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.

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.

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.

scholarly journals 634 Long term prognostic effect of lipoprotein in patients with and without diabetes mellitus after myocardial infarction

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Michele Tedeschi ◽  
Francesco Paolo Cancro ◽  
Marco Maria Busiello ◽  
Valentina Butrico ◽  
Marco Torre ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Myocardial Infarction ◽  
Serum Level ◽  
Clinical Outcome ◽  
Primary Study ◽  
Term Survival ◽  
Long Term Outcome ◽  
Study Population

Abstract Aims The aim is to describe the baseline clinical, laboratory, and angiographic characteristics of patients with acute myocardial infarction (MI) according to the presence or not of diabetes mellitus (DM), and to evaluate if DM may influence the effect of lipoproteina [Lpa] serum level on long-term outcome in this very high-risk population. Methods and results This was a retrospective, single-centre, study including consecutive patients admitted with MI diagnosis between 1 January 2017 and 31 December 2020. The availability of data on baseline Lpa serum level was considered as an inclusion criterion. The study population was divided into two groups according to the presence or not of DM. The Lpa value of 50 mg/dl was used to test the hypothesis of a different effect of Lpa on the clinical outcome of patients with or without DM. The primary study outcome was all-cause death at 3-year follow-up. The study population included 997 patients (mean age 63.7 ± 13.5 years; 75.7% were males). Diabetes was reported in 280 (28.1%) patients. DM patients were older than those without DM (67.8 ± 12.1 vs. 62.0 ± 13.7 years, P < 0.001) and showed a significantly higher prevalence of dyslipidaemia, hypertension, obesity, prior MI, and prior coronary revascularization (P < 0.001). DM patients showed higher SYNTAX score value (19.8 vs. 15.1, P < 0.001) and a higher prevalence of left main involvement (6.3 vs. 3.1, P = 0.023). At Kaplan–Meier analysis, in the group without DM, patients with Lpa ≥ 50 mg/dl showed a significantly lower long-term survival compared with those with Lpa < 50 mg/dl (Log-Rank = 0.004). In DM patients, conversely, no survival difference was found between patients with Lpa ≥ 50 mg/dl vs. those with Lpa < 50 mg/dl. At multivariable Cox regression analysis, in patients without DM, Lpa serum level (HR: 2.68, 95% CI: 1.23–5.83; P = 0.013) and age (HR: 1.06, 95% CI: 1.04–1.09; P < 0.001) were independent predictors of mortality at 3-year follow-up. Among DM patients, only age was independently associated with 3-year mortality (HR: 1.07, 95% CI: 1.03–1.10; P < 0.001) (Table). Conclusions In this MI population, Lpa was independently associated with long-term mortality in patients without DM, but not in patients with DM. Whether DM can modify the effect of Lpa on clinical outcome after MI requires confirmation by larger prospective studies.

Airway Reconstruction in Pediatric Burn Patients

2005 ◽  
Vol 133 (3) ◽  
pp. 362-365 ◽  
Author(s):  
David R. White ◽  
Diego A. Preciado ◽  
Becky Stamper ◽  
J. Paul Willging ◽  
Charles M. Myer ◽  
...  
Keyword(s):  
Tracheostomy Tube ◽  
Control Group ◽  
Clinical Impression ◽  
Burn Patients ◽  
Long Term Outcomes ◽  
Retrospective Case ◽  
Burn Victims ◽  
Laryngotracheal Reconstruction ◽  
Airway Reconstruction

OBJECTIVE: Reconstruction of the laryngotracheal airway in pediatric burn victims has been described anecdotally as less successful than reconstruction performed in other populations. To evaluate this clinical impression, outcomes of laryngotracheal reconstruction (LTR) in pediatric burn victims were compared with a randomly selected, matched control population of children receiving LTR. DESIGN: Retrospective case control study. SUBJECTS: The records of 34 pediatric burn victims undergoing LTR were reviewed. A control group of 48 children undergoing LTR for acquired stenosis was randomly selected from a population matched for age and grade of stenosis. RESULTS: Decannulation rate after 1st procedure, number of open airway procedures required, and length of time after 1st procedure until decannulation were not significantly different between the 2 groups. Two deaths (both tracheostomy tube related) occurred in the burn group; 1 occurred in the control group. Two patients in the burn group and 3 patients in the control group remain tracheostomy tube dependent at least 1 year after the initial reconstructive attempt. CONCLUSIONS: Long-term outcomes of LTR in burn patients are not significantly different from outcomes of LTR in the pediatric acquired airway stenosis population.

scholarly journals 622 Long term prognostic impact of right ventricular dysfunction in patients with COVID-19

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Angelo Silverio ◽  
Fernando Scudiero ◽  
Marco Di Maio ◽  
Vincenzo Russo ◽  
Francesco Paolo Cancro ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Left Ventricular ◽  
Hospitalized Patients ◽  
Left Ventricular Ejection ◽  
Common Finding ◽  
Primary Study ◽  
Prognostic Impact ◽  
Term Survival ◽  
Study Population

Abstract Aims The characteristics and clinical course of hospitalized patients with Coronavirus disease 2019 (COVID-19) have been widely described, while long-term data are still poor. The aim of this study was to evaluate the long-term clinical outcome and its association with right ventricular (RV) dysfunction in hospitalized patients with COVID-19. Methods and results This was a retrospective multicentre study of consecutive COVID-19 patients hospitalized at seven Italian Hospitals from 28 February to 20 April 2020. The study population was divided into two groups according to echocardiographic evidence of RV dysfunction defined by tricuspid annular plane systolic excursion (TAPSE) value <17 mm in accordance with the current guidelines. The primary study outcome was 1-year mortality. The study population consisted of 224 patients (mean age 69 ± 14, male sex 62%); RV dysfunction was diagnosed in 63 cases (28%). Patients with RV dysfunction were older (75 vs. 67 years, P < 0.001) and showed a higher prevalence of coronary artery disease (27% vs. 11%, P = 0.003), heart failure (5% vs. 22%; P < 0.001), chronic obstructive pulmonary disease (13% vs. 38%; P < 0.001), and chronic kidney disease (12% vs. 39%; P < 0.001). Left ventricular ejection fraction (LVEF) was significantly lower in patients with RV dysfunction that in those without (55% vs. 50%; P < 0.001). The rate of mortality at 1-year was significantly higher in patients with RV dysfunction as compared with those without (67% vs. 28%; P ≤ 0.001). After propensity score matching, patients with RV dysfunction showed a significantly lower long-term survival than patients without RV dysfunction (62% vs. 29%, P < 0.001). At multivariable Cox regression analysis, TAPSE, LVEF and acute respiratory distress syndrome during the hospitalization were independently associated with 1-year mortality (Table). Conclusions RV dysfunction is a relatively common finding in hospitalized patients with COVID-19 and is independently associated with an higher risk of mortality at one-year follow-up.

Infections and ABO Blood Groups in Burn Patients.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 4179-4179
Author(s):  
Areta Kowal-Vern ◽  
Leonard I. Boral ◽  
Mariano G. Yogore ◽  
Harita Patel ◽  
Susan Brown
Keyword(s):  
Blood Group ◽  
Inhalation Injury ◽  
Blood Groups ◽  
Burn Patients ◽  
Abo Blood Groups ◽  
Chi Square ◽  
Significant Difference ◽  
Study Population ◽  
Tract Infections ◽  
Burn Patient

Abstract Background: Lack of isohemmaglutinins may predispose individuals to infection. The purpose of this study was to determine if there was a relationship between infections and burn patient blood groups. Methods: This was a retrospective review of burn patient data on infections and ABO blood groups between March 1999-May 2004. Chi-square and Mann-Whitney U with one-way ANOVA statistical analyses were performed. Results: There were 1615 burn admissions; 794 patients were typed for blood groups; 179 patients received blood transfusions. Of the study population, African-Americans constituted 59%, Hispanics 21%, Caucasians 16%, and others 4%. Although age (mean±se: 37±2 years), % TBSA (11±2%), and inhalation injury (15%) were similar in all groups, patients with B blood group had longer BICU stays compared to the O blood group, p<0.01. There was no statistically significant difference among the blood groups in the number of nosocomial wound infections, episodes of sepsis, bacteremia, urinary tract infections (UTIs) or pneumonia. The bacterial etiology was similar in all blood groups without any species preponderance. Transfused patients had a higher frequency of infections compared to those who were not transfused and significance was only reached in the comparison for UTIs, p=0.02. Conclusions: Our data shows that burn patients with B and AB blood groups did not have an increased frequency of infections compared to the patients with A and O blood groups. Burn patients were immunosuppressed as part of their injury. Those who received transfusions probably had a further perturbation of their immune system, since blood products cause immunosuppression. Other factors such as inhalation injury and %TBSA also predisposed burn patients to infection. Transfusions rather than blood groups were associated with an increased number of nosocomial UTIs in burn patients. Demographic Characteristics of the Burn Population by ABO Groups Blood Groups AB A B O mean ± s.e. Study Population # (%) 27 (3) 258 (32) 134 (17) 375 (47) Study African American (%) 4 29 21 46 Study Hispanic (%) 1 36 7 56 Study Caucasian (%) 3 37 14 46 BICU stay (days) 15±6 13±2 23±4 11±1 PRBC Transfusions (units) 7±2 9±2 13±3 8±1 UTI/Transfused # (%) 5 (100) 12 (92) 8 (89) 20 (60) UTI/Not Transfused # (%) 0 1 (8) 1 (11) 13 (40)

A Transapical or Transluminal Approach to Aortic Valve Implantation Does Not Attenuate the Inflammatory Response

2011 ◽  
Vol 14 (2) ◽  
pp. 110 ◽  
Author(s):  
Benjamin O'Brien ◽  
Miralem Pasic ◽  
Hermann Kuppe ◽  
Roland Hetzer ◽  
Helmut Habazettl ◽  
...  
Keyword(s):  
Chronic Disease ◽  
Aortic Valve ◽  
Inflammatory Response ◽  
Pulmonary Disease ◽  
Outcome Data ◽  
Surgical Trauma ◽  
Retrospective Case ◽  
Study Population ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Background: Cardiopulmonary bypass (CPB) and cardiac surgery cause an inflammatory response, as measurable by an increase in the concentration of C-reactive protein (CRP), a nonspecific inflammation marker. Previous publications have demonstrated typical perioperative CRP concentration profiles in cases of uncomplicated aortic valve replacement (AVR) with CPB. A regression analysis for modifying factors showed that chronic disease (heart failure, diabetes, and pulmonary disease), along with obesity and sex, all tend to influence the CRP response. We analyzed the inflammatory response to aortic valve implantation (AVI) with interventional techniques, mainly transapical but also transfemoral and transaxillary approaches, in a retrospective case-control study design.Methods: Sixty-eight patients who underwent AVI by the transapical (59 patients), transfemoral (7 patients), or transaxillary (2 patients) approach were matched by age, sex, body mass index (BMI), and chronic-disease state (absence or presence of diabetes, pulmonary disease, and renal impairment) with 68 patients who underwent conventional AVR with CPB. We compared the 2 groups with respect to perioperative CRP concentration, EuroSCORE, and outcome data (time to extubation and 30-day mortality). All data were collected prospectively and analyzed retrospectively.Results: The 2 groupsthe study population (interventional) and the control population (conventional)were similar in age, sex distribution, BMI, and chronic-disease status. As expected, the study population had a significantly higher median EuroSCORE. The 2 groups had similar postoperative CRP profiles over time, but the interventional group had significantly higher peak concentrations on days 2, 3, and 4. The short-term outcomes, as assessed by ventilation time and 30-day mortality, were similar for the 2 groups.Conclusions: Using an interventional transcatheter approach to AVI (thereby eliminating CPB from the procedure and reducing surgical trauma) does not attenuate the patient's innate inflammatory response.

Associations of CYP2A6 Gene Polymorphism with Smoking Status Among Jordanians: Gender-Related Differences

2019 ◽  
Vol 20 (9) ◽  
pp. 765-770 ◽  
Author(s):  
Hana M. Hammad ◽  
Amer Imraish ◽  
Belal Azab ◽  
Al M. Best ◽  
Yousef S. Khader ◽  
...  
Keyword(s):  
Cytochrome P450 ◽  
Genetic Polymorphism ◽  
Smoking Status ◽  
Hepatic Enzyme ◽  
Nicotine Metabolism ◽  
Significant Frequency ◽  
Cytochrome P450 2A6 ◽  
Study Population ◽  
Major Metabolic Pathway ◽  
Cyp2a6 Gene

Background: Cytochrome P450 2A6 enzyme (CYP2A6), an essential hepatic enzyme involved in the metabolism of drugs, is responsible for a major metabolic pathway of nicotine. Variation in the activity of polymorphic CYP2A6 alleles has been implicated in inter-individual differences in nicotine metabolism. Aims: The objective of the current study was to assess the association between the smoking status and the cytochrome P450 2A6 enzyme (CYP2A6) genotype in Jordanians. Methods: In the current study, 218 (117 Male and 101 female) healthy unrelated Jordanian volunteers were recruited. CYP2A6*1B, CYP2A6*4 and CYP2A6*9 were determined and correlated with subject smoking status. Results: *1A/*1A was the most common genetic polymorphism in the overall study population, with no significant frequency differences between smokers and non-smokers. When the population was divided according to gender, only male smokers showed a significant correlation between genotype and smoking status. Considering the CYP2A6*9 genotype, the results showed differences in distribution between smokers and non-smokers, but only women showed a significant association between CYP2A6*9 allele genotype and smoking status. Conclusion: The results of this study show that there is a significant association between CYP2A6*9 genotype and smoking status. They also show that CYP2A6 genotype is significantly influenced by gender.

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.

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