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VOLUME 16 , ISSUE 2 ( April, 2012 ) > List of Articles

RESEARCH ARTICLE

Isolated inhalational injury: Clinical course and outcomes in a multidisciplinary intensive care unit

Gagan Brar, Jose Chacko, Ramanathan Moorthy, Nikahat Jahan

Keywords : Inhalational injury, intensive care, outcomes

Citation Information : Brar G, Chacko J, Moorthy R, Jahan N. Isolated inhalational injury: Clinical course and outcomes in a multidisciplinary intensive care unit. Indian J Crit Care Med 2012; 16 (2):93-99.

DOI: 10.4103/0972-5229.99120

License: CC BY-ND 3.0

Published Online: 01-04-2012

Copyright Statement:  Copyright © 2012; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Background and Aims: Although smoke inhalation is well known to cause acute lung injury, there are few reports in literature that study the evolution, clinical course and outcomes of isolated inhalational lung injury in a modern intensive care setting. A major fire disaster provided us the opportunity to study victims of isolated inhalational injury admitted to our Multidisciplinary Intensive Care Unit (MICU). Materials and Methods: We studied the clinical course, ICU and hospital outcomes of 13 victims of a fire disaster who required mechanical ventilation for isolated inhalational lung injury. All patients were followed up at regular intervals, and their functional status was assessed at 8 months after hospital discharge. Results: The Lung Injury Scores (LIS) worsened to reach a nadir on Day 3 of injury. There was a significant correlation between the LIS on Day 3 and duration of mechanical ventilation (r = 0.8; P = 0.003), ICU (r = 0.8; P = 0.002) and hospital (r = 0.6; P = 0.02) days. Late-onset airway complications were encountered in four patients. Three of them required long-term artificial airways - two with a tracheostomy while the third patient required surgical insertion of a “T” tube. Persistent problems with phonation occurred in two patients. At 8 months postdischarge, all patients were independent with activities of daily living; all were back to work, except for two who continued to need artificial airways. Conclusions: Inhalational lung injury progresses over the first few days and is worst after 72 h. Late-onset airway complications may manifest after several weeks and require repeated intervention.


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  1. Early and late complications among 15 victims exposed to indoor fire and smoke inhalation. Burns 2008;34:533-8.
  2. Isolated smoke inhalation injuries: Acute respiratory dysfunction, clinical outcomes, and short-term evolution of pulmonary functions with the effects of steroids. Burns 2007;33:200-8.
  3. The short-term effects of smoke exposure on the pulmonary function of firefighters. Chest 1990;97:806-9.
  4. The effect of smoke inhalation on lung function and airway responsiveness in wildland fire fighters. Am Rev Respir Dis 1992;146:1469-73.
  5. Burns. N Engl J Med 1985;313:1389-98
  6. Oxygen radical dependent lung damage following thermal injury of rat skin. J Trauma 1983;23:269-77.
  7. Lung water changes after thermal injury: The effects of crystalloid resuscitation and sepsis. Ann Surg 1980;192:479-90.
  8. Smoke inhalation: Diagnosis and treatment. Burns 1988;14:473-94.
  9. Smoke, burns, and the natural history of inhalation injury in fire victims: A correlation of experimental and clinical data. Ann Surg 1977;185:100-10.
  10. Tracheostomies in burn patients. Ann Surg 1989;209:471-4.
  11. Is tracheostomy warranted in the burn patient? Indications and complications. J Burn Care Rehabil 1986;7:492-5.
  12. Oxidants and the pathophysiology of burn and smoke inhalation injury. Free Radic Biol Med 1992;1212:409-15.
  13. Smoke inhalation injury in sheep is caused by the particle phase not the gas phase. J Appl Physiol 1994;77:15-22.
  14. Increased airway reactivity after smoke inhalation. Lancet 1991;337:597-7.
  15. Respiratory effects of short-term, high-intensity toxic inhalations: Smoke, gases, and fumes. J Intensive Care Med 1987;2:260-5.
  16. Prolonged airway and systemic inflammatory reactions after smoke inhalation. Chest 2003;123:475-80.
  17. Recombinant human activated protein C improves pulmonary function in ovine acute lung injury resulting from smoke inhalation and sepsis. Crit Care Med 2006;34:2432-8.
  18. Inhalation of JNK activation prolongs survival after smoke inhalation from fires. Am J Physio 2007;292:984-91.
  19. Respiratory complications in burned patients: Pathogenesis and spectrum of inhalation injury. J Crit Care 1987;2:49-53.
  20. Aerosolized deferoxamine prevents lung and systemic injury caused by smoke inhalation. J Appl Physiol 1994;77:2057-64.
  21. Role of anti-L-selectin antibody in burn and smoke inhalation injury in sheep. Am J Physiol Lung cell Mol Physiol 2002;283:1043-50.
  22. New clinically relevant sheep model of severe respiratory failure secondary to combined smoke inhalation/cutaneous flame burn injury. Crit Care Med 2000;28:1469-76.
  23. Role of nitric oxide in vascular permeability after combined burns and smoke inhalation injury. Am J Respir Crit Care Med 2001;163:745-52.
  24. Role of hypoxic pulmonary vasoconstriction in pulmonary gas exchange and blood flow distribution. 2. Pathophysiology. Intensive Care Med 1994;20:379-89.
  25. Airway obstruction in sheep with burn and smoke inhalation injuries. Am J Respir Cell Mol Biol 2003;29:295-302.
  26. Early complications and value of initial clinical and paraclinical observations in victims of smoke inhalation without burns. Chest 1997;111:671-5.
  27. Nasocomial bronchopneumonia in the critically ill. Am Rev Respir Dis 1992;146:1059-66.
  28. Smoke inhalation and airway management at a regional burn unit. J Burn Care Rehabil 1989;10:52-62.
  29. Respiratory Complications in Burns: An Evolving Spectrum of Injury. Clin Pulm Med 1990;16:132-38.
  30. Clinical smoke inhalation injury: Pulmonary effects. Occup Med 1993;8:430-68.
  31. Tracheal stenosis complicating cutaneous burns: An underestimated problem. Am Rev Respir Dis 1986;134:1315-8.
  32. Laryngotracheal injury due to endotracheal intubation: Incidence, evolution, and predisposing factors. A prospective long-term study. Crit Care Med 1983;11:362-7.
  33. Irritant- associated vocal cord dysfunction. J Occup Environ Med 1998;40:136-43.
  34. Acute inhalation injury. Clin Chest Med 2002;23:707-15.
  35. Prehospital administration of hydroxocobalamin for smoke inhalation-associated cyanide poisoning. Clin Toxicol 2006;44:S37-44.
  36. Warehouse workers′ headache: Emergency evaluation and management of 30 patients with carbon monoxide poisoning. Am J Med 1995;98:145-55.
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