Inhalational Injury in Burn Patients

سال انتشار: 1397
نوع سند: مقاله کنفرانسی
زبان: انگلیسی
مشاهده: 331

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شناسه ملی سند علمی:

NCBMED08_026

تاریخ نمایه سازی: 18 تیر 1398

چکیده مقاله:

There is no injury that affects more organ systems than a severe burn injury. The resulted physiologic responses to that injury lead to a severe systemic catabolism and increased morbidity and mortality. Advances in critical care, nutritional support, wound management, and infection control policies have substantially improved outcomes for severe burn patients. However, when burns are accompanied by inhalation injury, health care providers and clinicians have yet to make major influence on survival.Inhalation injury may be present in up to one-third of all burn injuries; however, it may be responsible in some way for up to 90% of all burn-related mortality. Inhalation injury causes localized damage to respiratory system through direct cellular damage, changes in regional blood flow, airway obstruction, and toxin and proinflammatory cytokine release. Inhalation injuries has major negative effects on mucociliary clearance and alveolar macrophages. These changes can predispose patients to bacterial infection of lungs, the most important cause of death for patients with severe burns.Burn critical care units have the highest rates of ventilator associated pneumonia, and if inhalational injury is concomitantly present, the rate of ventilator associated pneumonia may be doubled. Moreover, pneumonia associated mortality increases from 40% to 60% when a burned patient with inhalation injury has pneumonia compared with patients with just dermal burn.Despite advances in burn critical care, clinicians have failed to make significant success in improving outcomes in inhalation injury. Supportive strategies like bronchodilators, muscarinic receptor antagonists, N-acetylcysteine, inhalational heparin are promising, but large, multicenter trials are needed to show robust results for many of these pharmacologic therapies.

نویسندگان

Farid Zand

Intensivist, Professor of Critical Care Medicine