Dynamics of acute respiratory distress syndrome development due to smoke inhalation injury

Smoke inhalation injury (SIJ) is associated with an increase in morbidity and mortality in patients with burns. SIJ causes airway damage, inflammation, and bronchial obstruction, resulting in decreased oxygenation and perfusion status in these patients. Retrospective studies have compared the use of nebulized heparin (NH) plus nebulized N-acetylcysteine (NAC) and albuterol in patients with SIJ to those who received standard ventilator support with bronchodilator therapy. These studies are associated with a decrease in mortality when NH and nebulized NAC are administered to patients with SIJ. Approximately 20% of patients who develop SIJ will also develop acute respiratory distress syndrome (ARDS). Epoprostenol, a selective pulmonary vasodilator, has been utilized in the treatment of ARDS with mixed results for improving gas exchange. To our knowledge, this is the first case report of the concomitant administration of NH, nebulized NAC, and nebulized epoprostenol following SIJ in a burn patient with ARDS.

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A novel large animal model of smoke inhalation-induced acute respiratory distress syndrome

Respiratory Research ◽

10.1186/s12931-021-01788-8 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Premila D. Leiphrakpam ◽

Hannah R. Weber ◽

Andrea McCain ◽

Roser Romaguera Matas ◽

Ernesto Martinez Duarte ◽

...

Keyword(s):

Animal Model ◽

Acute Respiratory Distress Syndrome ◽

Respiratory Distress Syndrome ◽

Distress Syndrome ◽

Inhalation Injury ◽

Smoke Inhalation ◽

Large Animal Model ◽

Large Animal ◽

X Ray ◽

Chest X Ray

Abstract Background Acute respiratory distress syndrome (ARDS) is multifactorial and can result from sepsis, trauma, or pneumonia, amongst other primary pathologies. It is one of the major causes of death in critically ill patients with a reported mortality rate up to 45%. The present study focuses on the development of a large animal model of smoke inhalation-induced ARDS in an effort to provide the scientific community with a reliable, reproducible large animal model of isolated toxic inhalation injury-induced ARDS. Methods Animals (n = 21) were exposed to smoke under general anesthesia for 1 to 2 h (median smoke exposure = 0.5 to 1 L of oak wood smoke) after the ultrasound-guided placement of carotid, pulmonary, and femoral artery catheters. Peripheral oxygen saturation (SpO2), vital signs, and ventilator parameters were monitored throughout the procedure. Chest x-ray, carotid, femoral and pulmonary artery blood samples were collected before, during, and after smoke exposure. Animals were euthanized and lung tissue collected for analysis 48 h after smoke inhalation. Results Animals developed ARDS 48 h after smoke inhalation as reflected by a decrease in SpO2 by approximately 31%, PaO2/FiO2 ratio by approximately 208 (50%), and development of bilateral, diffuse infiltrates on chest x-ray. Study animals also demonstrated a significant increase in IL-6 level, lung tissue injury score and wet/dry ratio, as well as changes in other arterial blood gas (ABG) parameters. Conclusions This study reports, for the first time, a novel large animal model of isolated smoke inhalation-induced ARDS without confounding variables such as cutaneous burn injury. Use of this unique model may be of benefit in studying the pathophysiology of inhalation injury or for development of novel therapeutics.

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Acute Lung Injury, Acute Respiratory Distress Syndrome and Inhalation Injury: An Overview

Drug and Chemical Toxicology ◽

10.3109/01480549909029726 ◽

1999 ◽

Vol 22 (1) ◽

pp. 91-128 ◽

Cited By ~ 30

Author(s):

Edgar C. Kimmel ◽

Kenneth R. Still

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Acute Lung Injury ◽

Lung Injury ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Inhalation Injury

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Acute respiratory distress syndrome caused by carbon monoxide poisoning and inhalation injury recovered after extracorporeal membrane oxygenation along with direct hemoperfusion with polymyxin B-immobilized fiber column: a case report

Journal of Medical Case Reports ◽

10.1186/s13256-021-03023-w ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

Ji Hoon Jang ◽

Hang Jea Jang ◽

Hyun-Kuk Kim ◽

Jin Han Park ◽

Hyo-Jung Kim ◽

...

Keyword(s):

Carbon Monoxide ◽

Acute Respiratory Distress Syndrome ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Carbon Monoxide Poisoning ◽

Polymyxin B ◽

Inhalation Injury ◽

Cytokine Storm ◽

Direct Hemoperfusion

Abstract Background Inhalation injury from smoke or chemical products and carbon monoxide poisoning are major causes of death in burn patients from fire accidents. Respiratory tract injuries from inhalation injury and carbon monoxide poisoning can lead to acute respiratory distress syndrome and cytokine storm syndrome. In the case of acute respiratory failure needing mechanical ventilation accompanied by cytokine storm, mortality is high and immediate adequate treatment at the emergency department is very important. Case presentation This report describes a case of acute respiratory distress syndrome and cytokine storm followed by carbon monoxide poisoning in a 34-year-old Korean male patient who was in a house fire, and was successfully treated by extracorporeal membrane oxygenation and direct hemoperfusion with polymyxin B-immobilized fiber column at emergency department. Conclusions To prevent mortality in acute respiratory distress syndrome with cytokine storm from inhalation injury and to promote a better prognosis, we suggest that early implication of extracorporeal membranous oxygenation along with direct hemoperfusion with polymyxin B-immobilized fiber column even at the emergency department should be considered.

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Incidence and Mortality of Acute Respiratory Distress Syndrome in Patients With Burns: A Systematic Review and Meta-Analysis

Frontiers in Medicine ◽

10.3389/fmed.2021.709642 ◽

2021 ◽

Vol 8 ◽

Author(s):

Baoli Wang ◽

Wei Chenru ◽

Yong Jiang ◽

Lunyang Hu ◽

He Fang ◽

...

Keyword(s):

Systematic Review ◽

Mechanical Ventilation ◽

Acute Respiratory Distress Syndrome ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Meta Analysis ◽

Inhalation Injury ◽

African Countries ◽

Incidence And Mortality

Objective: We conducted a systematic review and meta-analysis to comprehensively estimate the incidence and mortality of acute respiratory distress syndrome (ARDS) in overall and subgroups of patients with burns.Data sources: Pubmed, Embase, the Cochrane Library, CINAHL databases, and China National Knowledge Infrastructure database were searched until September 1, 2021.Study selection: Articles that report study data on incidence or mortality of ARDS in patients with burns were selected.Data extraction: Two researchers independently screened the literature, extracted data, and assessed the quality. We performed a meta-analysis of the incidence and mortality of ARDS in patients with burns using a random effects model, which made subgroup analysis according to the study type, inclusion (mechanical ventilation, minimal burn surface), definitions of ARDS, geographic location, mean age, burn severity, and inhalation injury. Primary outcomes were the incidence and mortality of burns patients with ARDS, and secondary outcomes were incidence for different subgroups.Data synthesis: Pooled weighted estimate of the incidence and mortality of ARDS in patients with burns was 0.24 [95% confidence interval (CI)0.2–0.28] and 0.31 [95% CI 0.18−0.44]. Incidences of ARDS were obviously higher in patients on mechanical ventilation (incidence = 0.37), diagnosed by Berlin definition (incidence = 0.35), and with over 50% inhalation injury proportion (incidence = 0.41) than in overall patients with burns. Patients with burns who came from western countries and with inhalation injury have a significantly higher incidence of ARDS compared with those who came from Asian/African countries (0.28 vs. 0.25) and without inhalation injury (0.41 vs. 0.24).Conclusion: This systematic review and meta-analysis revealed that the incidence of ARDS in patients with burns is 24% and that mortality is as high as 31%. The incidence rates are related to mechanical ventilation, location, and inhalation injury. The patients with burns from western countries and with inhalation injury have a significantly higher incidence than patients from Asian/African countries and without inhalation injury.Systematic Review Registration: identifier: CRD42021144888.

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Club Cell Protein, CC10, Attenuates Acute Respiratory Distress Syndrome Induced by Smoke Inhalation

Shock ◽

10.1097/shk.0000000000001365 ◽

2020 ◽

Vol 53 (3) ◽

pp. 317-326 ◽

Cited By ~ 1

Author(s):

Ernesto Lopez ◽

Osamu Fujiwara ◽

Christina Nelson ◽

Melissa E. Winn ◽

Richard S. Clayton ◽

...

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Smoke Inhalation ◽

Cell Protein ◽

Club Cell

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Ketorolac may control more than pain

Clinical Science ◽

10.1042/cs20030275 ◽

2003 ◽

Vol 105 (5) ◽

pp. 549-550 ◽

Cited By ~ 1

Author(s):

Frank ISIK

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Inhalation Injury ◽

Clinical Science ◽

Inflammatory Cascade ◽

Life Threatening

Life-threatening acute respiratory distress syndrome (ARDS) complicates the recovery of patients with burn and inhalation injury. The study by Enkhbaatar and co-workers in this issue of Clinical Science suggests that reducing the early and robust inflammatory cascade may provide patients with protection from developing cardiopulmonary compromise seen early after burn and inhalation injury.

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Extracorporeal Life Support for Severely Burned Patients with Concurrent Inhalation Injury and Acute Respiratory Distress Syndrome: Experience From A Military Medical Burn Center

10.21203/rs.3.rs-754275/v1 ◽

2021 ◽

Author(s):

Chih-Han Huang ◽

Chien-Sung Tsai ◽

Jia-Lin Chen ◽

Hung-Hui Liu ◽

Yi-Ting Tsai ◽

...

Keyword(s):

Risk Factors ◽

Acute Respiratory Distress Syndrome ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Life Support ◽

Extracorporeal Life Support ◽

Inhalation Injury ◽

Burn Center ◽

The Mean

Abstract Background: Both inhalation injury and acute respiratory distress syndrome (ARDS) are risk factors that predict mortality in severely burned patients. Extracorporeal life support (ECLS) is widely used to rescue these patients; however, its efficacy and safety in this critical population have not been well defined. We report our experience of using ECLS for treatment of severely burned patients with concurrent inhalation injury and ARDS. Methods: This is a retrospective analysis of 14 patients, including 10 males and four females, collected from a single medical burn center from 2012 to 2019. The mean age was 38.6±12.3 (range, 19-59) years. All suffered from major burns with inhalation injury. The average total body surface area of deep dermal or full thickness (DD/FT) burns was 81.6±20.0% (range, 47–99%). The average revised Baux score was 137.3 ± 22.6 (range, 107 – 172). All had developed ARDS with mean PaO2/FiO2 of 67.8±17.3. Indications for ECLS included sustained hypoxemia and unstable hemodynamics. The mean interval for initiating ECLS was 20.3 ± 40.8 days (range, 1-156 days). Results: The mean duration of ECLS was 5.0±5.6 days (range, 0.3-16.7 days). The overall survival to discharge was 42.8%. Causes of death included sepsis (n=4) and multiple organ failure (n=4). The ECLS-related complications included cannulation bleeding, catheter-related infection, and hemolysis. The predicted risk factors of mortality before ECLS included lactate>8 mmol/L and Baux score>120. Conclusions: For severely burned patients with concurrent inhalation injury and ARDS, ECLS could be a salvage treatment to improve sustained hypoxemia. However, the efficacy of hemodynamic support seemed limited. Definite ECLS indications and rigorous patient selection would contribute to better clinical outcomes.

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