Inhalation of products of combustion

Cohen, Merrill A.; Guzzardi, Lawrence J.

doi:10.1016/s0196-0644(83)80209-1

Cited by 58 publications

(21 citation statements)

References 31 publications

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“…It has previously been postulated that increased salivary secretions may be precipitated in this population by concomitant inhalation injury, with poor cilia functioning and sloughing of and damage to the mucosa causing increased secretion production and decreased sensation 11,56,62 .…”

Section: Resultsmentioning

confidence: 99%

Physiological Characteristics of Dysphagia Following Thermal Burn Injury

et al. 2011

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1 This project was supported by funding from the Royal Brisbane and Women's Hospital (RBWH) Foundation. 2 Physiological characteristics of dysphagia following thermal burn injury 3 AbstractThe study aim was to document the acute physiological characteristics of the swallowing impairment following thermal burn injury. A series of 19 participants admitted to a specialised burn centre with thermal burn injury were identified with suspected aspiration risk by a clinical swallow examination (CSE) conducted by a speech-language pathologist and referred to the study. Once medically stable, each then underwent more detailed assessment using both a CSE and a fiberoptic evaluation of swallowing (FEES). Subsequent to this assessment, FEES confirmed 6 individuals (32%) had no aspiration risk, and were excluded from further analyses. Of the remaining 13, CSE confirmed two had specific oral phase deficits due to orofacial scarring and contractures, and all 13 had generalised oromotor weakness. FEES revealed numerous pharyngeal phase deficits with major finding evident in greater than 50% being: impaired secretion management, laryngotracheal edema, delayed swallow initiation, impaired sensation, inadequate movement of structures within the hypopharynx and larynx, and diffuse pharyngeal residue. Penetration and/or aspiration occurred in 83% (n = 10/12) of thin fluids trials, with a lack of response to the penetration/aspiration noted in 60% (n = 6/10 penetration/aspiration events) of cases. Most events occurred post swallow. Findings support that individuals with dysphagia post thermal burn present with multiple risk factors for aspiration that appear predominantly related to generalised weakness and inefficiency and further impacted by edema and sensory impairments. Generalised oromotor weakness and orofacial contractures (when present) impact oral stage swallow function. This study has identified a range of factors which may be contributing to both oral and pharyngeal stage dysfunction in this clinical population and highlights the 4 importance of using a combination of clinical and instrumental assessment to fully understand the influence of burn injury on oral intake and swallowing.

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Section: Resultsmentioning

confidence: 99%

Physiological Characteristics of Dysphagia Following Thermal Burn Injury

et al. 2011

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“…The presence of an ETT or tracheostomy tube has been shown to alter the mechanoreceptors and chemoreceptors of the pharyngeal and laryngeal mucosae, causing dysfunction of the swallowing reflex (de Larminat et al, 1995). Furthermore, it has previously been postulated that concomitant inhalation injury, resulting in sloughing of and damage to the mucosa may precipitate decreased sensation (Cohen & Guzzardi, 1983;Gaissert et al, 1993). The underlying mechanisms contributing to recovery of pharyngeal and laryngeal sensitivity may be accounted for by (1) the healing of burnaffected tissues, as well as (2) the withdrawal of medical treatments (e.g., removal of ETT/tracheostomy, weaning of sedation, removal of NGT to allow normalisation of function of chemo-and/or mechanoreceptors located in the pharyngeal and laryngeal mucosae).…”

Section: Discussionmentioning

confidence: 99%

Charting the recovery of dysphagia in two complex cases of post-thermal burn injury: Physiological characteristics and functional outcomes

Rumbach¹,

Ward²,

Zheng³

et al. 2015

Speech, Language and Hearing

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2Charting the recovery of dysphagia in two complex cases of post-thermal burn injury: Physiological characteristics and functional outcomes 3 Abstract Purpose: The current study examined the physiological deficits, recovery pattern and outcomes observed clinically and instrumentally in two participants with dysphagia post thermal burn. Methods: Participants were followed prospectively using clinical and instrumental tools of assessment until dysphagia recovery. Clinical swallowing examinations were carried out every 1 to 2 days, or as clinically indicated. Instrumental assessment using fiberoptic endoscopic examination of swallowing was carried out at fortnightly intervals.Results: Despite variability in the achievement of oral intake milestones, both cases demonstrated protracted recovery from dysphagia contributed to by medical instability and lengthy periods of ventilation and intubation. Instrumental assessment confirmed silent aspiration in both participants, likely due to decreased laryngopharyngeal sensation.By discharge, participants had returned to their pre-morbid diets.Conclusions: This study highlights the protracted and complex recovery pattern associated with dysphagia following thermal burn injury. The presence of silent aspiration emphasizes the need for instrumental assessment to objectively assess aspiration risk and to facilitate dysphagia recovery within this population.

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“…The complexity of the chemical composition of smoke is also due, in part, to the presence of secondary products; after the products of combustion are formed, they remain chemical ly active and continue to react long after the fire has ceased to burn. The list of chemicals of toxicological concern is long (21,26). Smoke from burning oil has been characterized and found to have mutagenic activity in in vitro assays (5); this is undoubtedly also true for other common types of fires.…”

Section: Chemical Hazardsmentioning

confidence: 99%