Smoke Inhalation Injury and the Effect of Carbon Monoxide in the Sheep Model

Concomitant smoke inhalation trauma in burn patients is a serious medical problem. Previous investigations in our sheep model revealed that these injuries lead to significant airway hyperemia, enhanced pulmonary fluid extravasation, and severely impaired pulmonary function. However, the pathophysiological mechanisms are still not fully understood. The lung is innervated by sensory nerves containing peptides such as substance P and calcitonin gene-related peptide. Noxious stimuli in the airways can induce a neurogenic inflammatory response, which has previously been implicated in several airway diseases. Calcitonin gene-related peptide is known to be a potent vasodilator. We hypothesized that calcitonin gene-related peptide is also a mediator of the pulmonary reaction to toxic smoke and planned experiments to evaluate its role in this model. We tested the effects of pretreatment with a specific antagonist of the major receptor for calcitonin gene-related peptide (BIBN4096BS; 32 μg/kg, followed by continuous infusion of 6.4 μg·kg−1·h−1) until the animal was killed 48 h after injury in an established ovine model of burn (40% total body surface, third degree) and smoke inhalation (48 breaths, <40°C) injury. In treated animals ( n = 7), the injury-related increases in tracheal blood flow and lung lymph flow were significantly attenuated compared with untreated controls ( n = 5). Furthermore, the treatment significantly attenuated abnormalities in respiratory gas exchange. The data suggest that calcitonin gene-related peptide contributes to early airway hyperemia, transvascular fluid flux, and respiratory malfunction following ovine burn and smoke inhalation injury. Future studies will be needed to clarify the potential therapeutic benefit for patients with this injury.

Download Full-text

Smoke inhalation injury during enclosed-space fires: an update

Jornal Brasileiro de Pneumologia ◽

10.1590/s1806-37132013000300016 ◽

2013 ◽

Vol 39 (3) ◽

pp. 373-381 ◽

Cited By ~ 17

Author(s):

Ana Carolina Pecanha Antonio ◽

Priscylla Souza Castro ◽

Luiz Octavio Freire

Keyword(s):

Carbon Monoxide ◽

Carbon Monoxide Poisoning ◽

Fiberoptic Bronchoscopy ◽

Orotracheal Intubation ◽

Inhalation Injury ◽

Smoke Inhalation ◽

Cyanide Poisoning ◽

Smoke Inhalation Injury ◽

Acute Airway Obstruction ◽

Enclosed Space

In view of the tragic fire at a nightclub in the city of Santa Maria, Brazil, which culminated in the sudden death of 232 young people, we decided to review the literature regarding smoke inhalation injury caused by enclosed-space fires, which can be divided into direct thermal damage, carbon monoxide poisoning, and cyanide poisoning. Such injuries often call for immediate orotracheal intubation, either due to acute airway obstruction or due to a reduced level of consciousness. The diagnosis and the severity of the thermal injury can be determined by fiberoptic bronchoscopy. The levels of gases and gas by-products in the bloodstream should be assessed as rapidly as possible, even while still at the scene of the incident. First responders can also treat carbon monoxide poisoning, with immediate administration of oxygen at 100%, as well as cyanide poisoning, with oxygen therapy and hydroxocobalamin injection

Download Full-text

Bilateral Lobar Lung Transplantation after Smoke Inhalation Injury - A Case Report

The Journal of Heart and Lung Transplantation ◽

10.1016/j.healun.2021.01.2075 ◽

2021 ◽

Vol 40 (4) ◽

pp. S515

Author(s):

E. Olsson ◽

M. Silverborn ◽

U. Smedh ◽

G.C. Riise ◽

J.M. Magnusson ◽

...

Keyword(s):

Case Report ◽

Lung Transplantation ◽

Inhalation Injury ◽

Smoke Inhalation ◽

Smoke Inhalation Injury

Download Full-text

523 Retrospective Outcomes Analysis of Tracheostomy in Paediatric Burn Population

Journal of Burn Care & Research ◽

10.1093/jbcr/irab032.174 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

pp. S108-S109

Author(s):

Nicholas Iglesias ◽

Anesh Prasai ◽

George Golovko ◽

Deepak K Ozhathil ◽

Steven E Wolf

Keyword(s):

Inhalation Injury ◽

Smoke Inhalation ◽

Research Network ◽

Burn Patients ◽

Pulmonary Injury ◽

Smoke Inhalation Injury ◽

Mortality And Morbidity ◽

Laryngeal Injury ◽

Icd 10 ◽

Potential Benefits

Abstract Introduction For decades, controversy has raged regarding the placement of tracheostomy in severe paediatric burns. Numerous variables including extent of smoke inhalation injury, % TBSA burned, age of the patient, and co-morbidities among others complicate reaching consensus. Furthermore, paediatric patients are particularly susceptible to complications including inadvertent loss of airway and long-term swallowing and other anatomic issues. Additionally, previous analysis of the efficacy of tracheostomy in paediatric burn patients appears to be hindered by a lack of nationwide analysis. The aim of this study was to explore the efficacy of tracheostomy in the general paediatric burn patient population. Methods De-identified patient data was obtained from the TriNetX Research Network database. Two cohorts were identified: paediatric burn patients with tracheostomy (cohort A) and paediatric burn patients without tracheostomy (cohort B). Burn patients were identified using the ICD-10 codes T20-T25 & T30-T32. Tracheostomy was identified using the ICD-10 codes 1005887, 1014613, 31600, 31601, 31603, 31604, 31610, and Z93.0. A total of 132 patients were identified in cohort A in 23 HCOs and 83,117 patients were identified in cohort B in 38 HCOs. Infection, hypovolemia, pulmonary injury, laryngeal injury, pneumonia, and death were compared between the cohorts. Results Cohort A had a mean age of 11 (SD=5) and Cohort B had a mean age of 9 (SD=5). Paediatric burn patients with tracheostomy had a higher risk for death, infection, hypovolemia, pulmonary injury, laryngeal injury, and pneumonia when compared to their non-tracheostomy counterparts. The risk ratios for these outcomes were 62.452, 4.713, 9.267, 26.483, 116.163, and 18.154, respectively. Conclusions The analysis of the longitudinal outcomes of pediatric burn patients with tracheostomy as compared to those without tracheostomy demonstrated the tracheostomy cohort suffered much worse mortality and morbidity across several metrics. The potential benefits of tracheostomy placement in pediatric burn patients should be weighed against these outcomes.

Download Full-text