Indications of early intubation for patients with inhalation injury

Onishi, Shozo; Osuka, Akinori; Kuroki, Yoshio; Ueyama, Masashi

doi:10.1002/ams2.269

Cited by 26 publications

(20 citation statements)

References 24 publications

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“…Risk factors associated with the need for intubation in specific populations such as patients with inhalation injury or acute poisoning have been reported 27 , 28 . However, intubation risk prediction models have generally focused on patients with respiratory failure 3 , 4 , 8 , 29 .…”

Section: Discussionmentioning

confidence: 99%

Predicting the need for intubation in the first 24 h after critical care admission using machine learning approaches

Siu

Kwak

Ling

et al. 2020

Sci Rep

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Early and accurate prediction of the need for intubation may provide more time for preparation and increase safety margins by avoiding high risk late intubation. This study evaluates whether machine learning can predict the need for intubation within 24 h using commonly available bedside and laboratory parameters taken at critical care admission. We extracted data from 2 large critical care databases (MIMIC-III and eICU-CRD). Missing variables were imputed using autoencoder. Machine learning classifiers using logistic regression and random forest were trained using 60% of the data and tested using the remaining 40% of the data. We compared the performance of logistic regression and random forest models to predict intubation in critically ill patients. After excluding patients with limitations of therapy and missing data, we included 17,616 critically ill patients in this retrospective cohort. Within 24 h of admission, 2,292 patients required intubation, whilst 15,324 patients were not intubated. Blood gas parameters (PaO2, PaCO2, HCO3−), Glasgow Coma Score, respiratory variables (respiratory rate, SpO2), temperature, age, and oxygen therapy were used to predict intubation. Random forest had AUC 0.86 (95% CI 0.85–0.87) and logistic regression had AUC 0.77 (95% CI 0.76–0.78) for intubation prediction performance. Random forest model had sensitivity of 0.88 (95% CI 0.86–0.90) and specificity of 0.66 (95% CI 0.63–0.69), with good calibration throughout the range of intubation risks. The results showed that machine learning could predict the need for intubation in critically ill patients using commonly collected bedside clinical parameters and laboratory results. It may be used in real-time to help clinicians predict the need for intubation within 24 h of intensive care unit admission.

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Section: Discussionmentioning

confidence: 99%

Predicting the need for intubation in the first 24 h after critical care admission using machine learning approaches

Siu

Kwak

Ling

et al. 2020

Sci Rep

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“…Arterial blood gas analysis was described as a good tool for the early detection of inhalation injury, while (Onishi, S. et al) carboxyhemoglobin levels (HbCO) were considered a useful predictor of inhalation injury below the glottis. [13,14] In addition, the utility of chest X-rays (increased perihilar or peribronchial in ltration, ground glass haziness of the lung, or other signs that may indicate pulmonary edema or respiratory distress) or even computed tomographic scans (bronchial wall thickness) for the detection of signi cant inhalation injuries have also been reported. [14] Similar to the ndings of previous studies and current guidelines for facial burn management, in the current study, patients who were intubated in the ED had signi cantly more positive signs on physical examinations or abnormal blood gas analysis results (Table 1).…”

Section: Discussionmentioning

confidence: 99%

“…[13,14] In addition, the utility of chest X-rays (increased perihilar or peribronchial in ltration, ground glass haziness of the lung, or other signs that may indicate pulmonary edema or respiratory distress) or even computed tomographic scans (bronchial wall thickness) for the detection of signi cant inhalation injuries have also been reported. [14] Similar to the ndings of previous studies and current guidelines for facial burn management, in the current study, patients who were intubated in the ED had signi cantly more positive signs on physical examinations or abnormal blood gas analysis results (Table 1). However, after undergoing bronchoscopy as a de nitive evaluation, 39.7% of the intubated patients were not found to have airway injuries (Fig.…”

Section: Discussionmentioning

confidence: 99%

Positive Signs on Physical Examination Are Not Always Indications for Endotracheal Tube Intubation in Patients with Facial Burn

Huang¹,

Chen²,

Hsiao³

et al. 2020

Preprint

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BackgroundAfter 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.MethodsFacial burn patients between January 2013 and May 2016 were reviewed. Patients who were and were not intubated in the ED were compared. All intubated patients received routine bronchoscopy to evaluate whether they had inhalation injuries. 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 facial burn patients. The reasons for intubation in patients without inhalation injuries were also investigated.ResultsDuring 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 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 patients with a TBSA over 60% were intubated in the ED even if they did not have inhalation injuries.ConclusionIn 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 paid to facial burn patients with shortness of breath and a high TBSA because they have an increased risk of inhalation injuries. Airway protection is needed in facial burn patients without inhalation injuries because of their associated injuries and treatment.

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“…В исследовании Университета Колорадо, касающемся взрослых ожоговых пациентов, было обнаружено, что критерии Денвера обладают повышенной точностью при прогнозировании необходимости интубации [22]. Однако в других исследованиях было показано, что наличие опален-ных носовых волос само по себе не является показателем для ранней интубации [23]. Есть публикации, авторы которых в качестве показаний для интубации указывают клинически обоснованные подозрения на ингаляционное повреждение или ожог TBSA (общая площадь поверхности тела)> 40% [24].…”

Section: лечение термоигналяционной травмыunclassified

Diagnosis and Management of Inhalation Injuries in U. S. Children

Shahi

Phillips

Moulton

2020

Rossijskij vestnik detskoj hirurgii, anesteziologii i reanimato

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Ингаляционные травмы являются основной причиной детской смертности при пожарах, так как у детей, из-за анатомо-физиологических особенностей дыхательных путей, риск летальных исходов выше, чем у взрослых. В результате сочетанного воздействия теплового и химического факторов повреждающего агента и возникающих при этом вторичных эффектов возможно прямое повреждение паренхимы легких. Диагностика. Фиброоптическая бронхоскопия является современным диагностическим стандартом при диагностике ингаляционного поражения и констатации его выраженности. КТ (компьютерная томография) органов грудной клетки дает дополнительную возможность определения повреждения паренхимы легких у пациентов с ингаляционным поражением. Лечение. Лечение пациентов с ингаляционной травмой направлено на уменьшение бронхоспазма и отека дыхательных путей. Бронходилятаторы являются основой терапии ингаляционных травм. Преимущества вентиляции с высоким дыхательным объемом у детей заключаются в уменьшении дней на ИВЛ, снижении риска развития ОРДС и ателектазов. Физиотерапия грудной клетки, включая всасывание, технику кашля и раннюю мобилизацию, может быть полезной для пациентов с ингаляционными травмами. Заключение. Большинство детей, перенесших серьезную ожоговую травму, выживают. Хотя те, кто получил термоингаляционную травму, подвержены большему риску развития инфекционных осложнений и неблагоприятному исходу заболевания. Сочетание современных методов лечения поражения дыхательных путей и вентиляционной поддержки, как правило, дают хорошие результаты.Ключевые слова: ингаляционная травма, ожог, дети, педиатрия, интубация, респираторная поддержка Диагностика и лечение ингаляционных травм у детей в США (обзор литературы)* Конфликт интересов: Все авторы согласились на публикацию этой статьи. Авторы декларируют отсутствие явных и потенциальных конфликтов интересов, связанных с публикацией настоящей статьи.Для цитирования: Niti Shahi, Ryan Phillips, Steven L. Moulton. Диагностика и лечение ингаляционных травм у детей в США. Российский вестник детской хирургии, анестезиологии и реаниматологии. 2019; 9(4):11-26 https://doi. AbstractInhalation injuries are the leading cause of mortality in fire related deaths in children, who because of their small and fragile airways have a greater risk of mortality than their adult counterparts. Direct injury to the lung parenchyma can be caused by a combination of heat and chemical damage, and their secondary effects. Diagnosis. Fiberoptic bronchoscopy is the current diagnostic standard when determining the presence and severity of an inhalation injury Chest CT (computed tomography) has been described as an adjunct to identifying parenchymal lung damage in inhalation injury patients. Management. The benefits of high tidal volume ventilation in this patient population include decreased ventilation days, decreased ARDS, and decreased atelectasis [The goals of medical therapy in patients with an inhalation injury are: 1) decrease bronchospasm, and 2) decrease airway edema. Bronchodilators are the mainstay of medical therapy f...

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Indications of early intubation for patients with inhalation injury

Cited by 26 publications

References 24 publications

Predicting the need for intubation in the first 24 h after critical care admission using machine learning approaches

Predicting the need for intubation in the first 24 h after critical care admission using machine learning approaches

Positive Signs on Physical Examination Are Not Always Indications for Endotracheal Tube Intubation in Patients with Facial Burn

Diagnosis and Management of Inhalation Injuries in U. S. Children

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