Inhalation injury after exposure to indoor fire and smoke: The Brazilian disaster experience. Issue 4 (June 2016)

• Record Type: Journal Article
• Authors: Rech, Tatiana Helena; Boniatti, Márcio Manozzo; Franke, Cristiano Augusto; Lisboa, Thiago; Wawrzeniak, Iuri Christmann; Teixeira, Cassiano; Maccari, Juçara Gasparetto; Schaich, Felipe; Sauthier, Angelica; Schifelbain, Luciele Medianeira; Riveiro, Diego Fontoura Mendes; da Fonseca, Deisi Leticia Oliveira; Berto, Paula Pinheiro; Marques, Leonardo; dos Santos, Moreno Calcagnotto; de Oliveira, Vanessa Martins; Dornelles, Carlos Fernando Drumond; Vieira, Sílvia Regina Rios
• Is Part Of: Burns. Volume 42:Issue 4(2016)
• Page Start: 884
• Page End: 890
• Publication Date: 2016-06
• Subjects: Inhalation injury -- Fire victims -- Disaster -- Burn; Burns and scalds -- Periodicals; 617.11
• DOI: 10.1016/j.burns.2016.02.017
• Languages: English
• ISSNs: 0305-4179

Abstract

Highlights: We described the pre-hospital, emergency department and ICU care of victims from a fire disaster. The course of disease is mainly determined by the percentage of burned body surface area. The degree of inhalation injury seems to have a less important role. Abstract: Objective: To describe the pre-hospital, emergency department, and intensive care unit (ICU) care and prognosis of patients with inhalation injury after exposure to indoor fire and smoke. Materials and methods: This is a prospective observational cohort study that includes patients admitted to seven ICUs after a fire disaster. The following data were collected: demographic characteristics; use of fiberoptic bronchoscopy; degree of inhalation injury; percentage of burned body surface area; mechanical ventilation parameters; and subsequent events during ICU stay. Patients were followed to determine the ICU and hospital mortality rates. Results: Within 24 h of the incident, 68 patients were admitted to seven ICUs. The patients were young and had no comorbidities. Most patients ( n = 35; 51.5%) only had an inhalation injury. The mean ventilator-free days for patients with an inhalation injury degree of 0 or I was 12.5 ± 8.1 days. For patients with an inhalation injury degree of II or III, the mean ventilator-free days was 9.4 ± 5.8 days ( p = 0.12). In terms of the length of ICU stay for patients with degrees 0 or I, and patients with degrees II or III, the median was 7.0 days (5.0–8.0 days) and 12.0 days (8.0–23.0 days) ( p < 0.001), respectively. In addition, patients with a larger percentage of burned surface areas also had a longer ICU stay; however, no association with ventilator-free days was found. The patients with <10% of burned body surface area showed a mean of 9.2 ± 5.4 ventilator-free days. The mean ventilator-free days for patients who had >10% burned body surface area was 11.9 ± 9.5 ( p = 0.26). The length of ICU stay for the <10% and >10% burned body surface area patients was 7.0 days (5.0–10.0 days) and 23.0 days (11.5–25.5 days) ( p < 0.001), respectively. Conclusions: We conclude that burn patients with inhalation injuries have different courses of disease, which are mainly determined by the percentage of burned body surface area.