17 Long-Term Pulmonary Sequelae After Inhalation Injury: A Retrospective Cohort Study

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S17-S17
Author(s):  
Julian Wier ◽  
Ian F Hulsebos ◽  
Haig A Yenikomshian ◽  
Justin Gillenwater
Keyword(s):  
Pulmonary Disease ◽  
Multinomial Logistic Regression ◽  
Smoking Status ◽  
Group Versus ◽  
Inhalation Injury ◽  
Primary Study ◽  
Burn Patients ◽  
Post Discharge ◽  
Ventilated Patients

Abstract Introduction Inhalation injury (INHI) has strong associations with increased rates of in-patient mortality and pneumonia. Data describing long-term health outcomes after inhalation injury are scarce and the true sequelae are largely unknown. The aim of the study is to review long-term pulmonary outcomes in inhalation injury patients. We hypothesize that INHI patients are at greater risk of developing long-term pulmonary sequelae. Methods We present a retrospective case-control of burn patients admitted to an ABA certified facility. We included burn patients with or without medically confirmed INHI who were admitted between 06/2016 to 11/2019 and were part of the regional Department of Health Services (DHS) system. The experimental group was patients with bronchoscopy confirmed INHI. The control groups were ventilated patients with confirmed non-inhalation injury (V) and non-ventilated patients with confirmed non-inhalation injury (NV). These were matched for age, TBSA, sex, previous comorbid pulmonary disease, and smoking status. Primary study outcomes were rates of post-discharge pulmonary sequelae, including ineffective airway clearance, infections, shortness of breath, and malignancy. Secondary outcomes included rates of post-discharge surgeries and readmission, post-discharge non-pulmonary sequelae, and post-discharge days to pulmonary/non-pulmonary sequelae. Results The study population included 33 INHI, 45 V, and 50 NV patients. There were no significant differences in age (P=.98), sex (P=.68), TBSA (P=.18), pulmonary comorbidity (P=.5), or smoking status (P=.92). Outpatient pulmonary sequelae were significantly higher for both INHI and V groups as compared to NV (21% and 17% vs 4%, P=.023, .043). The number of days from discharge to pulmonary sequelae was significantly shorter in the INHI group versus the V group (162±139 days vs 513±314 days, P=.024). Multinomial logistic regression for both INHI and V groups using the variables comorbid pulmonary disease, smoking status, and inpatient course and complications, indicated no effect on post-discharge pulmonary sequelae (all P >.05). All other measures were not significant when comparing INHI to V or NV (all P >.05). Conclusions Both INHI and V groups resulted in higher rates of outpatient pulmonary sequelae independent of inpatient course as compared to NV. While outpatient pulmonary sequelae were not significantly different between INHI and V, the INHI patients presented with complaints earlier. Thus one can conclude that ventilation alone is a significant contributing factor for the long-term pulmonary sequelae reported in this patient population.

Long-term pulmonary sequelae after inhalation injury: A retrospective case-control study

2021 ◽  
Author(s):  
Julian Wier ◽  
Ian Hulsebos ◽  
Leigh Spera ◽  
Haig Yenikomshian ◽  
T Justin Gillenwater
Keyword(s):  
Smoking Status ◽  
Group Versus ◽  
Inhalation Injury ◽  
Primary Study ◽  
Burn Patients ◽  
Post Discharge ◽  
Retrospective Case ◽  
Study Population ◽  
Ventilated Patients

Abstract Inhalation injury (INHI) has strong associations with increased rates of in-patient mortality and pneumonia. This study’s aim is to review long-term pulmonary outcomes in inhalation injury patients. We present a retrospective cohort of burn patients admitted to an ABA certified burn unit. Burn patients with or without medically confirmed INHI who were admitted were studied. The control groups were ventilated patients with (V) and non-ventilated patients (NV). Primary study outcomes were rates of post-discharge pulmonary sequelae, including ineffective airway clearance, infections, shortness of breath, and malignancy. Secondary outcomes included rates of post-discharge surgeries and readmission, post-discharge non-pulmonary sequelae, and post-discharge days to pulmonary/non-pulmonary sequelae. The study population included 33 INHI, 45 V, and 50 NV patients. There were no significant differences in age (P=.98), sex (P=.68), % TBSA (P=.18), pulmonary comorbidity (P=.5), or smoking status (P=.92). Outpatient pulmonary sequelae were significantly higher for both INHI and V groups as compared to NV (21% and 17% vs 4%, P=.023, .043). The number of days from discharge to pulmonary sequelae was significantly shorter in the INHI group versus the V group (162±139 days vs 513±314 days, P=.024). All other measures were not significant when comparing INHI to V or NV (P>.05). Both INHI and V groups resulted in higher rates of outpatient pulmonary sequelae independent of inpatient course as compared to NV. While outpatient pulmonary sequelae were not significantly different between INHI and V, the INHI patients presented with complaints earlier.

scholarly journals Long-Term Risk of Mortality and Pulmonary Morbidity after Inhalation Injury among Burn Patients

2017 ◽  
Vol 225 (4) ◽  
pp. S56-S57 ◽  
Author(s):  
Cordelie E. Witt ◽  
Ali Rowhani-Rahbar ◽  
Frederick P. Rivara ◽  
Monica S. Vavilala ◽  
Tam N. Pham ◽  
...  
Keyword(s):  
Inhalation Injury ◽  
Burn Patients ◽  
Risk Of Mortality ◽  
Pulmonary Morbidity

scholarly journals Epidemiologic and clinical characteristics of severe burn patients: results of a retrospective multicenter study in China, 2011–2015

2018 ◽  
Vol 6 ◽  
Author(s):  
Hao Tian ◽  
Liangxi Wang ◽  
Weiguo Xie ◽  
Chuanan Shen ◽  
Guanghua Guo ◽  
...  
Keyword(s):  
Social Impact ◽  
Injury Severity ◽  
Survival Rates ◽  
Inhalation Injury ◽  
Burn Patients ◽  
Severe Burns ◽  
Medical Centers ◽  
Male Patients ◽  
Length Of Hospitalization

Abstract Background Severe burns injury is a serious pathology, leading to teratogenicity and significant mortality, and it also has a long-term social impact. The aim of this article is to describe the hospitalized population with severe burns injuries in eight burn centers in China between 2011 and 2015 and to suggest future preventive strategies. Methods This 5-year retrospective review included all patients with severe burns in a database at eight institutions. The data collected included gender, age, month distribution, etiology, location, presence of inhalation injury, total burn surface area, depth of the burn, the length of hospitalization, and mortality. SPSS 19.0 software was used to analyze the data. Results A total of 1126 patients were included: 803 (71.3%) male patients and 323 (28.7%) female patients. Scalds were the most common cause of burns (476, 42.27%), followed by fire (457, 40.59%). The extremities were the most frequently affected areas, followed by the trunk. The median length of hospitalization was 30 (15, 52) days. The overall mortality rate was 14.21%. Conclusions Although medical centers have devoted intensive resources to improving the survival rates of burn patients, expenditures for prevention and education programs are minimal. Our findings suggest that more attention should be paid to the importance of prevention and the reduction of injury severity. This study may contribute to the establishment of a nationwide burn database and the elaboration of strategies to prevent severe burns injury.

11 Vitamin D Deficiency on Admission and the Association with Length of Stay in Patients with Thermal Injury: A Multi-center Analysis

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S13-S14
Author(s):  
Sarah Zavala ◽  
Kate Pape ◽  
Todd A Walroth ◽  
Melissa A Reger ◽  
Katelyn Garner ◽  
...  
Keyword(s):  
Vitamin D ◽  
Length Of Stay ◽  
Vitamin D Deficiency ◽  
Burn Injury ◽  
Total Body Surface Area ◽  
Inhalation Injury ◽  
Hospital Length Of Stay ◽  
Burn Patients ◽  
Comfort Care ◽  
The Impact

Abstract Introduction In burn patients, vitamin D deficiency has been associated with increased incidence of sepsis. The objective of this study was to assess the impact of vitamin D deficiency in adult burn patients on hospital length of stay (LOS). Methods This was a multi-center retrospective study of adult patients at 7 burn centers admitted between January 1, 2016 and July 25, 2019 who had a 25-hydroxyvitamin D (25OHD) concentration drawn within the first 7 days of injury. Patients were excluded if admitted for a non-burn injury, total body surface area (TBSA) burn less than 5%, pregnant, incarcerated, or made comfort care or expired within 48 hours of admission. The primary endpoint was to compare hospital LOS between burn patients with vitamin D deficiency (defined as 25OHD < 20 ng/mL) and sufficiency (25OHD ≥ 20 ng/mL). Secondary endpoints include in-hospital mortality, ventilator-free days of the first 28, renal replacement therapy (RRT), length of ICU stay, and days requiring vasopressors. Additional data collected included demographics, Charlson Comorbidity Index, injury characteristics, form of vitamin D received (ergocalciferol or cholecalciferol) and dosing during admission, timing of vitamin D initiation, and form of nutrition provided. Dichotomous variables were compared via Chi-square test. Continuous data were compared via student t-test or Mann-Whitney U test. Univariable linear regression was utilized to identify variables associated with LOS (p < 0.05) to analyze further. Cox Proportional Hazard Model was utilized to analyze association with LOS, while censoring for death, and controlling for TBSA, age, presence of inhalation injury, and potential for a center effect. Results Of 1,147 patients screened, 412 were included. Fifty-seven percent were vitamin D deficient. Patients with vitamin D deficiency had longer LOS (18.0 vs 12.0 days, p < 0.001), acute kidney injury (AKI) requiring RRT (7.3 vs 1.7%, p = 0.009), more days requiring vasopressors (mean 1.24 vs 0.58 days, p = 0.008), and fewer ventilator free days of the first 28 days (mean 22.9 vs 25.1, p < 0.001). Univariable analysis identified burn center, AKI, TBSA, inhalation injury, admission concentration, days until concentration drawn, days until initiating supplementation, and dose as significantly associated with LOS. After controlling for center, TBSA, age, and inhalation injury, the best fit model included only deficiency and days until vitamin D initiation. Conclusions Patients with thermal injuries and vitamin D deficiency on admission have increased length of stay and worsened clinical outcomes as compared to patients with sufficient vitamin D concentrations.

scholarly journals Identifying classes of the pain, fatigue, and depression symptom cluster in long-term prostate cancer survivors—results from the multi-regional Prostate Cancer Survivorship Study in Switzerland (PROCAS)

2021 ◽  
Author(s):  
Salome Adam ◽  
Melissa S. Y. Thong ◽  
Eva Martin-Diener ◽  
Bertrand Camey ◽  
Céline Egger Hayoz ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Depressive Symptoms ◽  
Cancer Survivorship ◽  
Latent Class ◽  
Multinomial Logistic Regression ◽  
Symptom Cluster ◽  
Depression Symptom ◽  
Class 1 ◽  
Eortc Qlq

Abstract Purpose Aside from urological and sexual problems, long-term (≥5 years after initial diagnosis) prostate cancer (PC) survivors might suffer from pain, fatigue, and depression. These concurrent symptoms can form a cluster. In this study, we aimed to investigate classes of this symptom cluster in long-term PC survivors, to classify PC survivors accordingly, and to explore associations between classes of this cluster and health-related quality of life (HRQoL). Methods Six hundred fifty-three stage T1-T3N0M0 survivors were identified from the Prostate Cancer Survivorship in Switzerland (PROCAS) study. Fatigue was assessed with the EORTC QLQ-FA12, depressive symptoms with the MHI-5, and pain with the EORTC QLQ-C30 questionnaire. Latent class analysis was used to derive cluster classes. Factors associated with the derived classes were determined using multinomial logistic regression analysis. Results Three classes were identified: class 1 (61.4%) – “low pain, low physical and emotional fatigue, moderate depressive symptoms”; class 2 (15.1%) – “low physical fatigue and pain, moderate emotional fatigue, high depressive symptoms”; class 3 (23.5%) – high scores for all symptoms. Survivors in classes 2 and 3 were more likely to be physically inactive, report a history of depression or some other specific comorbidity, be treated with radiation therapy, and have worse HRQoL outcomes compared to class 1. Conclusion Three distinct classes of the pain, fatigue, and depression cluster were identified, which are associated with treatment, comorbidities, lifestyle factors, and HRQoL outcomes. Improving classification of PC survivors according to severity of multiple symptoms could assist in developing interventions tailored to survivors’ needs.

scholarly journals First line treatment selection modifies disease course and long-term clinical outcomes in Mycobacterium avium complex pulmonary disease

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Kiyoharu Fukushima ◽  
Seigo Kitada ◽  
Sho Komukai ◽  
Tomoki Kuge ◽  
Takanori Matsuki ◽  
...  
Keyword(s):  
Pulmonary Disease ◽  
Mycobacterium Avium ◽  
Propensity Scores ◽  
Cox Regression ◽  
Line Treatment ◽  
First Line ◽  
Standard Regimen ◽  
Cox Regression Analysis ◽  
First Line Treatment

AbstractThe combination of rifamycin (RFP), ethambutol (EB), and macrolides is currently the standard regimen for treatment of Mycobacterium avium complex pulmonary disease (MAC-PD). However, poor adherence to the standardized regimens recommended by current guidelines have been reported. We undertook a single-centred retrospective cohort study to evaluate the long-term outcomes in 295 patients with MAC-PD following first line treatment with standard (RFP, EB, clarithromycin [CAM]) or alternative (EB and CAM with or without fluoroquinolones (FQs) or RFP, CAM, and FQs) regimens. In this cohort, 80.7% were treated with standard regimens and 19.3% were treated with alternative regimens. After heterogeneity was statistically corrected using propensity scores, outcomes were superior in patients treated with standard regimens. Furthermore, alternative regimens were significantly and independently associated with sputum non-conversion, treatment failure and emergence of CAM resistance. Multivariate cox regression analysis revealed that older age, male, old tuberculosis, diabetes mellitus, higher C-reactive protein, and cavity were positively associated with mortality, while higher body mass index and M. avium infection were negatively associated with mortality. These data suggest that, although different combination regimens are not associated with mortality, first line administration of a standard RFP + EB + macrolide regimen offers the best chance of preventing disease progression in MAC-PD patients.

15 Use of Bioelectric Impedance Analysis in Burn Patients: A Pilot Study

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S16-S16
Author(s):  
Ian F Hulsebos ◽  
Maxwell B Johnson ◽  
Leigh J Spera ◽  
Megan C Fobar ◽  
Zachary J Collier ◽  
...  
Keyword(s):  
Body Composition ◽  
High Risk ◽  
Phase Angle ◽  
Impedance Analysis ◽  
Inhalation Injury ◽  
Burn Patients ◽  
Bioelectric Impedance Analysis ◽  
High Risk Patients ◽  
Severity Of Injury ◽  
Risk Patients

Abstract Introduction Bioelectric Impedance Analysis (BIA) is a rapid, non-invasive, and inexpensive technology based on electrical conductivity. BIA assesses body composition, fluid shifts, and phase angle, an electrical force vector where smaller values suggest cellular injury. Our objective was to use BIA to longitudinally track the clinical status of burn patients. We hypothesized that BIA would detect progressive decreases in muscle mass throughout the patient’s hospital course and that low phase angle values would correlate with severity of injury. Methods A cohort study of 10 patients from January 1, 2020 to March 13, 2020 was performed at an ABA-verified burn center. Patient and burn characteristics and laboratory data were collected. BIA measurements were performed daily for the first 10 days of admission and then twice weekly until discharge. The primary outcome was to detect changes in body composition. The secondary objectives were to detect differences between low and high-risk patients in terms of water composition and phase angle. Patients with APACHE II > 15, measured at burn unit admission, were considered high risk for burn injury related morbidity and mortality. Results BIA detected a statistically significant negative correlation between time spent hospitalized and leg lean mass (LM) (r2=0.56, P< 0.0001), right arm LM (r2=0.52, P< 0.0001) and left leg LM (r2=0.57, P< 0.0001), and positive correlation between body fat mass (BFM) and time spent hospitalized (r2=0.50, P=0.0004). Water composition (volume of extracellular water (ECW) per total body water (TBW)) negatively correlated with low-risk patients: right arm (r2=0.51, P< 0.0001), left arm (0.71, P< 0.001), thorax (0.66, P< 0.0001), right leg (0.74, P< 0.0001), left leg (0.35, P=0.002). Full body phase angle increased with low-risk patients over their hospital course (r2=0.62, P< 0.0001), while phase angle decreased with high-risk patients (r2=0.71, P=0.0006). Full body phase angle differentiated high risk patients (P< 0.0001), and phase angle of thorax differentiated between patients with and without inhalation injury (P=0.002). Conclusions Our study demonstrates that BIA measures changes in body composition and fluid shifts, identifies inhalation injury, and correlates with severity of injury in hospitalized burn patients. This pilot study included a limited number of participants with varying anatomic injuries presenting unique measurement challenges. Regardless, our preliminary data justifies a larger prospective study to confirm these results and correlate them with clinical outcomes.

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