Bethesda, MD, USA; Infectious Diseases Service, Department of Medicine, Walter Reed National Military Medical Center, Bethesda, MD, USA
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9
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Zhou YY, Wang Y, Wang L, Jiang H. The efficacy of Omega-3 polyunsaturated fatty acids for severe burn patients: A systematic review and trial sequential meta-analysis of randomized controlled trials. Clin Nutr ESPEN 2024; 59:126-134. [PMID: 38220365 DOI: 10.1016/j.clnesp.2023.11.019] [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] [Received: 06/13/2023] [Revised: 08/03/2023] [Accepted: 11/26/2023] [Indexed: 01/16/2024]
Abstract
BACKGROUND & AIMS Severe burns lead to metabolic changes, systemic inflammatory response syndrome, and multiple organ dysfunction syndrome. Omege-3 polyunsaturated fatty acids (PUFAs) have anti-inflammatory properties. In the absence of substantial evidence for use on major burns, we systematically reviewed the efficacy of omega-3 PUFAs for patients with severe burns. METHODS We comprehensively searched MEDLINE, Web of Science, Embase, Cochrane Library, China National Knowledge Internet, Wang Fang Data, Chinese Biomedicine Database, and Science Direct databases to collect randomised controlled trials of omega-3 PUFAs administered to patients with burns from January 2000 to June 2023. Two researchers independently screened the literatures, extracted the data, and assessed the risk of bias in the included studies. The outcomes were mortality, the risk of severe sepsis, septic shock, and multiple organ dysfunction syndrome. Data synthesis was conducted using Review Manager. Trial sequential analyses (TSA) for outcomes were performed. RESULTS Three randomised controlled trials involving 140 patients were included. Of these, 71 patients received omega-3 PUFAs. The results showed that omega-3 PUFAs significantly reduced the incidence of severe sepsis, septic shock, multiple organ dysfunction syndrome (RR = 0.38, 95 % CI [0.19, 0.75], P = 0.005), C-reactive protein levels (MD = -39.70[-81.63, 2.23], P = 0.06), and improved respiratory outcomes. However, there was no difference in 14-day mortality (RR = 1.10, 95%CI [0.59, 2.05], P = 0.75). TSA showed that the results for the incidence of severe sepsis, septic shock, multiple organ dysfunction syndrome are insufficient and inconclusive. CONCLUSIONS Omega-3 PUFAs may reduce inflammatory response and risk of sepsis, septic shock, and multiple organ dysfunction syndrome in severe burns patients and may shorten hospital stay but cannot reduce risk of death. Due to the limitation of the quantity and quality of the included studies, the evidence level is low, and the conclusions need to be verified by larger scale and higher quality randomised controlled trials.
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Affiliation(s)
- Yi-Yue Zhou
- Department of Biology (life sciences), Sorbonne University, 4 Pl. Jussieu, Paris 75005, France.
| | - Yu Wang
- Department of Clinical Nutrition, Department of Health Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuai fu yuan Wang fu jing, Dong cheng District, Beijing 100730, China.
| | - Lu Wang
- Institute for Emergency and Disaster Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, No.32, Yi Huan Lu Xi Er Duan, Chengdu 610072, China; Sichuan Clinical Research Center for Emergency Medicine and Critical Illness, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, No.32, Yi Huan Lu Xi Er Duan, Chengdu 610072, China.
| | - Hua Jiang
- Institute for Emergency and Disaster Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, No.32, Yi Huan Lu Xi Er Duan, Chengdu 610072, China; Sichuan Clinical Research Center for Emergency Medicine and Critical Illness, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, No.32, Yi Huan Lu Xi Er Duan, Chengdu 610072, China.
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10
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Kim JH, Kim M, Oh M, Lee SK, Kwon YS. Effect of sugammadex on postoperative complications in patients with severe burn who underwent surgery: a retrospective study. Sci Rep 2024; 14:525. [PMID: 38177213 PMCID: PMC10767056 DOI: 10.1038/s41598-024-51171-y] [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] [Received: 03/30/2023] [Accepted: 01/01/2024] [Indexed: 01/06/2024] Open
Abstract
This retrospective study investigated the association of sugammadex with postoperative pulmonary complication risk between 2013 and 2021 in patients with severe burn of five hospitals. Postoperative pulmonary complications included atelectasis, pulmonary edema, pulmonary effusion, pneumothorax, pneumonia, pulmonary thromboembolism, respiratory failure and acute respiratory distress. To identify whether sugammadex reduced the risk of postoperative pulmonary complication in patients with severe burn who underwent surgery, Kaplan-Meier curve were used to check the difference of incidence according to surgical cases and time-varying Cox hazard regression were used to calculate the hazard ratio. The study included 1213 patients with severe burn who underwent 2259 surgeries. Postoperative pulmonary complications were occurred in 313 (25.8%) patients. Among 2259 surgeries, sugammadex was used in 649 (28.7%) surgeries. Cumulative postoperative pulmonary complication were 268 (16.6%) cases in surgeries without sugammadex, and 45 (6.9%) cases in surgeries with sugammadex, respectively (P < 0.005). The postoperative pulmonary complications risk was reduced significantly in patients who use sugammadex than those who did not use sugammadex. (Adjusted hazard ratio, 0.61; 95% confidence interval, 0.42-0.89; P = 0.011). In conclusion, sugammadex reduced risk of postoperative pulmonary complications compared with nonuse of sugammadex in patients with severe burn who underwent surgery.
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Affiliation(s)
- Jong Ho Kim
- Department of Anesthesiology and Pain Medicine, College of Medicine, Chuncheon Sacred Heart Hospital, Hallym University, 77 Sakju-ro, Chuncheon, 24253, South Korea
- Institute of New Frontier Research Team, Hallym University, Chuncheon, South Korea
| | - Minguan Kim
- Department of Anesthesiology and Pain Medicine, College of Medicine, Chuncheon Sacred Heart Hospital, Hallym University, 77 Sakju-ro, Chuncheon, 24253, South Korea
| | - Minho Oh
- Department of Anesthesiology and Pain Medicine, College of Medicine, Hallym University Sacred Heart Hospital, Hallym University, Anyang, Republic of Korea
| | - Soo-Kyung Lee
- Department of Anesthesiology and Pain Medicine, College of Medicine, Hallym University Sacred Heart Hospital, Hallym University, Anyang, Republic of Korea
| | - Young Suk Kwon
- Department of Anesthesiology and Pain Medicine, College of Medicine, Chuncheon Sacred Heart Hospital, Hallym University, 77 Sakju-ro, Chuncheon, 24253, South Korea.
- Institute of New Frontier Research Team, Hallym University, Chuncheon, South Korea.
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11
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Ronkar NC, Galet C, Richey K, Foster K, Wibbenmeyer L. Predictors and Impact of Pneumonia on Adverse Outcomes in Inhalation Injury Patients. J Burn Care Res 2023; 44:1289-1297. [PMID: 37352120 DOI: 10.1093/jbcr/irad099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Indexed: 06/25/2023]
Abstract
Inhalation injury (II) is the third mortality prognostic factor for burn injury following age and burn size. II can lead to pulmonary complications such as pneumonia and acute respiratory distress syndrome (ARDS); all of which have been hypothesized to increase morbidity and mortality in II. Herein, we aimed to identify variables associated with the risk of developing pneumonia and to determine the impact of pneumonia on selected II outcomes. De-identified data from the Prospective Inhalation Study titled Inhalation Injury Scoring System to Predict Inhalation Injury Severity (ISIS) were used. II was confirmed by fiberoptic bronchoscopy. Demographics, injury, and hospital course information were recorded. P < .05 was considered significant. One hundred subjects were included. On univariate analysis, pneumonia was associated with burn severity, race, and receipt of colloid during the first 24 hours. Patients who developed pneumonia spent more time on a ventilator, had longer hospitalizations (LOS) and were more likely to need a tracheostomy. On multivariate analysis, total number of ventilator days was associated with pneumonia (Odd ratio (OR) = 1.122 [1.048-1.200], P = .001). Both pneumonia and receipt of colloid were predictive of increased ventilator days (OR = 2.545 [1.363-4.753], P < .001 and OR = 2.809 [1.548-5.098], P < .001, respectively). Pneumonia was not an independent predictor of LOS, ARDS, or mortality. Pneumonia remains a high-risk complication associated with two times more ventilator days in II. Future research should focus on prevention of pneumonia and the relationship between colloid fluids and pneumonia and early ventilator liberation in II patients.
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Affiliation(s)
- Nicolas C Ronkar
- Carver College of Medicine, University Iowa, Iowa City, Iowa 52242, USA
| | - Colette Galet
- Division of Acute Care Surgery, Department of Surgery, University Iowa, Iowa City, Iowa, USA
| | - Karen Richey
- Maricopa County Burn Center, Phoenix, Arizona, USA
| | - Kevin Foster
- Maricopa County Burn Center, Phoenix, Arizona, USA
| | - Lucy Wibbenmeyer
- Division of Acute Care Surgery, Department of Surgery, University Iowa, Iowa City, Iowa, USA
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12
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Greenhalgh DG, Hill DM, Burmeister DM, Gus EI, Cleland H, Padiglione A, Holden D, Huss F, Chew MS, Kubasiak JC, Burrell A, Manzanares W, Gómez MC, Yoshimura Y, Sjöberg F, Xie WG, Egipto P, Lavrentieva A, Jain A, Miranda-Altamirano A, Raby E, Aramendi I, Sen S, Chung KK, Alvarez RJQ, Han C, Matsushima A, Elmasry M, Liu Y, Donoso CS, Bolgiani A, Johnson LS, Vana LPM, de Romero RVD, Allorto N, Abesamis G, Luna VN, Gragnani A, González CB, Basilico H, Wood F, Jeng J, Li A, Singer M, Luo G, Palmieri T, Kahn S, Joe V, Cartotto R. Surviving Sepsis After Burn Campaign. Burns 2023; 49:1487-1524. [PMID: 37839919 DOI: 10.1016/j.burns.2023.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 05/02/2023] [Indexed: 10/17/2023]
Abstract
INTRODUCTION The Surviving Sepsis Campaign was developed to improve outcomes for all patients with sepsis. Despite sepsis being the primary cause of death after thermal injury, burns have always been excluded from the Surviving Sepsis efforts. To improve sepsis outcomes in burn patients, an international group of burn experts developed the Surviving Sepsis After Burn Campaign (SSABC) as a testable guideline to improve burn sepsis outcomes. METHODS The International Society for Burn Injuries (ISBI) reached out to regional or national burn organizations to recommend members to participate in the program. Two members of the ISBI developed specific "patient/population, intervention, comparison and outcome" (PICO) questions that paralleled the 2021 Surviving Sepsis Campaign [1]. SSABC participants were asked to search the current literature and rate its quality for each topic. At the Congress of the ISBI, in Guadalajara, Mexico, August 28, 2022, a majority of the participants met to create "statements" based on the literature. The "summary statements" were then sent to all members for comment with the hope of developing an 80% consensus. After four reviews, a consensus statement for each topic was created or "no consensus" was reported. RESULTS The committee developed sixty statements within fourteen topics that provide guidance for the early treatment of sepsis in burn patients. These statements should be used to improve the care of sepsis in burn patients. The statements should not be considered as "static" comments but should rather be used as guidelines for future testing of the best treatments for sepsis in burn patients. They should be updated on a regular basis. CONCLUSION Members of the burn community from the around the world have developed the Surviving Sepsis After Burn Campaign guidelines with the goal of improving the outcome of sepsis in burn patients.
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Affiliation(s)
- David G Greenhalgh
- Department of Burns, Shriners Children's Northern California and Department of Surgery, University of California, Davis, Sacramento, CA, USA.
| | - David M Hill
- Department of Clinical Pharmacy & Translational Scre have been several studies that have evaluatedience, College of Pharmacy, University of Tennessee, Health Science Center; Memphis, TN, USA
| | - David M Burmeister
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Eduardo I Gus
- Division of Plastic & Reconstructive Surgery, The Hospital for Sick Children; Department of Surgery, University of Toronto, Toronto, Canada
| | - Heather Cleland
- Department of Surgery, Monash University and Alfred Hospital, Melbourne, Australia
| | - Alex Padiglione
- Department of Surgery, Monash University and Alfred Hospital, Melbourne, Australia
| | - Dane Holden
- Department of Surgery, Monash University and Alfred Hospital, Melbourne, Australia
| | - Fredrik Huss
- Department of Surgical Sciences, Plastic Surgery, Uppsala University/Burn Center, Department of Plastic and Maxillofacial Surgery, Uppsala University Hospital, Uppsala, Sweden
| | - Michelle S Chew
- Department of Anaesthesia and Intensive Care, Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - John C Kubasiak
- Department of Surgery, Loyola University Medical Center, Maywood, IL, USA
| | - Aidan Burrell
- Department of Epidemiology and Preventative Medicine, Monash University and Alfred Hospital, Intensive Care Research Center (ANZIC-RC), Melbourne, Australia
| | - William Manzanares
- Department of Critical Care Medicine, Universidad de la República (UdelaR), Montevideo, Uruguay
| | - María Chacón Gómez
- Division of Intensive Care and Critical Medicine, Centro Nacional de Investigacion y Atencion de Quemados (CENIAQ), National Rehabilitation Institute, LGII, Mexico
| | - Yuya Yoshimura
- Department of Emergency and Critical Care Medicine, Hachinohe City Hospital, Hachinohe, Japan
| | - Folke Sjöberg
- Department of Anaesthesia and Intensive Care, Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Wei-Guo Xie
- Institute of Burns, Tongren Hospital of Wuhan University (Wuhan Third Hospital), Wuhan, China
| | - Paula Egipto
- Centro Hospitalar e Universitário São João - Burn Unit, Porto, Portugal
| | | | | | | | - Ed Raby
- Infectious Diseases Department, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | | | - Soman Sen
- Department of Burns, Shriners Children's Northern California and Department of Surgery, University of California, Davis, Sacramento, CA, USA
| | - Kevin K Chung
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | | | - Chunmao Han
- Department of Burn and Wound Repair, Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, China
| | - Asako Matsushima
- Department of Emergency and Critical Care, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Moustafa Elmasry
- Department of Hand, Plastic Surgery and Burns, Linköping University, Linköping, Sweden
| | - Yan Liu
- Department of Burn, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Carlos Segovia Donoso
- Intensive Care Unit for Major Burns, Mutual Security Clinical Hospital, Santiago, Chile
| | - Alberto Bolgiani
- Department of Surgery, Deutsches Hospital, Buenos Aires, Argentina
| | - Laura S Johnson
- Department of Surgery, Emory University School of Medicine and Grady Health System, Georgia
| | - Luiz Philipe Molina Vana
- Disciplina de Cirurgia Plastica da Escola Paulista de Medicina da Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | | | - Nikki Allorto
- Grey's Hospital Pietermaritzburg Metropolitan Burn Service, University of KwaZulu Natal, Pietermaritzburg, South Africa
| | - Gerald Abesamis
- Alfredo T. Ramirez Burn Center, Division of Burns, Department of Surgery, University of Philippines Manila - Philippine General Hospital, Manila, Philippines
| | - Virginia Nuñez Luna
- Unidad Michou y Mau Xochimilco for Burnt Children, Secretaria Salud Ciudad de México, Mexico
| | - Alfredo Gragnani
- Disciplina de Cirurgia Plastica da Escola Paulista de Medicina da Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - Carolina Bonilla González
- Department of Pediatrics and Intensive Care, Pediatric Burn Unit, Clinical Studies and Clinical Epidemiology Division, Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Hugo Basilico
- Intensive Care Area - Burn Unit - Pediatric Hospital "Prof. Dr. Juan P. Garrahan", Buenos Aires, Argentina
| | - Fiona Wood
- Department of Surgery, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - James Jeng
- Department of Surgery, University of California, Irvine, CA, USA
| | - Andrew Li
- Department of Surgery, Monash University and Alfred Hospital, Melbourne, Australia
| | - Mervyn Singer
- Department of Intensive Care Medicine, University College London, London, United Kingdom
| | - Gaoxing Luo
- Institute of Burn Research, Southwest Hospital, Army (Third Military) Medical University, Chongqing, China
| | - Tina Palmieri
- Department of Burns, Shriners Children's Northern California and Department of Surgery, University of California, Davis, Sacramento, CA, USA
| | - Steven Kahn
- The South Carolina Burn Center, Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Victor Joe
- Department of Surgery, University of California, Irvine, CA, USA
| | - Robert Cartotto
- Department of Surgery, Sunnybrook Medical Center, Toronto, Ontario, Canada
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Yang SY, Huang CJ, Yen CI, Kao YC, Hsiao YC, Yang JY, Chang SY, Chuang SS, Chen HC. Machine learning approach for predicting inhalation injury in patients with burns. Burns 2023; 49:1592-1601. [PMID: 37055284 PMCID: PMC10032063 DOI: 10.1016/j.burns.2023.03.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 03/07/2023] [Accepted: 03/16/2023] [Indexed: 03/24/2023]
Abstract
BACKGROUND The coronavirus disease pandemic has had a tangible impact on bronchoscopy for burn inpatients due to isolation and triage measures. We utilised the machine-learning approach to identify risk factors for predicting mild and severe inhalation injury and whether patients with burns experienced inhalation injury. We also examined the ability of two dichotomous models to predict clinical outcomes including mortality, pneumonia, and duration of hospitalisation. METHODS A retrospective 14-year single-centre dataset of 341 intubated patients with burns with suspected inhalation injury was established. The medical data on day one of admission and bronchoscopy-diagnosed inhalation injury grade were compiled using a gradient boosting-based machine-learning algorithm to create two prediction models: model 1, mild vs. severe inhalation injury; and model 2, no inhalation injury vs. inhalation injury. RESULTS The area under the curve (AUC) for model 1 was 0·883, indicating excellent discrimination. The AUC for model 2 was 0·862, indicating acceptable discrimination. In model 1, the incidence of pneumonia (P < 0·001) and mortality rate (P < 0·001), but not duration of hospitalisation (P = 0·1052), were significantly higher in patients with severe inhalation injury. In model 2, the incidence of pneumonia (P < 0·001), mortality (P < 0·001), and duration of hospitalisation (P = 0·021) were significantly higher in patients with inhalation injury. CONCLUSIONS We developed the first machine-learning tool for differentiating between mild and severe inhalation injury, and the absence/presence of inhalation injury in patients with burns, which is helpful when bronchoscopy is not available immediately. The dichotomous classification predicted by both models was associated with the clinical outcomes.
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Affiliation(s)
- Shih-Yi Yang
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou, College of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Chih-Jung Huang
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou, College of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Cheng-I Yen
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou, College of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Yu-Ching Kao
- Muen Biomedical and Optoelectronic Technologies Inc, China
| | - Yen-Chang Hsiao
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou, College of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Jui-Yung Yang
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou, College of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Shu-Yin Chang
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou, College of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Shiow-Shuh Chuang
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou, College of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Hung-Chang Chen
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou, College of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC.
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14
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Yazıcı H, Uğurlu O, Aygül Y, Yıldırım M, Deniz Uçar A. The effect of well-known burn-related features on machine learning algorithms in burn patients' mortality prediction. ULUS TRAVMA ACIL CER 2023; 29:1130-1137. [PMID: 37791433 PMCID: PMC10644077 DOI: 10.14744/tjtes.2023.79968] [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] [Received: 05/25/2023] [Revised: 05/26/2023] [Accepted: 08/14/2023] [Indexed: 10/05/2023]
Abstract
BACKGROUND Burns is one of the most common traumas worldwide. Severely injured burn patients have an increased risk for mortality and morbidity. This study aimed to evaluate well-known risk factors for burn mortality and comparison of six machine learn-ing (ML) Algorithms' predictive performances. METHODS The medical records of patients who had burn injuries treated at Izmir Bozyaka Training and Research Hospital's Burn Treatment Center were examined retrospectively. Patients' demographics such as age and gender, total burned surface area (TBSA), Inhalation injury (II), full-thickness burns (FTBSA), and burn types (BT) were recorded and used as input features in ML models. Pa-tients were analyzed under two groups: Survivors and Non-Survivors. Six ML algorithms, including k-Nearest Neighbor, Decision Tree, Random Forest, Support Vector Machine, Multi-Layer Perceptron, and AdaBoost (AB), were used for predicting mortality. Several different input feature combinations were evaluated for each algorithm. RESULTS The number of eligible patients was 363. All six parameters (TBSA, Gender, FTBSA, II, Age, BT) that were included in ML algorithms showed a significant difference (p<0.001). The results show that AB algorithm using all input features had the best predic-tion performance with an accuracy of 90% and an area under the curve of 92%. CONCLUSION ML algorithms showed strong predictive performance in burn mortality. The development of an ML algorithm with the right input features could be useful in the clinical practice. Further investigations are needed on this topic.
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Affiliation(s)
- Hilmi Yazıcı
- Department of General Surgery, Marmara University, Pendik Training and Research Hospital, İstanbul-Türkiye
| | - Onur Uğurlu
- Faculty of Engineering and Architecture, Izmir Bakircay University, İzmir-Türkiye
| | - Yeşim Aygül
- Department of Mathematics, Ege University, İzmir-Türkiye
| | - Mehmet Yıldırım
- Department of General Surgery, University of Health Sciences, Izmir Bozyaka Training and Research Hospital, İzmir-Türkiye
| | - Ahmet Deniz Uçar
- Department of General Surgery, University of Health Sciences, Izmir Bozyaka Training and Research Hospital, İzmir-Türkiye
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15
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Young MD, Cancio TS, Thorpe CR, Willis RP, Snook JK, Jordan BS, Demons ST, Salinas J, Yang Z. Circulatory HMGB1 is an early predictive and prognostic biomarker of ARDS and mortality in a swine model of polytrauma. Front Immunol 2023; 14:1227751. [PMID: 37520569 PMCID: PMC10382277 DOI: 10.3389/fimmu.2023.1227751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 06/28/2023] [Indexed: 08/01/2023] Open
Abstract
Acute respiratory distress syndrome (ARDS) is a leading cause of morbidity and mortality in polytrauma patients. Pharmacological treatments of ARDS are lacking, and ARDS patients rely on supportive care. Accurate diagnosis of ARDS is vital for early intervention and improved outcomes but is presently delayed up to days. The use of biomarkers for early identification of ARDS development is a potential solution. Inflammatory mediators high-mobility group box 1 (HMGB1), syndecan-1 (SDC-1), and C3a have been previously proposed as potential biomarkers. For this study, we analyzed these biomarkers in animals undergoing smoke inhalation and 40% total body surface area burns, followed by intensive care for 72 h post-injury (PI) to determine their association with ARDS and mortality. We found that the levels of inflammatory mediators in serum were affected, as well as the degree of HMGB1 and Toll-like receptor 4 (TLR4) signal activation in the lung. The results showed significantly increased HMGB1 expression levels in animals that developed ARDS compared with those that did not. Receiver operating characteristic (ROC) analysis showed that HMGB1 levels at 6 h PI were significantly associated with ARDS development (AUROC=0.77) and mortality (AUROC=0.82). Logistic regression analysis revealed that levels of HMGB1 ≥24.10 ng/ml are associated with a 13-fold higher incidence of ARDS [OR:13.57 (2.76-104.3)], whereas the levels of HMGB1 ≥31.39 ng/ml are associated with a 12-fold increase in mortality [OR: 12.00 (2.36-93.47)]. In addition, we found that mesenchymal stem cell (MSC) therapeutic treatment led to a significant decrease in systemic HMGB1 elevation but failed to block SDC-1 and C3a increases. Immunohistochemistry analyses showed that smoke inhalation and burn injury induced the expression of HMGB1 and TLR4 and stimulated co-localization of HMGB1 and TLR4 in the lung. Interestingly, MSC treatment reduced the presence of HMGB1, TLR4, and the HMGB1-TLR4 co-localization. These results show that serum HMGB1 is a prognostic biomarker for predicting the incidence of ARDS and mortality in swine with smoke inhalation and burn injury. Therapeutically blocking HMGB1 signal activation might be an effective approach for attenuating ARDS development in combat casualties or civilian patients.
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16
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Williams JM, Ingle CL, Schauer SG, Maddry JK. Prehospital and Emergency Management. Surg Clin North Am 2023; 103:389-401. [PMID: 37149376 DOI: 10.1016/j.suc.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Burn care in the prehospital and emergency settings requires rapid assessment of airway, breathing, and circulation. Intubation (if indicated) and fluid resuscitation are most important in emergency burn care. Total body surface area burned and depth of burn are important early assessments that help guide resuscitation and disposition. Burn care in the emergency department further includes carbon monoxide and cyanide toxicity evaluation and management.
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Affiliation(s)
| | | | - Steven G Schauer
- Brooke Army Medical Center, JBSA Fort Sam Houston, TX, USA; US Army Institute of Surgical Research, 3698 Chambers Pass, JBSA Fort Sam Houston, TX 78234, USA; Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Joseph K Maddry
- Brooke Army Medical Center, JBSA Fort Sam Houston, TX, USA; US Army Institute of Surgical Research, 3698 Chambers Pass, JBSA Fort Sam Houston, TX 78234, USA; Uniformed Services University of the Health Sciences, Bethesda, MD, USA; 59th Medical Wing, JBSA Lackland, TX, USA
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17
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Tokushige H, Kobayashi M, Iimori M, Ito H, Ueshiba H, Urayama S, Kurimoto S. Inhalation injury in 11 Thoroughbred racehorses: Clinical course on bronchoscopy, treatment and postinjury racing performance. EQUINE VET EDUC 2023. [DOI: 10.1111/eve.13790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
Affiliation(s)
- Hirotaka Tokushige
- Racehorse Hospital, Ritto Training Center, Japan Racing Association Ritto Shiga Japan
| | - Minoru Kobayashi
- Racehorse Hospital, Ritto Training Center, Japan Racing Association Ritto Shiga Japan
| | - Mai Iimori
- Racehorse Hospital, Ritto Training Center, Japan Racing Association Ritto Shiga Japan
| | - Hiroki Ito
- Racehorse Hospital, Miho Training Center, Japan Racing Association Miho Inashiki, Ibaraki Japan
| | - Hiroki Ueshiba
- Racehorse Hospital, Ritto Training Center, Japan Racing Association Ritto Shiga Japan
| | - Shuntaro Urayama
- Racehorse Hospital, Ritto Training Center, Japan Racing Association Ritto Shiga Japan
| | - Shinjiro Kurimoto
- Epizootic Prevention Section, Equine Department Japan Racing Association Minato Tokyo Japan
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18
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Ashworth ET, Burrowes KS, Clark AR, Ebrahimi BSS, Tawhai MH. An in silico approach to understanding the interaction between cardiovascular and pulmonary lymphatic dysfunction. Am J Physiol Heart Circ Physiol 2023; 324:H318-H329. [PMID: 36607796 DOI: 10.1152/ajpheart.00591.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The lung is extremely sensitive to interstitial fluid balance, yet the role of pulmonary lymphatics in lung fluid homeostasis and its interaction with cardiovascular pressures is poorly understood. In health, there is a fine balance between fluid extravasated from the pulmonary capillaries into the interstitium and the return of fluid to the circulation via the lymphatic vessels. This balance is maintained by an extremely interdependent system governed by pressures in the fluids (air and blood) and tissue (interstitium), lung motion during breathing, and the permeability of the tissues. Chronic elevation in left atrial pressure (LAP) due to left heart disease increases the capillary blood pressure. The consequent fluid accumulation in the delicate lung tissue increases its weight, decreases its compliance, and impairs gas exchange. This interdependent system is difficult, if not impossible, to study experimentally. Computational modeling provides a unique perspective to analyze fluid movement in the cardiopulmonary vasculature in health and disease. We have developed an initial in silico model of pulmonary lymphatic function using an anatomically structured model to represent ventilation and perfusion and underlying biophysical laws governing fluid transfer at the interstitium. This novel model was tested against increased LAP and noncardiogenic effects (increased permeability). The model returned physiologically reasonable values for all applications, predicting pulmonary edema when LAP reached 25 mmHg and with increased permeability.NEW & NOTEWORTHY This model presents a novel approach to understanding the interaction between cardiac dysfunction and pulmonary lymphatic function, using anatomically structured models and biophysical equations to estimate regional variation in fluid transport from blood to interstitial and lymphatic flux. This fluid transport model brings together advanced models of ventilation, perfusion, and lung mechanics to produce a detailed model of fluid transport in health and various altered pathological conditions.
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Affiliation(s)
- E T Ashworth
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - K S Burrowes
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - A R Clark
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | | | - M H Tawhai
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
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19
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Single-Cell RNA-Sequencing Reveals Epithelial Cell Signature of Multiple Subtypes in Chemically Induced Acute Lung Injury. Int J Mol Sci 2022; 24:ijms24010277. [PMID: 36613719 PMCID: PMC9820093 DOI: 10.3390/ijms24010277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 12/09/2022] [Accepted: 12/15/2022] [Indexed: 12/28/2022] Open
Abstract
Alveolar epithelial cells (AECs) play a role in chemically induced acute lung injury (CALI). However, the mechanisms that induce alveolar epithelial type 2 cells (AEC2s) to proliferate, exit the cell cycle, and transdifferentiate into alveolar epithelial type 1 cells (AEC1s) are unclear. Here, we investigated the epithelial cell types and states in a phosgene-induced CALI rat model. Single-cell RNA-sequencing of bronchoalveolar lavage fluid (BALF) samples from phosgene-induced CALI rat models (Gas) and normal controls (NC) was performed. From the NC and Gas BALF samples, 37,245 and 29,853 high-quality cells were extracted, respectively. All cell types and states were identified and divided into 23 clusters; three cell types were identified: macrophages, epithelial cells, and macrophage proliferating cells. From NC and Gas samples, 1315 and 1756 epithelial cells were extracted, respectively, and divided into 11 clusters. The number of AEC1s decreased considerably following phosgene inhalation. A unique SOX9-positive AEC2 cell type that expanded considerably in the CALI state was identified. This progenitor cell type may develop into alveolar cells, indicating its stem cell differentiation potential. We present a single-cell genome-scale transcription map that can help uncover disease-associated cytologic signatures for understanding biological changes and regeneration of lung tissues during CALI.
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Niu Z, Ding Z, Chan Y, Yan L, Zhang W, Wang H, Shi J, Lv Q, Hou S, Guo X, Fan H. Clinical characteristics and predictors of burn complicated with smoke inhalation injury: A retrospective analysis. Exp Ther Med 2022; 24:758. [PMID: 36561970 PMCID: PMC9748657 DOI: 10.3892/etm.2022.11694] [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: 04/14/2022] [Accepted: 09/13/2022] [Indexed: 11/11/2022] Open
Abstract
Fire smoke enters the human lungs through the respiratory tract. The damage to the respiratory tract and lung tissue is known as smoke inhalation injury (SII). Fire smoke can irritate airway epithelium cells, weaken endothelial cell adhesion and lyse alveolar type II epithelia cells, leading to emphysema, decreased lung function, pneumonia and risk of acute lung injury/acute respiratory distress syndrome (ARDS). The purpose of the present study was to analyze the clinical characteristics of patients with SII and the risk factors affecting their prognosis. A total of 103 patients with SII admitted between January 2016 to December 2021 to the Burns Unit of the Characteristic Medical Center of Chinese People's Armed Police Force and 983 Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army were selected for the present study. The demographics and clinical features between different severities of SII were analyzed. Univariate/multivariate logistic regression was used to analyze the potential predictors for severity, ARDS and mortality of patients with SII. Receiver operating characteristic (ROC) curves were used to screen independent risk factors and identify their prediction accuracy. It was concluded that total body surface area (TBSA), III burn area (of total %TBSA), cases of respiratory infections, ARDS morbidity, mortality, acute physiology and chronic health evaluation II, lung injury prediction score, lactic acid, white blood cells (WBC), alanine transaminase, blood urea nitrogen, serum creatinine and uric acid were indicators that were raised with increasing severity of SII. However red blood cells, hemoglobin, platelet count, total protein, albumin, and albumin/globulin were decreased with the increasing severity of SII (P<0.05). WBC >20.91 (109/l) was a reliable indicator for severe SII. Lactic acid >9.60 (mmol/l) demonstrated a high degree of accuracy in predicting ARDS development in patients with SII. Hemoglobin <83.00 (g/l) showed a high degree of accuracy in predicting mortality. In summary, the highlighted assessment parameters could be used to contribute to devising improved treatment plans to preempt worsening conditions (such as shock, ARDS, multiple organ dysfunction syndrome and death).
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Affiliation(s)
- Zhifang Niu
- Institute of Disaster and Emergency Medicine, Tianjin University, Tianjin 300072, P.R. China,Department of Emergency, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China
| | - Ziling Ding
- Institute of Disaster and Emergency Medicine, Tianjin University, Tianjin 300072, P.R. China
| | - Yion Chan
- Institute of Adolescent Safety Emergency Education, Institute of Disaster and Emergency Medicine, Tianjin University, Tianjin 300072, P.R. China
| | - Li Yan
- Department of Burns and Plastic Surgery, Characteristic Medical Center of Chinese People's Armed Police Force, Tianjin 300163, P.R. China
| | - Wenyu Zhang
- Department of Burns and Plastic Surgery, Characteristic Medical Center of Chinese People's Armed Police Force, Tianjin 300163, P.R. China
| | - Hongyu Wang
- Department of Burns and Plastic Surgery, 983 Hospital of The Joint Logistics Support Force of The Chinese People's Liberation Army, Tianjin 300162, P.R. China
| | - Jie Shi
- Institute of Disaster and Emergency Medicine, Tianjin University, Tianjin 300072, P.R. China
| | - Qi Lv
- Institute of Disaster and Emergency Medicine, Tianjin University, Tianjin 300072, P.R. China
| | - Shike Hou
- Institute of Disaster and Emergency Medicine, Tianjin University, Tianjin 300072, P.R. China
| | - Xiaoqin Guo
- Institute of Disaster and Emergency Medicine, Tianjin University, Tianjin 300072, P.R. China,Correspondence to: Professor Haojun Fan or Professor Xiaoqin Guo, Institute of Disaster and Emergency Medicine, Tianjin University, 92 Weijin Road, Nan Kai, Tianjin 300072, P.R. China
| | - Haojun Fan
- Institute of Disaster and Emergency Medicine, Tianjin University, Tianjin 300072, P.R. China,Correspondence to: Professor Haojun Fan or Professor Xiaoqin Guo, Institute of Disaster and Emergency Medicine, Tianjin University, 92 Weijin Road, Nan Kai, Tianjin 300072, P.R. China
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Ashouri S. An Introduction to Burns. Phys Med Rehabil Clin N Am 2022; 33:871-883. [DOI: 10.1016/j.pmr.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Hayes D, Board A, Calfee CS, Ellington S, Pollack LA, Kathuria H, Eakin MN, Weissman DN, Callahan SJ, Esper AM, Crotty Alexander LE, Sharma NS, Meyer NJ, Smith LS, Novosad S, Evans ME, Goodman AB, Click ES, Robinson RT, Ewart G, Twentyman E. Pulmonary and Critical Care Considerations for e-Cigarette, or Vaping, Product Use-Associated Lung Injury. Chest 2022; 162:256-264. [DOI: 10.1016/j.chest.2022.02.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 11/17/2021] [Accepted: 02/18/2022] [Indexed: 12/15/2022] Open
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Keskinidou C, Vassiliou AG, Dimopoulou I, Kotanidou A, Orfanos SE. Mechanistic Understanding of Lung Inflammation: Recent Advances and Emerging Techniques. J Inflamm Res 2022; 15:3501-3546. [PMID: 35734098 PMCID: PMC9207257 DOI: 10.2147/jir.s282695] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 05/04/2022] [Indexed: 12/12/2022] Open
Abstract
Acute respiratory distress syndrome (ARDS) is a life-threatening lung injury characterized by an acute inflammatory response in the lung parenchyma. Hence, it is considered as the most appropriate clinical syndrome to study pathogenic mechanisms of lung inflammation. ARDS is associated with increased morbidity and mortality in the intensive care unit (ICU), while no effective pharmacological treatment exists. It is very important therefore to fully characterize the underlying pathobiology and the related mechanisms, in order to develop novel therapeutic approaches. In vivo and in vitro models are important pre-clinical tools in biological and medical research in the mechanistic and pathological understanding of the majority of diseases. In this review, we will present data from selected experimental models of lung injury/acute lung inflammation, which have been based on clinical disorders that can lead to the development of ARDS and related inflammatory lung processes in humans, including ventilation-induced lung injury (VILI), sepsis, ischemia/reperfusion, smoke, acid aspiration, radiation, transfusion-related acute lung injury (TRALI), influenza, Streptococcus (S.) pneumoniae and coronaviruses infection. Data from the corresponding clinical conditions will also be presented. The mechanisms related to lung inflammation that will be covered are oxidative stress, neutrophil extracellular traps, mitogen-activated protein kinase (MAPK) pathways, surfactant, and water and ion channels. Finally, we will present a brief overview of emerging techniques in the field of omics research that have been applied to ARDS research, encompassing genomics, transcriptomics, proteomics, and metabolomics, which may recognize factors to help stratify ICU patients at risk, predict their prognosis, and possibly, serve as more specific therapeutic targets.
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Affiliation(s)
- Chrysi Keskinidou
- First Department of Critical Care Medicine and Pulmonary Services, School of Medicine, National and Kapodistrian University of Athens, "Evangelismos" Hospital, Athens, Greece
| | - Alice G Vassiliou
- First Department of Critical Care Medicine and Pulmonary Services, School of Medicine, National and Kapodistrian University of Athens, "Evangelismos" Hospital, Athens, Greece
| | - Ioanna Dimopoulou
- First Department of Critical Care Medicine and Pulmonary Services, School of Medicine, National and Kapodistrian University of Athens, "Evangelismos" Hospital, Athens, Greece
| | - Anastasia Kotanidou
- First Department of Critical Care Medicine and Pulmonary Services, School of Medicine, National and Kapodistrian University of Athens, "Evangelismos" Hospital, Athens, Greece
| | - Stylianos E Orfanos
- First Department of Critical Care Medicine and Pulmonary Services, School of Medicine, National and Kapodistrian University of Athens, "Evangelismos" Hospital, Athens, Greece
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Zhu X, Jiang S, Wang C, Gong H, Zhang W. Severe rectal burn induced by hot normal saline enema: a case report. Gastroenterol Rep (Oxf) 2022; 10:goac027. [PMID: 35711714 PMCID: PMC9195221 DOI: 10.1093/gastro/goac027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 05/19/2022] [Accepted: 05/20/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Xiaoming Zhu
- Department of Colorectal Surgery, Changhai Hospital, Shanghai, P. R. China
| | - Siyuan Jiang
- Department of Colorectal Surgery, Changhai Hospital, Shanghai, P. R. China
| | - Chen Wang
- Department of Colorectal Surgery, Changhai Hospital, Shanghai, P. R. China
| | - Haifeng Gong
- Department of Colorectal Surgery, Changhai Hospital, Shanghai, P. R. China
| | - Wei Zhang
- Department of Colorectal Surgery, Changhai Hospital, Shanghai, P. R. China
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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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Cutaneous steam burns and steam inhalation injuries: a literature review and a case presentation. EUROPEAN JOURNAL OF PLASTIC SURGERY 2022. [DOI: 10.1007/s00238-022-01955-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Abstract
Scald is one type of burn that s often mentioned alone and occurs mostly in the paediatric population. Inhaled steam is mostly cooled off in the airways, why thermal damage is rarely seen. A sudden exposure to hot steam/inhalation can cause a thermal inhalation injury. A scoping review was performed, with the aim to summarize all published papers in English, about steam-related injuries. The search was conducted using the PubMed® and Cochrane libraries on 19th of May 2021, without a set time period. Out of a total of 1186 identified records, 31 were chosen for review. Burns related to the contact with steam are generally rare and can be both minor and severe. The more severe cases related to steam exposure are mostly workplace accidents and the minor injuries reported in the literature are often related to steam inhalation therapy, especially in the paediatric population. This review describes the challenges that can be found dealing with patients suffering from cutaneous steam burns and/or steam inhalation injuries. A steam injury to the airways or the skin can be directly life-threatening and should be treated with caution. This type of injury can lead to acute respiratory insufficiency and sometimes death. A case of a male patient with extensive cutaneous steam burns and a steam inhalation injury who passed away after 11 days of treatment is also presented to illustrate this review.
Level of evidence: Level V, Therapeutic; Risk/Prognostic Study.
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Dries DJ, Perry JF, Tawfik PN. A Rationale for Safe Ventilation with Inhalation Injury: An Editorial Review. J Burn Care Res 2022; 43:irac061. [PMID: 35511894 DOI: 10.1093/jbcr/irac061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Indexed: 11/14/2022]
Abstract
Lung injury from smoke inhalation manifests as airway and parenchymal damage, at times leading to the acute respiratory distress syndrome. From the beginning of this millennium, the approach to mechanical ventilation in the patient with ARDS was based on reduction of tidal volume to 6 milliliters/kilogram of ideal body weight, maintaining a ceiling of plateau pressure, and titration of driving pressure (plateau pressure minus PEEP). Beyond these broad constraints, there is little specification for the mechanics of ventilator settings, consideration of the metabolic impact of the disease process on the patient, or interaction of patient disease and ventilator settings. Various studies suggest that inhomogeneity of lung injury, which increases the risk of regional lung trauma from mechanical ventilation, may be found in the patient with smoke inhalation. We now appreciate that energy transfer principles may affect optimal ventilator management and come into play in damaged heterogenous lungs. Mechanical ventilation in the patient with inhalation injury should consider various factors. Self-injurious respiratory demand by the patient can be reduced using analgesia and sedation. Dynamic factors beginning with rate management can reduce the incidence of potentially damaging ventilation. Moreover, preclinical study is underway to examine the flow of gas based on the ventilator mode selected, which may also be a factor triggering regional lung injury.
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Affiliation(s)
| | - John F Perry
- Chair of Trauma Surgery University of Minnesota, U.S.A
| | - Pierre N Tawfik
- Fellow Pulmonary and Critical Care Medicine University of Minnesota, U.S.A
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Lam N, Minh N. Risk Factors For Death And Prognosis Value Of Revised Baux Score For Burn Patients With Inhalation Injury. ANNALS OF BURNS AND FIRE DISASTERS 2022; 35:41-45. [PMID: 35582096 PMCID: PMC9020854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 05/11/2021] [Indexed: 06/15/2023]
Abstract
A retrospective study was conducted on 314 burn patients with inhalation injury admitted to the National Burn Hospital during the period 2015-2019. The results showed that adult and male was predominant (81.9% and 77.7%), with burns mostly caused by flame (93.6%) and burn extent of 68.6±24.3% and deep burn area of 44.6±25.2% total body surface area. Rate of required mechanical ventilation patients was 95.22%. Common complications were multiple organ failure (41.9%), pneumonia (29.9%), ARDS (25.5%) and septic shock (23.8%), with a mortality rate of 85.4%. Multivariate logistic analysis indicated that burn extent and age were independent risk factors for death of patients with inhalation injury. SMR of rBaux score was 1.01 with AUC of 0.84, Youden index 113, sensitivity 82.09%, specificity 70.21%. The SMR of adult and elderly patients was relatively close to 1 (1 and .97 respectively). In addition, the AUC value for the elderly was highest (.95) followed by adult patients (.84). However, predicting the value of rBaux on children with inhalation injury was quite low (SMR=1.57; AUC = 0.4). There is a need to determine an optimal prognosis score for children with inhalation injury.
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Affiliation(s)
- N.N. Lam
- National Burn Hospital, Hanoi, Vietnam
- Medical Military University, Vietnam
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Huang RY, Chen SJ, Hsiao YC, Kuo LW, Liao CH, Hsieh CH, Bajani F, Fu CY. Positive signs on physical examination are not always indications for endotracheal tube intubation in patients with facial burn. BMC Emerg Med 2022; 22:36. [PMID: 35260094 PMCID: PMC8903723 DOI: 10.1186/s12873-022-00594-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 02/24/2022] [Indexed: 11/10/2022] Open
Abstract
Background After clinical evaluation in the emergency department (ED), facial burn patients are usually intubated to protect their airways. However, the possibility of unnecessary intubation or delayed intubation after admission exists. Objective criteria for the evaluation of inhalation injury and the need for airway protection in facial burn patients are needed. Methods Facial burn patients between January 2013 and May 2016 were reviewed. Patients who were and were not intubated in the ED were compared. All the intubated patients received routine bronchoscopy and laboratory tests to evaluate whether they had inhalation injuries. The patients with and without confirmed inhalation injuries were compared. Multivariate logistic regression analysis was used to identify the independent risk factors for inhalation injuries in the facial burn patients. The reasons for intubation in the patients without inhalation injuries were also investigated. Results During the study period, 121 patients were intubated in the ED among a total of 335 facial burn patients. Only 73 (60.3%) patients were later confirmed to have inhalation injuries on bronchoscopy. The comparison between the patients with and without inhalation injuries showed that shortness of breath (odds ratio = 3.376, p = 0.027) and high total body surface area (TBSA) (odds ratio = 1.038, p = 0.001) were independent risk factors for inhalation injury. Other physical signs (e.g., hoarseness, burned nostril hair, etc.), laboratory examinations and chest X-ray findings were not predictive of inhalation injury in facial burn patients. All the patients with a TBSA over 60% were intubated in the ED even if they did not have inhalation injuries. Conclusions In the management of facial burn patients, positive signs on conventional physical examinations may not always be predictive of inhalation injury and the need for endotracheal tube intubation in the ED. More attention should be given to facial burn patients with shortness of breath and a high TBSA. Airway protection is needed in facial burn patients without inhalation injuries because of their associated injuries and treatments. Supplementary Information The online version contains supplementary material available at 10.1186/s12873-022-00594-9.
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Affiliation(s)
- Ruo-Yi Huang
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Szu-Jen Chen
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Yen-Chang Hsiao
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Ling-Wei Kuo
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Chien-Hung Liao
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Chi-Hsun Hsieh
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Francesco Bajani
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Chih-Yuan Fu
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.
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Nduagubam OC, Mba UC, Onumaegbu OO, Onah II, Chukwubuike KE, Bisi-Onyemaechi AI, Agwu S. Paediatric burn injuries in Enugu, South-East Nigeria: A 7-year multi-centre retrospective review. Burns 2022; 48:432-439. [PMID: 34001387 DOI: 10.1016/j.burns.2021.04.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 04/24/2021] [Accepted: 04/29/2021] [Indexed: 12/14/2022]
Abstract
Burn injuries contribute significantly to childhood morbidity and mortality. This study was designed to document the pattern of presentation and outcome of pediatric burn injury in Enugu. METHODS All children with burn injuries over a 7-year period (June 2011 to May 2018) and were managed at three tertiary health institutions, were studied. Information including their socio-demographics, clinical features and treatment outcome were obtained and analyzed using the Statistical Package for Social Sciences (SPSS) version 17.0. RESULTS 198 out of 201 records were available for analysis. Most (186; 93.9%) burn injuries occurred at home. Hot liquid (112; 56.7%) was the commonest cause of burn injury. A lot of substances were used topically for first aid, raw eggs (52; 31%) being the commonest. The outcome had significant association with cause of injury, depth of injury, total burn surface area (TBSA), and inhalation injury. Most were safely discharged home while a total of thirteen (6.6%) children died. LA50 was 54.87%, while the maximum TBSA salvaged was 65%. CONCLUSION Burn injuries in children in this environment remain a serious challenge in the face of widespread lack of awareness regarding safe practices in handling hot and flammable items at home.
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Affiliation(s)
- O C Nduagubam
- Department of Paediatrics, College of Medicine, Enugu State University of Science and Technology, PMB 01660, and ESUT Teaching Hospital, Parklane, PMB 1030 Enugu, Nigeria.
| | - U C Mba
- Department of Surgery, College of Medicine, Enugu State University of Science and Technology, PMB 01660, and ESUT Teaching Hospital, Parklane, PMB 1030 Enugu, Nigeria; Department of Plastic Surgery, National Orthopaedic Hospital, PMB 01294, Enugu, Nigeria.
| | - O O Onumaegbu
- Department of Surgery, College of Medicine, University of Nigeria, and UNTH Ituku-Ozalla, PMB 01129, Enugu, Nigeria.
| | - I I Onah
- Department of Plastic Surgery, National Orthopaedic Hospital, PMB 01294, Enugu, Nigeria; Department of Surgery, College of Medicine, Enugu State University of Science and Technology, PMB 01660, and ESUT Teaching Hospital, Parklane, PMB 1030 Enugu, Nigeria.
| | - K E Chukwubuike
- Department of Surgery, College of Medicine, Enugu State University of Science and Technology, PMB 01660, and ESUT Teaching Hospital, Parklane, PMB 1030 Enugu, Nigeria.
| | - A I Bisi-Onyemaechi
- Department of Paeditrics, College of Medicine, University of Nigeria, and UNTH Ituku-Ozalla, PMB 01129, Enugu, Nigeria.
| | - S Agwu
- Department of Paediatrics, College of Medicine, Enugu State University of Science and Technology, PMB 01660, and ESUT Teaching Hospital, Parklane, PMB 1030 Enugu, Nigeria.
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O'Neil AM, Rush C, Griffard L, Roggy D, Boyd A, Hartman B. 5 -Year Retrospective Analysis of a Vented Mobility Algorithm in the Burn ICU. J Burn Care Res 2022; 43:1129-1134. [PMID: 34978322 DOI: 10.1093/jbcr/irab248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Early mobilization with mechanically ventilated patients has received significant attention within recent literature, however limited research has focused specifically on the burn population. The purpose of this single center, retrospective analysis was to review the use of a burn critical care mobility algorithm, to determine safety and feasibility of a burn vented mobility program, share limitations preventing mobility progression at our facility, and discuss unique challenges to vented mobility with intubated burn patients. A retrospective review was completed for all intubated burn center admissions between January 2015 to December 2019. Burn Therapy notes were then reviewed for data collection, during the intubation period, using stages of the mobility algorithm. In 5 years following initial implementation, the vented mobility algorithm was utilized on 127 patients with an average total body surface area of 22.8%. No adverse events occurred. Stage 1 (Range of motion) was completed with 100% of patients (n=127). Chair mode of bed, stage 2a, was utilized in 39.4%(n=50) of patients, while 15.8% (n=20) of patients were dependently transferred to the cardiac chair in stage 2b. Stage 3 (sitting on the edge-of-bed) was completed with 25% (n=32) of patients, with 11% (n=14) progressing to stage 5 (standing), and 3.9% (n=5) actively transferring to a chair. In 5 years, only 4.7% (n=6) reached stage 6 (ambulation). The most common treatment limitations were medical complications (33%) and line placement (21%). Early mobilization during mechanical ventilation is safe and feasible within the burn population, despite challenges including airway stability, sedation, and line limitations.
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Affiliation(s)
| | | | | | - David Roggy
- Richard M Fairbanks Burn Center, Indianapolis, IN
| | - Allison Boyd
- Richard M Fairbanks Burn Center, Indianapolis, IN
| | - Brett Hartman
- Indiana University School of Medicine, Indianapolis, IN
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Ali ZA, Eladl HM, Abdelbasset WK, Eid MM, Mosa HE, Elsayeh SM. Inhalation Injury in Adult Males: Evaluation of the short-term efficacy of transcutaneous electrical acupoint stimulation on pulmonary functions and diaphragmatic mobility post-burn: A double-blind randomized controlled study. Burns 2022; 48:1933-1939. [DOI: 10.1016/j.burns.2022.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/08/2022] [Accepted: 01/21/2022] [Indexed: 11/02/2022]
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Belba M, Deda L, Belba G. Measurements Of Injury-Related Outcomes: Statistical And Analytical Data From Albania. ANNALS OF BURNS AND FIRE DISASTERS 2021; 34:301-311. [PMID: 35035322 PMCID: PMC8717911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 03/29/2021] [Indexed: 06/14/2023]
Abstract
Numerous burn mortality indicators and prognostic scores are necessary to classify with priorities severely burned patients in order to predict outcome. The purpose of this paper is to evaluate mortality predictors on admission, in order to determine Lethal Area 50 and to validate burn prognostic scores. The study is retrospective, clinical and analytical. The data utilized were accessed by investigating the medical charts of 5033 patients hospitalized with severe burns within the Intensive Care Unit of the Service of Burns in Tirana, Albania over the period 1992-2019. Descriptive and inferential statistics were performed using PSS 23 software. Statistical significance is defined as p<0.05. The incidence rate of hospitalization of patients with severe burns initially increased from 4.1 to 7.9 persons per 100,000 population/year in the period 1992 to 1999, followed by a decrease from 7.9 to 4.8 in 2019. Mortality was 12.2% and the average burn crude death rate was 0.7 patients per 100,000 population/year. Lethal Area 50 for the second decade (2010-2019) was 82.2%. All tested burn prognostic scores had good predictive values. In addition to the commonly used outcome predictors such as age, burn size and inhalation burn, we concluded that additional determinants like depth of burn and etiology of burns determined an unfavorable outcome. Fatality risk was 4 times higher in patients with full-thickness burns, 2.6 times higher in patients with flame burns, and 4 times higher in patients with inhalation injury.
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Affiliation(s)
- M.K. Belba
- University of Medicine, Tirana, Albania
- University Hospital Center ‘Mother Teresa’, Tirana, Albania
| | - L.N. Deda
- University Hospital Center ‘Mother Teresa’, Tirana, Albania
| | - G.P. Belba
- University Hospital Center ‘Mother Teresa’, Tirana, Albania
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Charles WN, Collins D, Mandalia S, Matwala K, Dutt A, Tatlock J, Singh S. Impact of inhalation injury on outcomes in critically ill burns patients: 12-year experience at a regional burns centre. Burns 2021; 48:1386-1395. [PMID: 34924231 DOI: 10.1016/j.burns.2021.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 11/15/2021] [Accepted: 11/22/2021] [Indexed: 11/02/2022]
Abstract
INTRODUCTION Burns inhalation injury increases the attributable mortality of burns related trauma. However, diagnostic uncertainties around bronchoscopically graded severity, and its effect on outcomes, remain. This study evaluated the impact of different bronchoscopic burns inhalation injury grades on outcomes. METHODS A single-centre cohort study of all patients admitted to the London Burns centre intensive care unit (BICU) over 12 years. Demographic data, burn and burns inhalation injury characteristics, and ICU-related parameters were collected retrospectively. The primary outcome was mortality. Secondary outcomes were hospital and ICU lengths of stay. The impact of pneumonia was determined. Univariate and multivariable Cox's proportional hazards regression analyses informed factors predicting mortality. RESULTS Burns inhalation injury was diagnosed in 84 of 231 (36%) critically ill burns patients; 20 mild (grade 1), 41 severe (grades 2/3) and 23 unclassified bronchoscopically. Median (IQR) total body surface area burned (TBSA) was 20% (10-40). Mortality was significantly higher in patients with burns inhalation injury vs those without burns inhalation injury (38/84 [45%] vs 35/147 [24%], p < 0.001). Patients with pneumonia had a higher mortality than those without (34/125 [27%] vs 8/71 [11%], p = 0.009). In multivariable analysis, severe burns inhalation injury significantly increased mortality (adjusted HR=2.14, 95%CI: 1.12-4.09, p = 0.022), compared with mild injury (adjusted HR=0.58, 95% CI: 0.18-1.86, p = 0.363). Facial burns (adjusted HR=3.13, 95%CI: 1.69-5.79, p < 0.001), higher TBSA (adjusted HR=1.05, 95%CI: 1.04-1.06, p < 0.001) and older age (adjusted HR=1.04, 95%CI: 1.02-1.07, p < 0.001) also independently predicted mortality, though pneumonia did not. CONCLUSIONS Severe burns inhalation injury is a significant risk factor for mortality in critically ill burns patients. However, pneumonia did not increase mortality from burns inhalation injury. This work confirms prior implications of bronchoscopically graded burns inhalation injury. Further study is suggested, through registries, into the diagnostic accuracy and reliability of bronchoscopy in burns related lung injury.
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Affiliation(s)
- Walton N Charles
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Declan Collins
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom; Department of Burns, Plastic and Reconstructive Surgery, Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
| | - Sundhiya Mandalia
- Intensive Care Unit, Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom; Department of Research and Development, Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
| | - Kabir Matwala
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Atul Dutt
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Jason Tatlock
- Intensive Care Unit, Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
| | - Suveer Singh
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom; Intensive Care Unit, Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom; Department of Research and Development, Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom; Academic Department of Anaesthesia, Pain Management and Intensive Care (APMIC), Imperial College London, Chelsea and Westminster Hospital NHS Foundation Trust and Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom.
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Alnasser SM. Drug and Chemical Poisoning Patterns in Makkah Region, Saudi Arabia. Drug Res (Stuttg) 2021; 72:148-155. [PMID: 34758501 DOI: 10.1055/a-1658-3036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This research reveals that drugs and chemicals poisoning have been reported to have severe and fetal side effects on health provided by doctors in statistics and periodical records. This work aimed to explore the interaction among drug and chemical poisoning patterns concerning risk factors, especially gender, age, exposure circumstances, and outcomes in the Makkah region. A retrospective analysis was of clinical drug and chemical poisoning cases (2014-2015). The data were retrieved from the Department of Environmental and Occupational Health, Ministry of Health, Makkah, Saudi Arabia. The Saudi Arabia Ministry of Health received 1216 reports of drug and chemical poisoning during 2014-2015 in Makkah. This study has found that, the most affected gender was that of males (65%). The most affected age category with drug poisoning was over 15 years old (67%), but under 5 years for chemical poisoning (60%). The majority of drug poisoning cases are unknown drugs (42%), which accidental poisoning was a minority compared with other drug causes (27%). Chemical poisoning accidents were the majority causes of the recorded cases (63%). We reported healthy recovered without complications for most patients from drug and chemical poisoning (85-95%). Antidotes were administered in only (5%) of cases, and fatalities were reported (0.5% of cases). We have shown a flagrant increase in the number of people poisoned by drugs and chemical agents during 2015. Increases poisoning cases involved both genders and all studied age categories, especially males over 15 years up to 25 (drugs) and < 5 years (chemicals). Most cases were accidental (chemicals) and reported healthy recovery for most patients.
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Do W, Kang D, Hong P, Kim HJ, Baik J, Lee D. Incidental operating room fire from a breathing circuit warmer system: a case report. BMC Anesthesiol 2021; 21:271. [PMID: 34740320 PMCID: PMC8569503 DOI: 10.1186/s12871-021-01488-2] [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: 07/07/2021] [Accepted: 10/26/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND An airway-associated fire in an operating room can have devastating consequences for patients. Breathing circuit warmers (BCWs) are widely used to provide heated and humidified anesthetic gases and eventually prevent hypothermia during general anesthesia. Herein, we describe a case of a BCW-related airway fire. CASE PRESENTATION In this case, an electrical short within a BCW wire caused a fire inside the circuit. Simultaneously, the fire was extinguished, ventilation was stopped, and the endotracheal tube was disconnected from the BCW. The patient was exposed to the fire for less than 10 s, resulting in burns to the trachea and bronchi. Immediately after airway burn, bronchoscopy showed no edema or narrowing except for soot in the trachea and both main bronchus. After the inhalation burn event, prophylactic antibiotics, bronchodilator, mucolytics nebulizer, and corticosteroid nebulizer were started. On bronchoscopy 3 days after the inhalation burn, mucosal erythematous edema was observed and the inflammatory reaction worsened. The inflammatory reaction showed aggravation for up to 2 weeks, and then gradually recovered, and the epithelium and mucous membrane of the upper respiratory tract returned to normal after 4 weeks. Eventually, the patient recovered without long-term complications and was successfully discharged. CONCLUSIONS This is the first report of a fire caused by BCW. We wanted to share our experience of how we responded to an airway-related fire in an OR and treated the patient. It cannot be overemphasized that the electrical medical appliance associated with the airways are fatal to the patient in the event of a fire, so caution should always be exercised.
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Affiliation(s)
- Wangseok Do
- Biomedical Research Institute, Pusan National University Hospital, Busan, 49241, Republic of Korea
| | - Dahyun Kang
- Biomedical Research Institute, Pusan National University Hospital, Busan, 49241, Republic of Korea
| | - Purna Hong
- Biomedical Research Institute, Pusan National University Hospital, Busan, 49241, Republic of Korea
| | - Hyae-Jin Kim
- Biomedical Research Institute, Pusan National University Hospital, Busan, 49241, Republic of Korea
| | - Jiseok Baik
- Biomedical Research Institute, Pusan National University Hospital, Busan, 49241, Republic of Korea.,Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, 179 Gudeok-ro, Seo-gu, Busan, 49241, Republic of Korea
| | - Dowon Lee
- Biomedical Research Institute, Pusan National University Hospital, Busan, 49241, Republic of Korea. .,Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, 179 Gudeok-ro, Seo-gu, Busan, 49241, Republic of Korea.
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Puyana S, Ruiz S, Amador F, Mckenney M, Young E, Lim R, Mir H. The Outcomes of Inhalation Injuries in Lesser Burns: Still a Deadly Injury. EPLASTY 2021; 21:e7. [PMID: 35603021 PMCID: PMC9097025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Although it has been widely proposed that inhalation injuries worsen burn outcomes, large-scale studies have yet to demonstrate the exact relationship. This study proposes inhalation injuries as an independent risk factor that worsens burn outcomes. METHODS A retrospective review of the American Burn Association Registry from 2002 to 2011 was conducted. Inclusion criteria included burn patients with a total body surface area (TBSA) of less than 15% and adequate data recording of the inhalation injury within the registry. Patients were stratified into 2 groups: inhalation injuries (group 1) vs non-inhalation injuries (group 2). Outcome measures included in-hospital mortality rate, hospital length of stay (LOS), intensive care unit (ICU) LOS, and days on a ventilator. RESULTS A total of 93781 burn patients met the inclusion criteria. There were 4204 patients in group 1 and 89577 patients in group 2. There was no statistically significant difference between the 2 groups in terms of TBSA, with 3.50% in group 1 and 3.58% in group 2. There was a significantly higher ICU LOS at 8.55 days in group 1 compared to 6.27 days in group 2. There was a significantly higher hospital LOS at 11.48 days in group 1 compared to 6.27 days in group 2. The in-hospital mortality was significantly higher in group 1 at 8.54% vs group 2 at 1.42%. CONCLUSION The presence of inhalation injury may be a predictor of increased mortality and poor outcome in burn patients, even in those with small sized burns.
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Affiliation(s)
- Salomon Puyana
- Department of Plastic Surgery, Tulane University, New Orleans, Louisiana
| | - Samuel Ruiz
- Department of Surgery, Kendall Regional Medical Center, Miami, Florida
| | - Francisco Amador
- Department of Medicine, Universidad del Norte, Barranquilla, Colombia
| | - Mark Mckenney
- Department of Surgery, Kendall Regional Medical Center, Miami, Florida
- Department of Surgery, University of South Florida, Tampa, Florida
| | | | - Rizal Lim
- Burn and Reconstructive Centers of Florida, Miami, Florida
| | - Haaris Mir
- Department of Surgery, Kendall Regional Medical Center, Miami, Florida
- Burn and Reconstructive Centers of Florida, Miami, Florida
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Fischbach A, Wiegand SB, Zazzeron L, Traeger L, di Fenza R, Bagchi A, Farinelli WA, Franco W, Korupolu S, Arens J, Grassi L, Zadek F, Bloch DB, Rox Anderson R, Zapol WM. Veno-venous extracorporeal blood phototherapy increases the rate of carbon monoxide (CO) elimination in CO-poisoned pigs. Lasers Surg Med 2021; 54:256-267. [PMID: 34350599 DOI: 10.1002/lsm.23462] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND AND OBJECTIVES Carbon monoxide (CO) inhalation is the leading cause of poison-related deaths in the United States. CO binds to hemoglobin (Hb), displaces oxygen, and reduces oxygen delivery to tissues. The optimal treatment for CO poisoning in patients with normal lung function is the administration of hyperbaric oxygen (HBO). However, hyperbaric chambers are only available in medical centers with specialized equipment, resulting in delayed therapy. Visible light dissociates CO from Hb with minimal effect on oxygen binding. In a previous study, we combined a membrane oxygenator with phototherapy at 623 nm to produce a "mini" photo-ECMO (extracorporeal membrane oxygenation) device, which improved CO elimination and survival in CO-poisoned rats. The objective of this study was to develop a larger photo-ECMO device ("maxi" photo-ECMO) and to test its ability to remove CO from a porcine model of CO poisoning. STUDY DESIGN/MATERIALS AND METHODS The "maxi" photo-ECMO device and the photo-ECMO system (six maxi photo-ECMO devices assembled in parallel), were tested in an in vitro circuit of CO poisoning. To assess the ability of the photo-ECMO device and the photo-ECMO system to remove CO from CO-poisoned blood in vitro, the half-life of COHb (COHb-t1/2 ), as well as the percent COHb reduction in a single blood pass through the device, were assessed. In the in vivo studies, we assessed the COHb-t1/2 in a CO-poisoned pig under three conditions: (1) While the pig breathed 100% oxygen through the endotracheal tube; (2) while the pig was connected to the photo-ECMO system with no light exposure; and (3) while the pig was connected to the photo-ECMO system, which was exposed to red light. RESULTS The photo-ECMO device was able to fully oxygenate the blood after a single pass through the device. Compared to ventilation with 100% oxygen alone, illumination with red light together with 100% oxygen was twice as efficient in removing CO from blood. Changes in gas flow rates did not alter CO elimination in one pass through the device. Increases in irradiance up to 214 mW/cm2 were associated with an increased rate of CO elimination. The photo-ECMO device was effective over a range of blood flow rates and with higher blood flow rates, more CO was eliminated. A photo-ECMO system composed of six photo-ECMO devices removed CO faster from CO-poisoned blood than a single photo-ECMO device. In a CO-poisoned pig, the photo-ECMO system increased the rate of CO elimination without significantly increasing the animal's body temperature or causing hemodynamic instability. CONCLUSION In this study, we developed a photo-ECMO system and demonstrated its ability to remove CO from CO-poisoned 45-kg pigs. Technical modifications of the photo-ECMO system, including the development of a compact, portable device, will permit treatment of patients with CO poisoning at the scene of their poisoning, during transit to a local emergency room, and in hospitals that lack HBO facilities.
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Affiliation(s)
- Anna Fischbach
- Anesthesia Center for Critical Care Research of the Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Steffen B Wiegand
- Anesthesia Center for Critical Care Research of the Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Department of Anesthesiology, University Hospital, LMU Munich, Munich, Germany
| | - Luca Zazzeron
- Anesthesia Center for Critical Care Research of the Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Lisa Traeger
- Anesthesia Center for Critical Care Research of the Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Raffaele di Fenza
- Anesthesia Center for Critical Care Research of the Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Aranya Bagchi
- Anesthesia Center for Critical Care Research of the Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - William A Farinelli
- Department of Dermatology, Massachusetts General Hospital and Harvard Medical School, Wellman Center for Photomedicine, Boston, Massachusetts, USA
| | - Walfre Franco
- Department of Biomedical Engineering, University of Massachusetts, Lowell, Massachusetts, USA
| | - Sandeep Korupolu
- Department of Dermatology, Massachusetts General Hospital and Harvard Medical School, Wellman Center for Photomedicine, Boston, Massachusetts, USA
| | - Jutta Arens
- Department of Biomechanical Engineering, Faculty of Engineering Technology, University of Twente, Twente, The Netherlands
| | - Luigi Grassi
- Anesthesia Center for Critical Care Research of the Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Francesco Zadek
- Anesthesia Center for Critical Care Research of the Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Donald B Bloch
- Anesthesia Center for Critical Care Research of the Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - R Rox Anderson
- Department of Dermatology, Massachusetts General Hospital and Harvard Medical School, Wellman Center for Photomedicine, Boston, Massachusetts, USA
| | - Warren M Zapol
- Anesthesia Center for Critical Care Research of the Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Bu R, Balakrishnan S, Iftimia N, Price H, Zdanski C, Mitran S, Oldenburg AL. Sensing Inhalation Injury-Associated Changes in Airway Wall Compliance by Anatomic Optical Coherence Elastography. IEEE Trans Biomed Eng 2021; 68:2360-2367. [PMID: 33175676 PMCID: PMC8110609 DOI: 10.1109/tbme.2020.3037288] [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] [Indexed: 11/09/2022]
Abstract
Quantitative methods for assessing the severity of inhalation (burn) injury are needed to aid in treatment decisions. We hypothesize that it is possible to assess the severity of injuries on the basis of differences in the compliance of the airway wall. Here, we demonstrate the use of a custom-built, endoscopic, anatomic optical coherence elastography (aOCE) system to measure airway wall compliance. The method was first validated using airway phantoms, then performed on ex vivo porcine tracheas under varying degrees of inhalation (steam) injury. A negative correlation between aOCE-derived compliance and severity of steam injuries is found, and spatially-resolved compliance maps reveal regional heterogeneity in airway properties.
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Affiliation(s)
- Ruofei Bu
- Department of Biomedical Engineering, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-3216 USA
| | - Santosh Balakrishnan
- Department of Biomedical Engineering, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-3216 USA
| | - Nicusor Iftimia
- Physical Sciences Inc., New England Business Center, Andover, MA 01810, USA
| | - Hillel Price
- Department of Physics and Astronomy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599- 3255 USA
| | - Carlton Zdanski
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7070, USA
| | - Sorin Mitran
- Department of Mathematics, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-3255, USA
| | - Amy L. Oldenburg
- Department of Biomedical Engineering, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-3216 USA
- Department of Physics and Astronomy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599- 3255 USA
- Biomedical Research Imaging Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-3216 USA
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Henrich SF, Rech TH, Ritter C, Michels M, Dal-Pizzol F, Friedman G. Association of uteroglobin-related protein 1 with smoke inhalation injury severity. Rev Bras Ter Intensiva 2021; 33:276-281. [PMID: 34231808 PMCID: PMC8275074 DOI: 10.5935/0103-507x.20210035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 08/18/2020] [Indexed: 11/29/2022] Open
Abstract
Objective To evaluate serum uteroglobin-related protein 1 expression early after smoke inhalation injuries and its association with the severity of inhalation injury in burned patients. Methods Smoke or chemical inhalation injury is associated with morbidity and mortality. The consequences of inhalation result from an inflammatory response. Uteroglobin-related protein 1 is an anti-inflammatory protein and may improve lung inflammation. We hypothesized that uteroglobin-related protein 1 levels could reflect disease severity and predict outcome in patients with inhalation injury. Sixteen patients diagnosed with acute respiratory distress syndrome secondary to smoke inhalation injury were prospectively included in the study. Plasma was collected upon intensive care unit admission and within 24 hours of the inhalation injury. Bronchoscopies were carried out in all patients to assess the severity of inhalation injury within 72 hours. Uteroglobin-related protein 1 plasma levels were determined in duplicate with enzyme-linked immunosorbent assay. Results The mean age was 23 ± 5 years, and the inhalation injury distribution was as follows: three of grade 1, four of grade 2, and nine of grade 3. The level of uteroglobin-related protein 1 was related to inhalation severity (grade 1: 0.389 ± 0.053 arbitrary units versus grade 2: 0.474 ± 0.0423 arbitrary units versus grade 3: 0.580 ± 0.094 arbitrary units; p = 0.007). Conclusion Plasma levels of uteroglobin-related protein 1 are associated with the degree of lung inhalation injury.
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Affiliation(s)
- Sabrina Frighetto Henrich
- Programa de Pós-Graduação em Ciências Pneumológicas, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brasil.,Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brasil
| | - Tatiana Helena Rech
- Programa de Pós-Graduação em Ciências Médicas: Endocrinologia, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brasil.,Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brasil
| | - Cristiane Ritter
- Programa de Pós-Graduação em Ciências Médicas, Universidade do Extremo Sul Catarinense - Criciúma (SC), Brasil
| | - Monique Michels
- Programa de Pós-Graduação em Ciências Médicas, Universidade do Extremo Sul Catarinense - Criciúma (SC), Brasil
| | - Felipe Dal-Pizzol
- Programa de Pós-Graduação em Ciências Médicas, Universidade do Extremo Sul Catarinense - Criciúma (SC), Brasil
| | - Gilberto Friedman
- Programa de Pós-Graduação em Ciências Pneumológicas, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brasil.,Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brasil
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Guo H, Yang R, He J, Chen K, Yang W, Liu J, Xiao K, Li H. Edaravone combined with dexamethasone exhibits synergic effects on attenuating smoke-induced inhalation lung injury in rats. Biomed Pharmacother 2021; 141:111894. [PMID: 34225014 DOI: 10.1016/j.biopha.2021.111894] [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: 03/02/2021] [Revised: 06/06/2021] [Accepted: 06/28/2021] [Indexed: 02/05/2023] Open
Abstract
Inhalational lung injury often leads to morbidity and mortality during fire disasters. In this study, we aimed to evaluate the protective effects of edaravone combined with dexamethasone on smoke-induced inhalational lung injury. Sprague-Dawley rats were divided into five groups, namely, the control, model (inhalation), and three treatment groups (edaravone, dexamethasone, and edaravone combined with dexamethasone). After drug intervention in the acute lung injury model, arterial blood gas, wet:dry weight ratio of the lung tissue, bronchoalveolar lavage fluid, and pulmonary histopathology were determined. The production of reactive oxygen species (ROS), mitochondrial membrane potential (MMP), inflammatory cytokines, peroxidase and apoptosis were further analyzed to explore the underlying mechanisms. The results of blood gas and inflammatory cytokine analysis and the histopathological data demonstrated that edaravone combined with dexamethasone had obvious protective effects on smoke infiltration and tissue injury. Moreover, after the co-administration of edaravone and dexamethasone, malondialdehyde and myeloperoxidase levels in the lung tissue decreased, whereas those of glutathione peroxidase and superoxide dismutase were elevated. In addition, this drug combination could inhibit smoke-induced apoptosis in lung tissues by reducing the cleavage of caspase-3, caspase-9, and poly ADP-ribose polymerase (PARP), and also reverse smoke-mediated mitochondrial dysfunction, including ROS generation, loss of MMP, early release of cytochrome C, second mitochondrial activator of caspases, and apoptosis-inducing factor. In conclusion, edaravone combined with dexamethasone had a protective effect on smoke-induced inhalational lung injury in rats and can be further explored as an attractive therapeutic option for the treatment of smoke inhalation-induced pulmonary dysfunction.
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Affiliation(s)
- Haidong Guo
- National Chengdu Center for Safety Evaluation of Drugs and National Clinical Research Center for Geriatrics, West China hospital, Sichuan University, Chengdu 610041, PR China; Sichuan Fire Research Institute of Ministry of Emergency Management, Chengdu 610036, PR China
| | - Runfang Yang
- National Chengdu Center for Safety Evaluation of Drugs and National Clinical Research Center for Geriatrics, West China hospital, Sichuan University, Chengdu 610041, PR China
| | - Jin He
- Sichuan Fire Research Institute of Ministry of Emergency Management, Chengdu 610036, PR China
| | - Ke Chen
- National Chengdu Center for Safety Evaluation of Drugs and National Clinical Research Center for Geriatrics, West China hospital, Sichuan University, Chengdu 610041, PR China
| | - Wen Yang
- National Chengdu Center for Safety Evaluation of Drugs and National Clinical Research Center for Geriatrics, West China hospital, Sichuan University, Chengdu 610041, PR China
| | - Junjun Liu
- Sichuan Fire Research Institute of Ministry of Emergency Management, Chengdu 610036, PR China
| | - Kai Xiao
- National Chengdu Center for Safety Evaluation of Drugs and National Clinical Research Center for Geriatrics, West China hospital, Sichuan University, Chengdu 610041, PR China; Precision Medicine Research Center, Sichuan Provincial Key Laboratory of Precision Medicine, West China Hospital, Sichuan University, Chengdu 610041, China.
| | - Hongxia Li
- National Chengdu Center for Safety Evaluation of Drugs and National Clinical Research Center for Geriatrics, West China hospital, Sichuan University, Chengdu 610041, PR China.
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Carey MG, Valcin EK, Lent D, White M. Nursing Care for the Initial Resuscitation of Burn Patients. Crit Care Nurs Clin North Am 2021; 33:275-285. [PMID: 34340790 DOI: 10.1016/j.cnc.2021.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Serious burn injuries may have lifelong impacts for individuals that experience them and require timely medical treatment in order to reduce associated morbidity and mortality. Initial management of a burn is nursing intensive and focuses primarily on stopping the burning process, maintaining homeostasis by keeping the patient warm, and replacing lost fluid and electrolytes. As healing progresses, nurses meet the critical needs of the patient and must skillfully manage pain levels, perform burn care, prevent infection, help the patient meet increased nutrient requirements, and address psychological concerns with the goal to restore health and function to the highest possible level.
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Affiliation(s)
- Mary G Carey
- Clinical Nursing Research Center, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY 14642, USA.
| | | | - David Lent
- Adult Critical Care Outcomes, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY 14642, USA
| | - Mackenzie White
- Burn/Trauma ICU, Adult Critical Care, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY 14642, USA
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Club Cell Protein, CC10, Attenuates Acute Respiratory Distress Syndrome Induced by Smoke Inhalation. Shock 2021; 53:317-326. [PMID: 31045988 DOI: 10.1097/shk.0000000000001365] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To evaluate the dose effects of Recombinant human Club cell 10-kDa protein (rhCC10) on lung function in a well-characterized ovine model of acute respiratory distress syndrome (ARDS) induced by smoke inhalation injury (SII); specifically, the potential of rhCC10 protein to control the inflammatory response and protect pulmonary tissue and function following SII. DESIGN Randomized, controlled, prospective, and large animal translational studies. SETTING University large animal intensive care unit. SUBJECTS Thirty-six adult female sheep were surgically prepared and allocated into five groups (Sham (no SII), n = 6; 1 mg/kg/d CC10, n = 8; 3 mg/kg/d CC10, n = 7; 10 mg/kg/d CC10, n = 8; Control SII, n = 7). INTERVENTIONS All groups except the sham group were subjected to SII with cooled cotton smoke. Then, the animals were placed on a ventilator, treated with 1, 3, and 10 mg/kg/d of intravenous rhCC10 or vehicle, divided evenly into two administrations per day every 12 h, fluid resuscitated, and monitored for 48 h in a conscious state. MEASUREMENTS AND MAIN RESULTS The group treated with 10 mg/kg/d rhCC10 attenuated changes in the following variables: PaO2/FiO2 ratio, oxygenation index, and peak inspiratory pressure; neutrophil content in the airway and myeloperoxidase levels; obstruction of the large and small airways; systemic leakage of fluid and proteins, and pulmonary edema. CONCLUSIONS In this study, high-dose rhCC10 significantly attenuated ARDS progression and lung dysfunction and significantly reduced systemic extravasation of fluid and proteins, normalizing fluid balance. Based on these results, rhCC10 may be considered a novel therapeutic option for the treatment of SII-induced ARDS.
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Lott C, Truhlář A, Alfonzo A, Barelli A, González-Salvado V, Hinkelbein J, Nolan JP, Paal P, Perkins GD, Thies KC, Yeung J, Zideman DA, Soar J. [Cardiac arrest under special circumstances]. Notf Rett Med 2021; 24:447-523. [PMID: 34127910 PMCID: PMC8190767 DOI: 10.1007/s10049-021-00891-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2021] [Indexed: 01/10/2023]
Abstract
These guidelines of the European Resuscitation Council (ERC) Cardiac Arrest under Special Circumstances are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. This section provides guidelines on the modifications required for basic and advanced life support for the prevention and treatment of cardiac arrest under special circumstances; in particular, specific causes (hypoxia, trauma, anaphylaxis, sepsis, hypo-/hyperkalaemia and other electrolyte disorders, hypothermia, avalanche, hyperthermia and malignant hyperthermia, pulmonary embolism, coronary thrombosis, cardiac tamponade, tension pneumothorax, toxic agents), specific settings (operating room, cardiac surgery, cardiac catheterization laboratory, dialysis unit, dental clinics, transportation [in-flight, cruise ships], sport, drowning, mass casualty incidents), and specific patient groups (asthma and chronic obstructive pulmonary disease, neurological disease, morbid obesity, pregnancy).
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Affiliation(s)
- Carsten Lott
- Department of Anesthesiology, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Deutschland
| | - Anatolij Truhlář
- Emergency Medical Services of the Hradec Králové Region, Hradec Králové, Tschechien
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Hradec Králové, Charles University in Prague, Hradec Králové, Tschechien
| | - Anette Alfonzo
- Departments of Renal and Internal Medicine, Victoria Hospital, Kirkcaldy, Fife Großbritannien
| | - Alessandro Barelli
- Anaesthesiology and Intensive Care, Teaching and research Unit, Emergency Territorial Agency ARES 118, Catholic University School of Medicine, Rom, Italien
| | - Violeta González-Salvado
- Cardiology Department, University Clinical Hospital of Santiago de Compostela, Institute of Health Research of Santiago de Compostela (IDIS), Biomedical Research Networking Centres on Cardiovascular Disease (CIBER-CV), A Coruña, Spanien
| | - Jochen Hinkelbein
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Köln, Deutschland
| | - Jerry P. Nolan
- Resuscitation Medicine, Warwick Medical School, University of Warwick, CV4 7AL Coventry, Großbritannien
- Anaesthesia and Intensive Care Medicine, Royal United Hospital, BA1 3NG Bath, Großbritannien
| | - Peter Paal
- Department of Anaesthesiology and Intensive Care Medicine, Hospitallers Brothers Hospital, Paracelsus Medical University, Salzburg, Österreich
| | - Gavin D. Perkins
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, Großbritannien
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, Großbritannien
| | - Karl-Christian Thies
- Dep. of Anesthesiology and Critical Care, Bethel Evangelical Hospital, University Medical Center OLW, Bielefeld University, Bielefeld, Deutschland
| | - Joyce Yeung
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, Großbritannien
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, Großbritannien
| | | | - Jasmeet Soar
- Southmead Hospital, North Bristol NHS Trust, Bristol, Großbritannien
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Lott C, Truhlář A, Alfonzo A, Barelli A, González-Salvado V, Hinkelbein J, Nolan JP, Paal P, Perkins GD, Thies KC, Yeung J, Zideman DA, Soar J. European Resuscitation Council Guidelines 2021: Cardiac arrest in special circumstances. Resuscitation 2021; 161:152-219. [PMID: 33773826 DOI: 10.1016/j.resuscitation.2021.02.011] [Citation(s) in RCA: 314] [Impact Index Per Article: 104.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
These European Resuscitation Council (ERC) Cardiac Arrest in Special Circumstances guidelines are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. This section provides guidelines on the modifications required to basic and advanced life support for the prevention and treatment of cardiac arrest in special circumstances; specifically special causes (hypoxia, trauma, anaphylaxis, sepsis, hypo/hyperkalaemia and other electrolyte disorders, hypothermia, avalanche, hyperthermia and malignant hyperthermia, pulmonary embolism, coronary thrombosis, cardiac tamponade, tension pneumothorax, toxic agents), special settings (operating room, cardiac surgery, catheter laboratory, dialysis unit, dental clinics, transportation (in-flight, cruise ships), sport, drowning, mass casualty incidents), and special patient groups (asthma and COPD, neurological disease, obesity, pregnancy).
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Affiliation(s)
- Carsten Lott
- Department of Anesthesiology, University Medical Center, Johannes Gutenberg-University Mainz, Germany.
| | - Anatolij Truhlář
- Emergency Medical Services of the Hradec Králové Region, Hradec Králové, Czech Republic; Department of Anaesthesiology and Intensive Care Medicine, Charles University in Prague, University Hospital Hradec Králové, Hradec Králové, Czech Republic
| | - Annette Alfonzo
- Departments of Renal and Internal Medicine, Victoria Hospital, Kirkcaldy, Fife, UK
| | - Alessandro Barelli
- Anaesthesiology and Intensive Care, Catholic University School of Medicine, Teaching and Research Unit, Emergency Territorial Agency ARES 118, Rome, Italy
| | - Violeta González-Salvado
- Cardiology Department, University Clinical Hospital of Santiago de Compostela, Institute of Health Research of Santiago de Compostela (IDIS), Biomedical Research Networking Centres on Cardiovascular Disease (CIBER-CV), A Coruña, Spain
| | - Jochen Hinkelbein
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne, Germany
| | - Jerry P Nolan
- Resuscitation Medicine, University of Warwick, Warwick Medical School, Coventry, CV4 7AL, UK; Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, BA1 3NG, UK
| | - Peter Paal
- Department of Anaesthesiology and Intensive Care Medicine, Hospitallers Brothers Hospital, Paracelsus Medical University, Salzburg, Austria
| | - Gavin D Perkins
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK; University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Karl-Christian Thies
- Department of Anesthesiology, Critical Care and Emergency Medicine, Bethel Medical Centre, OWL University Hospitals, Bielefeld University, Germany
| | - Joyce Yeung
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK; University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Jasmeet Soar
- Southmead Hospital, North Bristol NHS Trust, Bristol, UK
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Allam NM, Badawy MM. Does High-Frequency Chest Wall Oscillation Have an Impact on Improving Pulmonary Function in Patients With Smoke Inhalation Injury? J Burn Care Res 2021; 42:300-304. [PMID: 32860696 DOI: 10.1093/jbcr/iraa147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Smoke inhalation results in bronchospasm of the trachea, increasing secretion of mucus, casts formation, and improvement of blood flow of the airway. High frequency chest wall oscillation is a common modality used for clearing mucus secretion in patients suffering from hypersecretion of thick mucus and used also to help cough clearance. This study aimed to detect the effect of high frequency chest wall oscillation in improving pulmonary function in burn patients suffering from smoke inhalation. Sixty smoke inhalation injury patients were randomly distributed into two groups of equal size. Group A: received high frequency chest wall oscillation and conventional chest physical therapy (breathing exercises, early ambulation, and cough training) thrice per week for 8 weeks. Group B: received traditional chest physical therapy (breathing exercises, early ambulation, and cough training) thrice per week for 8 weeks. Pulmonary function test (forced vital capacity, forced expiratory volume in the first second and peak expiratory flow rate) was measured at enrollment and after 8 weeks by using spirometer. Pulmonary function increased significantly posttreatment when compared with that pretreatment in groups A and B (P > .001). Also, they increased significantly in group A compared with that of group B posttreatment (P > .05). High-frequency chest wall oscillation have an impact on improving pulmonary function and should be handled to be a part of the pulmonary rehabilitation plan for smoke inhalation injury patients.
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Affiliation(s)
- Nesma M Allam
- Department of Physical Therapy for Surgery, Faculty of Physical Therapy, Cairo University, Egypt
| | - Manar M Badawy
- Department of Physical Therapy for Cardiovascular, Pulmonary Disorders and Geriatrics, Faculty of Physical Therapy, Misr University for Science and Technology, Egypt
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Underner M, Perriot J, Peiffer G, Dewitte J, Jaafari N. Republication de : Intoxication au monoxyde de carbone chez les fumeurs actifs ou passifs de chicha. JOURNAL EUROPÉEN DES URGENCES ET DE RÉANIMATION 2021. [DOI: 10.1016/j.jeurea.2021.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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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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Yeong EK, Sheng WH. Does early bloodstream infection pose a significant risk of in-hospital mortality in adults with burns? JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2021; 55:95-101. [PMID: 33563562 DOI: 10.1016/j.jmii.2021.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 01/18/2021] [Accepted: 01/18/2021] [Indexed: 01/25/2023]
Abstract
BACKGROUD/PURPOSE Bloodstream infections (BSI) are common in patients with major burns, but its effect on mortality remains controversial. This study was aimed to investigate if BSI is significant risk factor of mortality? METHODS This is a retrospective chart review study included 266 adult patients admitted to our burn center from 2000 to 2019. Age, sex, inhalation injuries, total burn surface area (TBSA), duration of stay in intensive care unit, BSI and mortality were variables studied. Fisher exact test, Mann-Whitney test and logistic regression was used for statistical analysis. RESULTS There were 234 survivors and 32 non-survivors. Male was predominant. The overall incidence of BSI was 18.8%, and the overall crude mortality was 12%. Burns ≥30% TBSA and BSI were significant risk factors. A predictive function based on30% TBSA and BSI within 14 days after the onset of burns (BSI-14) was derived. The function has a sensitivity of 0.97, specificity of 0.42 and achieved a maximum Youden Index at functional value ≥0.05727. The mortality probability of BSI-14 in burns ≥30% TBSA was 40.8%. CONCLUSIONS BSI and burns ≥30% TBSA were significant risk factors of mortality. Early detection of BSI-14 is critical in burn care as its probability of mortality can be as high as 40% in patients ≥30% TBSA of burns. To reduce the risk of mortality, early in ventilator withdrawal, invasive lines and tubes removal, and early grafting should be emphasized besides infection control and appropriate use of antibiotics.
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Affiliation(s)
- Eng-Kean Yeong
- Surgical Department Plastic Division Burn Centre, National Taiwan University Hospital, Taipei, Taiwan
| | - Wang-Huei Sheng
- Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
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Tripathi K, Kanchwala N, Mohan RR, Baranwal S, Jha M, Bhattacharya S. Role of fibreoptic bronchoscopy in early diagnosis of inhalational burns in patients with facial burns. INDIAN JOURNAL OF BURNS 2021. [DOI: 10.4103/ijb.ijb_6_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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