Pulmonary histopathologic abnormalities and predictor variables in autopsies of burned pediatric patients

Abstract

Pulmonary abnormalities occur in 30–80% of fatalities after burn injury. The objective of our study is to investigate lung pathology in autopsy tissues of pediatric burn patients. METHODS Three scientists with pathology training in pediatric burn care reviewed masked autopsy slides of burned children who died after admission to a burn center from 2002–2012 (n=43). Autopsy lung tissue was assigned scores for histologic abnormalities in 9 categories, including alveolar and interstitial fibrosis, hyaline membranes, and type II epithelial cell proliferation. Scores were then tested for correlation with age, TBSA burn, number of days between burn and death, time between burn and admission, and the presence of inhalation injury using analyses with linear models. RESULTS Type II epithelial cell proliferation was significantly more common in cases with a longer time between burn and admission (p<0.02). Interstitial fibrosis was significantly more severe in cases with longer survival after burn (p<0.01). The scores for protein were significantly higher in cases with longer survival after burn (p<0.03). Enlarged air spaces were significantly more prominent in cases with longer survival after burn (p<0.01), and in cases with the presence of inhalation injury (p<0.01). CONCLUSIONS Histological findings associated with Diffuse Alveolar Damage (DAD), which is the pathological correlate of the Acute Respiratory Distress Syndrome (ARDS), were seen in approximately 42% of autopsies studied. Protein-rich alveolar edema, which is the abnormality that leads to ARDS, may occur from multiple causes, including inhalation injury.

Influence of solution of lactoprotein with sorbitol on ultrastructural changes in lungs of rats in the condition of burn shock

“…We also revealed ultrastructural changes in alveolocytes which indicate their low functional activity. The changes observed correspond to the data obtained in other studies in the period of burn shock (Sousse et al, 2015;Zhang et al, 2018). At day 7 of burn shock, using 0.9% of NaCl solution, signs of progression of destructive changes in the components of the aerohematic barrier were observed, indicating the weak protective effect of 0.9% NaCl solution.…”

“…However, further elucidation of the ultrastructural mechanism of homeostasis in the lungs will allow us to assess both early changes in the body and the effectiveness of the applied therapy. In general, the ultrastructural changes detected in the application of the physiological solution on days 3 and 7 indicate an inadequate effect of this type of infusion therapy in preventing cellular damage in the lungs, this is compared a c b with the data regarding the development of pulmonary complications in the application of 0.9% NaCl solution to burn patients and in experimental studies (Jacob et al, 2015;Sousse et al, 2015). The obtained data correspond to ultrastructural changes recorded in other experimental studies regarding cellular lung injury on the background of thermal burns (Zhang et al, 2018).…”

“…Pathogenesis of development and cellular mechanisms of lung damage is the least studied aspect of this problem, which, in turn, hinders the development of adequate and sufficiently effective methods of treatment of this pathology (Kaddoura et al, 2017). In the literature, morphofunctional changes in the structure of the lungs are not sufficiently studied, attention is not paid to the dynamics of these disorders, depending on the period of burn disease, and their relationship, which requires further research (Jacob et al, 2015;Sousse et al, 2015).…”

“…The pronounced disturbances of peripheral blood flow in certain areas of the lungs contribute to the formation of infiltrates, and later bronchopneumonia. In a morphological study of lungs (Sousse et al, 2015), it is possible to observe in the alveolus a protein-rich fluid with acuminate alveolocytes, macrophages, red blood cells, and fibrin cones. In cases of burn shock, functional activity decreases and the alveolar macrophage ultrastructure changes (Zhang et al, 2018).…”

Integrity of airway epithelium in pediatric burn autopsies: Association with age and extent of burn injury

“…Histologic study of 43 of these cases was included in a recent publication on autopsies of burn subjects with a focus on the semiquantitative assessment of changes associated with diffuse alveolar damage, the clinical correlate of ARDS [7]. Because changes in the airway epithelium have not been described in ARDS, that study did not include any assessment of the airways.…”