Macroscopic and histological findings in the healing process of inhalation injury

Arakawa, Atsuhiro; Fukamizu, Hidekazu; Hashizume, Ikko; Kasamatsu, Norio; Nagayoshi, Masaru; Shinozuka, Nariyuki; Yasuda, Tadashi; Ozawa, Takachika

doi:10.1016/j.burns.2006.10.405

Cited by 20 publications

(7 citation statements)

References 9 publications

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“…Severe inhalation injury is in part a mechanical process characterized by pulmonary edema, bronchial edema, and secretions, can occlude the airway leading to atelectasis and pneumonia. Aggressive use of bronchoscopy is highly effective in removing foreign particles and accumulated secretions that worsen the inflammatory response and may impede ventilation [34,35]. While it seems intuitive that bronchoscopy could improve pulmonary hygiene and outcomes by removing secretions and epithelial slough in burn patients, only recently has this question been addressed by a review of the National Burn Repository of the American Burn Association [33].…”

Section: Treatment Strategiesmentioning

confidence: 99%

Inhalation injury: epidemiology, pathology, treatment strategies

Dries

Endorf

2013

Scand J Trauma Resusc Emerg Med

212

137

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Lung injury resulting from inhalation of smoke or chemical products of combustion continues to be associated with significant morbidity and mortality. Combined with cutaneous burns, inhalation injury increases fluid resuscitation requirements, incidence of pulmonary complications and overall mortality of thermal injury. While many products and techniques have been developed to manage cutaneous thermal trauma, relatively few diagnosis-specific therapeutic options have been identified for patients with inhalation injury. Several factors explain slower progress for improvement in management of patients with inhalation injury. Inhalation injury is a more complex clinical problem. Burned cutaneous tissue may be excised and replaced with skin grafts. Injured pulmonary tissue must be protected from secondary injury due to resuscitation, mechanical ventilation and infection while host repair mechanisms receive appropriate support. Many of the consequences of smoke inhalation result from an inflammatory response involving mediators whose number and role remain incompletely understood despite improved tools for processing of clinical material. Improvements in mortality from inhalation injury are mostly due to widespread improvements in critical care rather than focused interventions for smoke inhalation.Morbidity associated with inhalation injury is produced by heat exposure and inhaled toxins. Management of toxin exposure in smoke inhalation remains controversial, particularly as related to carbon monoxide and cyanide. Hyperbaric oxygen treatment has been evaluated in multiple trials to manage neurologic sequelae of carbon monoxide exposure. Unfortunately, data to date do not support application of hyperbaric oxygen in this population outside the context of clinical trials. Cyanide is another toxin produced by combustion of natural or synthetic materials. A number of antidote strategies have been evaluated to address tissue hypoxia associated with cyanide exposure. Data from European centers supports application of specific antidotes for cyanide toxicity. Consistent international support for this therapy is lacking. Even diagnostic criteria are not consistently applied though bronchoscopy is one diagnostic and therapeutic tool. Medical strategies under investigation for specific treatment of smoke inhalation include beta-agonists, pulmonary blood flow modifiers, anticoagulants and antiinflammatory strategies. Until the value of these and other approaches is confirmed, however, the clinical approach to inhalation injury is supportive.

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Section: Treatment Strategiesmentioning

confidence: 99%

Inhalation injury: epidemiology, pathology, treatment strategies

Dries

Endorf

2013

Scand J Trauma Resusc Emerg Med

212

137

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“…A focus of care for children with inhalation injury is aggressive pulmonary toilet, which includes chest physiotherapy, therapeutic bronchoscopy in older children, coughing, and, if possible, early ambulation (57,58). If a child is mechanically ventilated, attention should be paid to minimize barotrauma and volutrauma by minimizing both peak airway pressures and tidal volumes (57).…”

Section: Perioperative Respiratory Managementmentioning

confidence: 99%

Inhalation burn injury in children

Fidkowski

Fuzaylov

Sheridan

et al. 2009

Pediatric Anesthesia

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SummaryWith advances in burn care, many children are surviving severe burn injuries. Inhalation injury remains a predictor of morbidity and mortality in burn injury. Inhalation of smoke and toxic gases leads to pulmonary complications, including airway obstruction from bronchial casts, pulmonary edema, decreased pulmonary compliance, and ventilation-perfusion mismatch, as well as systemic toxicity from carbon monoxide poisoning and cyanide toxicity. The diagnosis of inhalation injury is suggested by the history and physical exam and can be confirmed by bronchoscopy. Management consists of supportive measures, pulmonary toilet, treatment of pulmonary infection and ventilatory support as needed. This review details the pathophysiology, diagnosis, and management options for inhalation injury.

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“…Surprisingly, the tracheal wall thickness reached 9.0 mm on admission. The degree of thickening, which is thought to be primarily induced by mucosal edema [12,13], decreased after 2 days, although it did not normalize. Point-of-care US may be the first modality of choice for the initial evaluation of the upper trachea in patients who suffer smoke inhalation.…”

Section: Discussionmentioning

confidence: 99%

Point-of-care ultrasound detection of tracheal wall thickening caused by smoke inhalation

Kameda

Fujita

2014

Crit Ultrasound J

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Smoke inhalation is the leading cause of death due to fires. When a patient presents with smoke inhalation, prompt assessment of the airway and breathing is necessary. Point-of-care ultrasonography (US) is used for the rapid assessment of critically ill or injured patients. We herein present a case report of a 54-year-old male who was transferred to the emergency department with shortness of breath, coughing, carbonaceous sputa, and rhinorrhea after inhaling smoke caused by a fire in his locked bedroom. He had no surface burns on the face and no edema or erosion in the oral cavity. He had hoarseness without stridor. His breath sounds were positive for expiratory wheezes. Laryngoscopy showed light edema and erosive findings on the supraglottic region. Bedside point-of-care US revealed hypoechoic thickening of the tracheal wall. The thickening was confirmed by a computed tomographic scan. The patient was carefully monitored with preparation for emergency airway management and was treated with supplemental oxygen and an aerosolized beta-2 adrenergic agonist in the intensive care unit. The symptoms were subsequently relieved, and reexamination by US after 2 days showed remission of the wall thickening. Point-of-care US may therefore be a useful modality for the rapid diagnosis and effective follow-up of tracheal wall thickening caused by smoke inhalation.

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Macroscopic and histological findings in the healing process of inhalation injury

Cited by 20 publications

References 9 publications

Inhalation injury: epidemiology, pathology, treatment strategies

Inhalation injury: epidemiology, pathology, treatment strategies

Inhalation burn injury in children

Point-of-care ultrasound detection of tracheal wall thickening caused by smoke inhalation

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