Inhalation injury in burned patients: effects and treatment

Herndon, David N.; Barrow, Robert E.; Linares, Hugo A.; Rutan, Randi L.; Prien, T.; Traber, Lillian D.; Traber, Daniel L.

doi:10.1016/0305-4179(88)90002-2

Cited by 103 publications

(58 citation statements)

References 34 publications

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“…However, a proportion of the airway thickening changes seen on OCT disappears immediately following sacrifice, six hours postexposure. This would suggest that previously described hyperemia 1,2,26,27 in the initial stages following smoke exposure may be a significant component of this process. Furthermore, histology of the tracheal specimens following sacrifice does not demonstrate significant changes from controls, even in animals that had dramatic changes seen on OCT; this is consistent with published literature and suggests edema or hyperemia as major components of the early injury process that are lost during histologic preparation.…”

Section: Discussionmentioning

confidence: 84%

“…This can potentially facilitate follow up evaluations of smoke inhalation injury, which progresses over time, 1,2,26,27,33 and that may not be evident during bronchoscopic evaluation. This study was able to demonstrate that OCT has the capability of not only detecting changes in thickness in the layers of the mucosa, but also quantifying differences in the magnitude of changes in the upper and lower trachea.…”

Section: Discussionmentioning

confidence: 99%

“…High-resolution flexible fiber optic optical coherence tomography (OCT) provides the potential to observe real-time changes in the airway mucosa and epithelium using minimally invasive imaging techniques. [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] Most importantly, some of the early pathologic changes following smoke inhalation that may be indicative of the extent of injury such as edema and hyperemia 2,[26][27][28][29] may not be apparent clinically, endoscopically, or following histologic preparations of excised specimens, but can be readily detected on OCT. 30 Previous OCT airway injury studies 30 in rabbit smoke inhalation models suggested to us that the upper trachea airway may react very differently to acute smoke inhalation compared to distal trachea and proximal bronchi. The purpose of this study was to demonstrate the potential role of OCT in quantitatively detecting early smoke inhalation injury and assessing differences in response of more proximal versus distal large airways to smoke inhalation injury.…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 84%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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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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“…Pulmonary pathologic abnormalities occur in 30-80% of deaths from burn injury [6]. Pulmonary disease exists in several forms, including acute lung injury (ALI) and acute respiratory distress syndrome (ARDS).…”

Section: Open Access Http://scidocorg/ijfpphpmentioning

confidence: 99%

Acridine Orange Fluroscence Study of Lung - Histopathology in Autopsy Cases of Burns

Vm¹,

Bv²,

Nj³

2017

IJFP

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“…Corticosteroids are not routinely indicated and should be used only in cases of bronchospasm that is unresponsive to the initial measures. (4,18,19) Although the use of surfactant, deferoxamine and nitric oxide has proven efficacious in animal models, (20)(21)(22) clinical studies are needed. Cytological, immunocytochemical and biochemical analyses performed in bronchoalveolar lavage (BAL) specimens can be useful for determining the pulmonary response to injury and predicting the clinical evolution of patients with SII.…”

mentioning

confidence: 99%

Análise do lavado broncoalveolar em vítimas de queimaduras faciais graves

et al. 2009

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Objective: To analyze bronchoalveolar lavage (BAL) specimens of burn victims who inhaled smoke, in order to identify alterations associated with mortality or survival. Methods: Eighteen victims of facial burns were submitted to BAL up to 24 h after the event. We investigated cell and protein content, including TNF-α, HLA-DR, CD14, CD68 and iNOS. Results: Of the 18 patients submitted to bronchoscopy, 8 (44.4%) died during the follow-up period. The mean age of patients who died was significantly higher (44.7 vs. 31.5 years). On average, the patients who died had burns covering 60.1% of the total body surface area, compared with 26.1% in the survivors (p < 0.0001). Of the 18 patients submitted to bronchoscopy, 11 (61.1%) showed endoscopic signs of smoke inhalation injury, and 4 (36.4%) of those 11 died. Of the 7 patients with no signs of smoke inhalation injury, 4 (57.1%) died. The mean number of ciliated epithelial cells in the BAL fluid was significantly higher in the patients who died than in the survivors (6.6% vs. 1.4%; p = 0.03). There were no significant differences between the groups in terms of any of the other parameters evaluated. Conclusions: The total body surface area burned was a predictive factor for mortality. Increased numbers of ciliated epithelial cells in the BAL fluid, denoting bronchial epithelial desquamation, were associated with higher mortality in patients with facial burns. (44,7 vs. 31,5 anos). A superfície corporal queimada foi em média de 60,1% nos pacientes que morreram e de 26,1% nos sobreviventes (p < 0,0001). Entre os 18 pacientes submetidos à broncoscopia, 11 (61,1%) apresentaram sinais endoscópicos de lesão por inalação de fumaça, e 4 (36,4%) destes faleceram. Dos 7 pacientes sem sinais de lesão por inalação de fumaça, 4 (57,1%) faleceram. A média do número de células epiteliais ciliadas no LBA dos pacientes que morreram foi significativamente maior daquela dos sobreviventes (6,6% vs. 1,4%; p = 0,03). Os demais parâmetros analisados não mostraram diferença entre os grupos. Conclusões: A superfície corporal queimada mostrou ser um fator preditivo de mortalidade. O aumento do número de células epiteliais ciliadas no LBA, denotando descamação epitelial brônquica, esteve associado à maior mortalidade de pacientes com queimaduras faciais.Descritores: Queimaduras; Lesão por inalação de fumaça; Lavagem broncoalveolar; Células epiteliais brônquicas; Macrófagos; Fator de necrose tumoral alfa.

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Inhalation injury in burned patients: effects and treatment

Cited by 103 publications

References 34 publications

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

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

Acridine Orange Fluroscence Study of Lung - Histopathology in Autopsy Cases of Burns

Análise do lavado broncoalveolar em vítimas de queimaduras faciais graves

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