The Influence of Inhalation Injury and Pneumonia on Burn Mortality

Shirani, Khan Z.; Pruitt, Basil A.; Mason, Arthur D.

doi:10.1097/00000658-198701000-00015

Cited by 540 publications

(185 citation statements)

References 13 publications

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“…Along with the BSB, lesion depth and age, lung lesions also interfere with the patient's prognosis. [31] The association between inhalation injury and pneumonia may in-crease mortality by 60% [35]. The difference of the results shows that each BTC must know the clinical and epidemiological profile of patients treated in that locality.…”

Section: Discussionmentioning

confidence: 99%

Factors associated with survival of burned patients

et al. 2015

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Background: It is scarce in the literature studies regarding treatment and objective analysis of the survival chances of burned patients. Some investigations indicates the need for obtaining specific data to the population studied and characteristics such as social condition and nutritional status are suggested to be relevant to the patient's evolution. We aimed to describe the mortality of a Treatment Center Burn Unit (BU) in Brazil. Methods:We analyzed 76 burned victims hospitalized with a fatal outcome in the General Hospital of São Matheus in 10 years (1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009). The following collected data were investigated were: age, sex, period of permanence, body surface burned (BSB), degree of burns, the causal agent, inhalation injury, nature of the event, clinical complications, mortality and survival rates. Results:We observed predominantly male and the median age was 44 years old. The highest incidence was on June. The mean body surface area burned was 40%, and upper limbs, the most affected region. The causative agents involved were more flammable agents and fire. Pulmonary infection was the most frequent clinical complication. The mortality found in this center was 4.9%. The subgroup of suicide were predominantly female and the mortality rate was 22.44%. When studying survival rate, patients with inhalation injury and trauma were associated with shorter survival. Patients with sepsis remained alive for longer. Conclusion:The clinical, epidemiological and survival of patients with burns, enables the design of peculiar characteristics of this trauma in the studied area, thus, from these data, charts be established treatment and prognostic estimates, and assist in developing preventive public health policy more effective.

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Section: Discussionmentioning

confidence: 99%

Factors associated with survival of burned patients

et al. 2015

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“…Tracheobronchitis is a common precursor of bron-predominant organism and its antibiotic sensitivities. Although chopneumonia, particularly in patients with inhalation injury, of endoscopically directed bronchial lavage has been recomwhom 46% develop pneumonia within 12 days of injury [32]. If mended by some as a means of enhancing culture specificity pneumonia does not develop, the mortality associated with [35], in the authors' experience such culture techniques have tracheobronchitis is much less than that associated with pneu-not increased diagnostic accuracy in burn patients.…”

Section: I-l1lelectementioning

confidence: 99%

The changing epidemiology of infection in burn patients

1992

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Topical chemotherapy, prompt excision, and timely closure of the burn wound have significantly reduced the occurrence of invasive burn wound infection and its related mortality. Since wound protection is imperfect and invasive wound infection may still occur in patients with massive burns in whom wound closure is delayed, scheduled wound surveillance and biopsy monitoring are necessary to assess the microbial status of the burn wound and identify wound infections caused by resistant bacteria or non‐bacterial opportunists at a stage when therapeutic intervention can control the process. As a reflection of the systemic immunosuppressive effects of burn injury, infection remains the most common cause of morbidity and mortality even though the occurrence of wound infections has been significantly decreased. Pneumonia is the most frequent infection occurring in burn patients today but the improvements in patient management, wound care, and infection control have made bronchopneumonia the most common form of this infection and gram‐positive organisms the most common causative agents. The organisms causing bacteremia that exert a species specific effect on the mortality related to extent of burn injury and patient age have changed in concert with changes in wound flora. Infection control procedures, including scheduled surveillance cultures, utilization of cohort patient care methodology, strict enforcement of patient and staff hygiene, and patient monitoring have been effective in eliminating endemic resistant microbial strains, preventing the establishment of newly introduced resistant organisms, diagnosing infection in a timely fashion, instituting antibiotic and other necessary therapy in a prompt manner, and documenting the effectiveness of present day burn patient care and the improved survival of burn patients.

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“…The mortality of inhalation injury without cutaneous burn injury is approximately 10%, whereas with cutaneous burn injury, the mortality increases more than twice 1, 2. Inhalation injury increases fluid requirements3 and the incidence of pneumonia 4. In patients with inhalation injury, early intubation is indicated if upper airway patency is in danger.…”

Section: Introductionmentioning

confidence: 99%

Indications of early intubation for patients with inhalation injury

Onishi

Osuka

Kuroki

et al. 2017

Acute Medicine & Surgery

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AimFor patients with inhalation injury, the indications for early intubation are diverse. The purpose of this study was to identify the most reliable symptoms, physical findings, and medical examinations with which to determine the indications for early intubation in patients with inhalation injury.MethodsWe retrospectively collected patient data from medical records. Collected data included age, sex, burn size, symptoms, physical findings, carboxyhemoglobin levels (COHb), and bronchial wall thickness (BWT) determined from chest computed tomography images. We analyzed the relationships between these findings and the early intubation. We performed fiberoptic bronchoscopy in all patients, and analyzed the relationships between bronchoscopic severity and other findings.ResultsOf the 205 patients, 80 patients were diagnosed as having inhalation injury, and 34 patients were intubated. Burn size, facial burns, neck burns, use of accessory respiratory muscles, and COHb seemed to be related with intubation, whereas singed nasal hair was not. If the patients suffered ≥27% total body surface area burn and BWT ≥3.5 mm, the positive predictive value for early intubation was 1.00. If the patients suffered smaller cutaneous burn without neck burn, and their COHb <4.0%, the negative predictive value for early intubation was 0.97. Fiberoptic bronchoscopy findings from above the glottis were mainly related with patients’ symptoms. Findings from below the glottis were mainly related with BWT and COHb.ConclusionsPatients’ symptoms, especially use of accessory respiratory muscles, are reliable, and BWT and COHb are also useful tools, for determining the indication for early intubation.

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The Influence of Inhalation Injury and Pneumonia on Burn Mortality

Cited by 540 publications

References 13 publications

Factors associated with survival of burned patients

Factors associated with survival of burned patients

The changing epidemiology of infection in burn patients

Indications of early intubation for patients with inhalation injury

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