Assessment of Severity of Ovine Smoke Inhalation Injury by Analysis of Computed Tomographic Scans

Park, Myung S.; Cancio, Leopoldo C.; Batchinsky, Andriy I.; McCarthy, Michael J.; Jordan, Bryan S.; Brinkley, William W.; Dubick, Michael A.; Goodwin, Cleon W.

doi:10.1097/01.ta.0000083609.24440.7f

Cited by 55 publications

(25 citation statements)

References 31 publications

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“…The severity of inhalation injury can be difficult to classify on their admission to the burn center. Researchers have tried to characterize the severity of inhalation injury, using computed tomography (CT) to identify anatomical changes,7, 8 and the calculation of V/Q ratios to assess gas exchange 9. Others have investigated the possibility of biomarkers in plasma or alveolar fluid to determine the severity of inhalation injury 10, 11, 12.…”

Section: Introductionmentioning

confidence: 99%

Indications of early intubation for patients with inhalation injury

Onishi

Osuka

Kuroki

et al. 2017

Acute Medicine & Surgery

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AimFor patients with inhalation injury, the indications for early intubation are diverse. The purpose of this study was to identify the most reliable symptoms, physical findings, and medical examinations with which to determine the indications for early intubation in patients with inhalation injury.MethodsWe retrospectively collected patient data from medical records. Collected data included age, sex, burn size, symptoms, physical findings, carboxyhemoglobin levels (COHb), and bronchial wall thickness (BWT) determined from chest computed tomography images. We analyzed the relationships between these findings and the early intubation. We performed fiberoptic bronchoscopy in all patients, and analyzed the relationships between bronchoscopic severity and other findings.ResultsOf the 205 patients, 80 patients were diagnosed as having inhalation injury, and 34 patients were intubated. Burn size, facial burns, neck burns, use of accessory respiratory muscles, and COHb seemed to be related with intubation, whereas singed nasal hair was not. If the patients suffered ≥27% total body surface area burn and BWT ≥3.5 mm, the positive predictive value for early intubation was 1.00. If the patients suffered smaller cutaneous burn without neck burn, and their COHb <4.0%, the negative predictive value for early intubation was 0.97. Fiberoptic bronchoscopy findings from above the glottis were mainly related with patients’ symptoms. Findings from below the glottis were mainly related with BWT and COHb.ConclusionsPatients’ symptoms, especially use of accessory respiratory muscles, are reliable, and BWT and COHb are also useful tools, for determining the indication for early intubation.

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Section: Introductionmentioning

confidence: 99%

Indications of early intubation for patients with inhalation injury

Onishi

Osuka

Kuroki

et al. 2017

Acute Medicine & Surgery

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“…This is evidence of a dose-response relationship between total smoke exposure and early airway injury effects in this lower tracheal and proximal bronchial region. 32 In contrast, more upper trachea showed significantly less injury, and no correlation with carboxyhemoglobin levels at any time following exposure.…”

Section: Discussionmentioning

confidence: 86%

In vivo optical coherence tomography detection of differences in regional large airway smoke inhalation induced injury in a rabbit model

Brenner

Kreuter

et al. 2008

J. Biomed. Opt.

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Smoke inhalation injury causes acute airway injury that may result in airway compromise with significant morbidity and mortality. We investigate the ability of high resolution endobronchial optical coherence tomography (OCT) to obtain real-time images for quantitatively assessing regional differences between upper tracheal versus lower tracheal and bronchial airway injury responses to smoke inhalation in vivo using a prototype spectral domain (SLD)-OCT system we constructed, and flexible fiber optic probes. 33 New Zealand White rabbits are intubated and mechanically ventilated. The treatment groups are exposed to inhaled smoke. The OCT probe is introduced through the endotracheal tube and maintained in place for 5 to 6 h. Images of airway mucosa and submucosa are obtained at baseline and at specified intervals postexpo-sure. Starting within less than 15 min after smoke inhalation, there is significant airway thickening in the smoke-exposed animals. This is maintained over 5 h of imaging studies. The lower tracheal airway changes, correlating closely with carboxyhemoglobin levels, are much greater than upper tracheal changes. Significant differences are seen in lower trachea and bronchi after acute smoke inhalation compared to upper trachea as measured in vivo by minimally invasive OCT. OCT is capable of quantitatively detecting regional changes in airway swelling following inhalation injury.

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“…Veränderungen des Lungenröntgens innerhalb der ersten Tage nach dem Trauma wurden als Indiz für ein spätes Inhalationstrauma bezeichnet, dürften aber nach heutigem Wissensstand hauptsächlich iatrogen bedingt sein und mit der oftmals exzessiven Flüssigkeitssubsti-tution in Zusammenhang stehen (siehe Kapitel Therapie). Andere Untersuchungsmethoden wie Computertomographie [22,23] und Xenon Szintigraphie [24] haben sich in der klinischen Praxis nicht etablieren lönnen.…”

Section: Diagnoseunclassified

Das Inhalationstrauma – Epidemiologie, Diagnostik und Therapie

Thaler

Kraincuk

Kamolz

et al. 2010

Wien Klin Wochenschr

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Inhalation injury present with an attributable excess mortality and thus worsen the prognosis of burned patients. New insights into the pathogenesis of inhalation injury, however, have led to improved therapeutic possibilities with improved outcome. Necessary prerequisites are a timely diagnosis and restrictive volume management, especially in patients with extensive burns. Prospective studies are needed to be able to answer the many emerging questions.

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Assessment of Severity of Ovine Smoke Inhalation Injury by Analysis of Computed Tomographic Scans

Abstract: At 24 hours, CT scanning enabled SII severity stratification; qualitative evaluation (RADS) outperformed current semiautomated methods (DENS, FALT).

Cited by 55 publications

References 31 publications

Indications of early intubation for patients with inhalation injury

Indications of early intubation for patients with inhalation injury

In vivo optical coherence tomography detection of differences in regional large airway smoke inhalation induced injury in a rabbit model

Das Inhalationstrauma – Epidemiologie, Diagnostik und Therapie

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