Pulmonary Complications of Burns

Achauer, Bruce M.; Allyn, Patricia A.; Furnas, David W.; Bartlett, Robert H.

doi:10.1097/00000658-197303000-00012

Cited by 113 publications

(8 citation statements)

References 20 publications

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“…Humans with chest, back or torso circumferential burns have breathing patterns with rapid shallow breaths, not slow shallow breaths, as we have observed in our model (Achauer et al, 1973). These differences, however, may be attributed to the immediate care provided to human burn patients.…”

Section: Discussionsupporting

confidence: 71%

“…Restricted chest wall movement can cause burn patients to lose this ability. Without this interruption in tidal volume, the alveoli eventually collapse in a process known as atelectasis, resulting in decreased blood flow, oxygen exchange and the ability of the lungs to expand (Achauer et al, 1973; McCutcheon, 1953). Our data demonstrate that the loss of lung compliance with burn injury, even in the absence of inhalation injury, is further decreased when intoxication precedes burn injury.…”

Section: Discussionmentioning

confidence: 99%

“…Clinical data suggest that 42% of the mortality observed in burn patients is due to pulmonary complications (Achauer, Allyn, Furnas, & Bartlett, 1973; Phillips & Cope, 1962). Severe burn, even in the absence of inhalation injury, is a common predisposing factor for the development of Acute Respiratory Distress Syndrome (ARDS) (Liffner, Bak, Reske, & Sjoberg, 2005; Turnage et al, 2002).…”

Section: Introductionmentioning

confidence: 99%

“…ARDS is associated with rigid lungs, hypoxemia, and bi-lateral infiltrates in chest radiographs (Ashbaugh, Bigelow, Petty, & Levine, 1967). Overall, respiratory dysfunction in burn patients is characterized by shallow breathing and fluid accumulation in the lung interstitium, leading to heightened vascular resistance and an increased effort to breathe (Achauer et al, 1973; Turnage et al, 2002). A net result of insufficient gas exchange underlies the large percentage of burn fatalities due to pulmonary complications.…”

Section: Introductionmentioning

confidence: 99%

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Impaired respiratory function and heightened pulmonary inflammation in episodic binge ethanol intoxication and burn injury

Shults

Curtis

Chen

et al. 2015

Alcohol

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Clinical data indicate that cutaneous burn injuries covering greater than ten percent total body surface area are associated with significant morbidity and mortality, where pulmonary complications, including acute respiratory distress syndrome (ARDS), contribute to nearly half of all patient deaths. Approximately 50% of burn patients are intoxicated at the time of hospital admission, which increases days on ventilators by three-fold, and doubles length of hospital admittance, compared to non-intoxicated burn patients. The most common drinking pattern in the United States is binge drinking, where one rapidly consumes alcoholic beverages (4 for women, 5 for men) in 2 hours and an estimated 38 million Americans binge drink, often several times per month. Experimental data demonstrate a single binge ethanol exposure prior to scald injury, impairs innate and adaptive immune responses, thereby enhancing infection susceptibility and amplifying pulmonary inflammation, neutrophil infiltration, and edema, and is associated with increased mortality. Since these characteristics are similar to those observed in ARDS burn patients, our study objective was to determine whether ethanol intoxication and burn injury and the subsequent pulmonary congestion affects physiological parameters of lung function using non-invasive and unrestrained plethysmography in a murine model system. Furthermore, to mirror young adult binge drinking patterns, and to determine the effect of multiple ethanol exposures on pulmonary inflammation, we utilized an episodic binge ethanol exposure regimen, where mice were exposed to ethanol for a total of 6 days (3 days ethanol, 4 days rest, 3 days ethanol) prior to burn injury. Our analyses demonstrate mice exposed to episodic binge ethanol and burn injury have higher mortality, increased pulmonary congestion and neutrophil infiltration, elevated neutrophil chemoattractants, and respiratory dysfunction, compared to burn or ethanol intoxication alone. Overall, our study identifies plethysmography as a useful tool for characterizing respiratory function in a murine burn model and for future identification of therapeutic compounds capable of restoring pulmonary functionality.

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Section: Discussionsupporting

confidence: 71%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Impaired respiratory function and heightened pulmonary inflammation in episodic binge ethanol intoxication and burn injury

Shults

Curtis

Chen

et al. 2015

Alcohol

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“…Following major burns, mortality is usually attributable to pulmonary complications, which can occur in up to 41% of patients admitted to the hospital after burn [2–4]. Previous studies over the last three decades have shown the effect of burns on the respiratory system occurs in three phases [5–9]. …”

Section: Introductionmentioning

confidence: 99%

The effect of preexisting respiratory co-morbidities on burn outcomes

Knowlin

Stanford

Cairns

et al. 2017

Burns

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Introduction Burns cause physiologic changes in multiple organ systems in the body. Burn mortality is usually attributable to pulmonary complications, which can occur in up to 41% of patients admitted to the hospital after burn. Patients with preexisting comorbidities such as chronic lung diseases may be more susceptible. We therefore sought to examine the impact of preexisting respiratory disease on burn outcomes. Methods A retrospective analysis of patients admitted to a regional burn center from 2002–2012. Independent variables analyzed included basic demographics, burn mechanism, presence of inhalation injury, TBSA, pre-existing comorbidities, smoker status, length of hospital stay, and days of mechanical ventilation. Bivariate analysis was performed and Cox regression modeling using significant variables was utilized to estimate hazard of progression to mechanical ventilation and mortality. Results There were a total of 7640 patients over the study period. Overall survival rate was 96%. 8% (n=672) had a preexisting respiratory disease. Chronic lung disease patients had a higher mortality rate (7%) compared to those without lung disease (4%, p<0.01). The adjusted Cox regression model to estimate the hazard of progression to mechanical ventilation in patients with respiratory disease was 21% higher compared to those without respiratory disease (HR=1.21, 95% CI=1.01–1.44). The hazard of progression to mortality is 56% higher (HR=1.56, 95% CI=1.10–2.19) for patients with pre-existing respiratory disease compared to those without respiratory disease after controlling for patient demographics and injury characteristics. Conclusion Preexisting chronic respiratory disease significantly increases the hazard of progression to mechanical ventilation and mortality in patients following burn. Given the increasing number of Americans with chronic respiratory diseases, there will likely be a greater number of individuals at risk for worse outcomes following burn.

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