Standardizing the diagnosis of inhalation injury using a descriptive score based on mucosal injury criteria

Ikonomidis, Christos; Lang, Florian; Radu, Alexandre; Berger, Mette M.

doi:10.1016/j.burns.2011.11.009

Cited by 46 publications

(38 citation statements)

References 13 publications

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“…These authors associated the higher fluid requirement in ventilated patients with the requisite sedation and more frequent and extensive debridement and proposed that the requirement for ventilation should be critically evaluated, especially in patients with no inhalation trauma, and that extubation should be performed as early as possible. 5 Ikonomidis et al 33 , in a prospective study, also found an association between the duration of mechanical ventilation and fluid requirements during the first 24 hours after burn injury. In a recent study, ventilation and high amounts of sedatives were related to significantly increased replacement of fluids, and high liquid volumes were associated with a fatal outcome.…”

Section: Discussionmentioning

confidence: 91%

Reducing the Indication for Ventilatory Support in the Severely Burned Patient

Gille

Bauer

Malcharek

et al. 2016

Journal of Burn Care & Research

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Initial management of the severely injured routinely includes sedation and mechanical ventilatory support. However, nonjudiciously applied mechanical ventilatory support can itself lead to poorer patient outcomes. In an attempt to reduce this iatrogenic risk, a standardized, in-house, five-point protocol providing clinical guidance on the use and duration of ventilation was introduced and analyzed, and the impact on patient outcomes was assessed. In 2007, a protocol for early spontaneous breathing was introduced and established in clinical practice. This protocol included: 1) early extubation (≤6 hours after admission) in the absence of absolute ventilatory indication; 2) avoidance of "routine intubation" in spontaneously breathing patients; 3) early postoperative extubation, including patients requiring multiple surgical interventions; 4) intensive chest and respiratory physiotherapy with routine application of expectorants; and 5) early active mobilization. A retrospective clinical study compared patients (group A) over a 2-year period admitted under the new protocol with a historical patient group (group B). Patients in group A (n = 38) had fewer ventilator days over the time-course of treatment (3 [1; 5.8] vs 18.5 days [0.5; 20.5]; P = .0001) with a lower rate of tracheostomies (15.8 vs 54%; P = .0003). Patients on ventilation at admission in group A had shorter ventilation periods after admission (4.75 [4; 22.25] vs 378 hours [8.5; 681.5]; P = .0003), and 66.7% of these patients were extubated within 6 hours of admission (vs 9.1% in group B). No patients fulfilling the inclusion criteria required re- or emergency intubation. In the first 5 days of treatment, significantly lower Sequential Organ Failure Assessment scores were recorded in group A. There was also a trend for lower mortality rates (0 [0%] vs 6 [14%]), sepsis rates (24 [63.2%] vs 37 [88.1%]), and cumulative fluid balance on days 3 and 7 in group A. In contrast, group A demonstrated an elevated rate of pneumonia (15 [39.5%] vs 8 [19%]). These trends, however, lacked statistical significance. Our five-point protocol was safe and easily translated into clinical practice. In the authors experience, this protocol significantly reduced the ventilatory period in severely injured. Furthermore, this study suggests that many injured may be over-treated with routine ventilation, which carries accompanying risks.

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Section: Discussionmentioning

confidence: 91%

Reducing the Indication for Ventilatory Support in the Severely Burned Patient

Gille

Bauer

Malcharek

et al. 2016

Journal of Burn Care & Research

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“…Il est aussi responsable d'une action paralysante des centres nerveux respiratoires, à l'origine d'une apnée [15] ; -autres : le CO 2 , produit en grande quantité lors des incendies, n'est pas toxique mais provoque, même à de faibles concentrations, une hyperventilation favorisant l'inhalation des autres gaz toxiques. Il est aussi responsable d'acidose respiratoire favorisant la distribution cérébrale de certains toxiques comme les cyanures [16]. Le mécanisme exact de ces modifications de distribution tissulaire n'est pas univoque mais correspond à l'augmentation du débit sanguin cérébral et à de probables modifications de perméabilité de la barrière hématoencéphalique ;…”

Section: Effets Toxiques Chez L'hommeunclassified

“…De plus, l'hypoxie n'est pas corrélée à l'importance des anomalies radiologiques. La présence de suies dans les cavités nasales ou oropharyngées ne permet pas de prédire l'atteinte pulmonaire distale, mais est associée à une ventilation mécanique prolongée [16]. La réalisation systématique d'une fibroscopie bronchique a été proposée à des fins diagnostique, pronostique et thérapeutique.…”

Section: Effets Toxiques Chez L'hommeunclassified

Mécanismes de toxicité des fumées d’incendie (monoxyde de carbone et cyanures exclus)

Labadie¹,

Capaldo²,

Courtois³

et al. 2016

Réanimation

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“…One limitation of the present study was that it was a small retrospective cohort. Ikonomidis et al (27) used a different grading system that subcategorized bronchoscopic findings into upper airway and lower tracheobronchial tree to show that lower extension of injury is associated with prolonged mechanical ventilation. This was a single-centre study lacking external validation.…”

Section: Figure 5) Proportion Of Canadian Burn Centres That Use Antibmentioning

confidence: 99%

A survey of current practices in the diagnosis of and interventions for inhalational injuries in Canadian burn centres

Yeung

Leung

Papp

2013

Canadian Journal of Plastic Surgery

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Objective To summarize current Canadian practice patterns in the diagnosis of and interventions for inhalation injuries (INHI). Methods A 10-question survey regarding the diagnosis of and interventions for INHI was sent to the medical directors of all 16 burn centres across Canada. Results The response rate to the survey was 50%. Fibreoptic bronchoscopy is required for the diagnosis of INHI in only four centres (50%). The departments of intensive care, plastic surgery, otolaryngology and respirology are involved in performing fibreoptic bronchoscopy in 87.5%, 37.5%, 12.5% and 12.5% of Canadian burn centres, respectively. Intubation for INHI is most often based on physical examination results (87.5%) and clinical history (75%). The most common physical features believed to be most consistent with INHI are dyspnea (87.5%) and hoarseness (87.5%). Common treatments include intubation (87.5%), routine ventilatory support (87.5%) and chest physiotherapy (75%). None of the centres used nebulized heparin. A total of five centres (62.5%) routinely changed the fluid resuscitation protocol when INHI was diagnosed. Only two centres (25%) routinely used prophylactic antibiotics for INHI. Conclusion Prospective, multicentre trials are needed to generate evidence-based consensus in the areas of diagnosis, grading and treatment for INHI in Canada.

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Standardizing the diagnosis of inhalation injury using a descriptive score based on mucosal injury criteria

Cited by 46 publications

References 13 publications

Reducing the Indication for Ventilatory Support in the Severely Burned Patient

Reducing the Indication for Ventilatory Support in the Severely Burned Patient

Mécanismes de toxicité des fumées d’incendie (monoxyde de carbone et cyanures exclus)

A survey of current practices in the diagnosis of and interventions for inhalational injuries in Canadian burn centres

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