Smoking-Related Home Oxygen Burn Injuries: Continued Cause for Alarm

Carlos, W. Graham; Baker, Mary S.; McPherson, Katie; Bosslet, Gabriel T.; Sood, Rajiv; Torke, Alexia M.

doi:10.1159/000443798

Cited by 19 publications

(11 citation statements)

References 9 publications

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“…In agreement with previous studies, we suggest that there is a need to update the guidelines regarding smoking during LTOT 2,12,16. Efforts to cease smoking should be optimized.…”

Section: Discussionsupporting

confidence: 91%

“…This is in line with studies from the USA, where the mean age of patients on LTOT with burn injuries, was 62–64 years, ie, significantly younger than the LTOT patients in general 1,12,13. A previous study has shown that at least 21% of Danish COPD patients on LTOT were still smoking, and the smokers were on average 2.3 years younger than the nonsmokers 5.…”

Section: Discussionsupporting

confidence: 89%

“…This is lower compared with the study by Carlos et al12 (n=55), which reported that 14.5% of patients died within a mean of 10 days (range, 1–53 days) after discharge from a burn unit for smoking-related, home oxygen injury. The lower mortality rate in the present study could be explained by a less selected population and by capturing less severe burn injuries using national hospitalization and outpatient data.…”

Section: Discussioncontrasting

confidence: 64%

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Burn injury during long-term oxygen therapy in Denmark and Sweden: the potential role of smoking

Tanash

Ringbæk

Huss

et al. 2017

COPD

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BackgroundLong-term oxygen therapy (LTOT) increases life expectancy in patients with COPD and severe hypoxemia. Smoking is the main cause of burn injury during LTOT. Policy regarding smoking while on LTOT varies between countries. In this study, we compare the incidence of burn injury that required contact with a health care specialist, between Sweden (a country with a strict policy regarding smoking while on LTOT) and Denmark (a country with less strict smoking policy).MethodsThis was a population-based, cohort study of patients initiating LTOT due to any cause in Sweden and Denmark. Data on diagnoses, external causes, and procedures were obtained from the Swedish and Danish National Patient Registers for inpatient and outpatient care. Patients were followed from January 1, 2000, until the first of the following: LTOT withdrawal, death, or study end (December 31, 2009). The primary end point was burn injury during LTOT.ResultsA total of 23,741 patients received LTOT in Denmark and 7,754 patients in Sweden. Most patients started LTOT due to COPD, both in Sweden (74%) and in Denmark (62%). The rate of burn injury while on LTOT was higher in Denmark than in Sweden; 170 (95% confidence interval [CI], 126–225) vs 85 (95% CI, 44–148) per 100,000 person-years; rate ratio 2.0 (95% CI, 1.0–4.1). The risk remained higher after adjustment for gender, age, and diagnosis in multivariate Cox regression, hazard ratio 1.8 (95% CI, 1.0−3.5). Thirty-day mortality after burn injury was 8% in both countries.ConclusionCompared to Sweden, the rate of burn injury was twice as high in Denmark where smoking is not a contraindication for prescribing LTOT.

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“…In agreement with previous studies, we suggest that there is a need to update the guidelines regarding smoking during LTOT 2,12,16. Efforts to cease smoking should be optimized.…”

Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 89%

Section: Discussioncontrasting

confidence: 64%

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Burn injury during long-term oxygen therapy in Denmark and Sweden: the potential role of smoking

Tanash

Ringbæk

Huss

et al. 2017

COPD

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“…Individuals with COPD on home oxygen are at increased risk of burn [12–14]. Sharma et al found that the absolute risk of burn in patients prescribed oxygen therapy was 2.98 per 1000 patients compared with 1.69 per 1000 patients not prescribed oxygen during a 22-month period [15].…”

Section: Discussionmentioning

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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“…In a recent issue of Respiration , Carlos et al [9] report their experience with smoking-related home oxygen burn injuries. Their aim was to quantify the morbidity and mortality of these events over a 6-year period by reviewing the charts of all patients admitted to their large regional burn center with approximately 350 admissions per year.…”

mentioning

confidence: 99%