Impact of inhalation injury on outcomes in critically ill burns patients: 12-year experience at a regional burns centre |
| |
| Institution: | 1. Department of Surgery and Cancer, Imperial College London, London, United Kingdom;2. Department of Burns, Plastic and Reconstructive Surgery, Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom;3. Intensive Care Unit, Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom;4. Department of Research and Development, Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom;5. Academic Department of Anaesthesia, Pain Management and Intensive Care (APMIC), Imperial College London, Chelsea and Westminster Hospital NHS Foundation Trust and Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom;1. Division of Plastic and Aesthetic Surgery, Department of Surgery, Far Eastern Memorial Hospital, No. 21, Section 2, Nanya South Road, Banqiao District, New Taipei City, Taiwan;2. School of Medicine, National Yang Ming Chiao Tung University, Taiwan;3. Department of Information Management, Yuan Ze University, Taiwan;4. School of Medicine, National Taiwan University, Taiwan;1. Department of Burns and Plastic Surgery, Southmead Hospital, North Bristol NHS Foundation Trust, BS10 5BN, United Kingdom;2. Department of Dermatology, Royal United Hospitals Bath, Combe Park, Bath BA1 3NG, United Kingdom;1. Aboqir General Hospital, Plastic, Reconstructive Surgery, and Burn Therapy Department, Alexandria, Egypt;2. Histology and Cell Biology Department, Faculty of Medicine, Alexandria University, Egypt |
| |
| Abstract: | IntroductionBurns inhalation injury increases the attributable mortality of burns related trauma. However, diagnostic uncertainties around bronchoscopically graded severity, and its effect on outcomes, remain. This study evaluated the impact of different bronchoscopic burns inhalation injury grades on outcomes.MethodsA single-centre cohort study of all patients admitted to the London Burns centre intensive care unit (BICU) over 12 years. Demographic data, burn and burns inhalation injury characteristics, and ICU-related parameters were collected retrospectively. The primary outcome was mortality. Secondary outcomes were hospital and ICU lengths of stay. The impact of pneumonia was determined. Univariate and multivariable Cox’s proportional hazards regression analyses informed factors predicting mortality.ResultsBurns inhalation injury was diagnosed in 84 of 231 (36%) critically ill burns patients; 20 mild (grade 1), 41 severe (grades 2/3) and 23 unclassified bronchoscopically. Median (IQR) total body surface area burned (TBSA) was 20% (10?40). Mortality was significantly higher in patients with burns inhalation injury vs those without burns inhalation injury (38/84 45%] vs 35/147 24%], p < 0.001). Patients with pneumonia had a higher mortality than those without (34/125 27%] vs 8/71 11%], p = 0.009). In multivariable analysis, severe burns inhalation injury significantly increased mortality (adjusted HR=2.14, 95%CI: 1.12–4.09, p = 0.022), compared with mild injury (adjusted HR=0.58, 95% CI: 0.18–1.86, p = 0.363). Facial burns (adjusted HR=3.13, 95%CI: 1.69–5.79, p < 0.001), higher TBSA (adjusted HR=1.05, 95%CI: 1.04–1.06, p < 0.001) and older age (adjusted HR=1.04, 95%CI: 1.02–1.07, p < 0.001) also independently predicted mortality, though pneumonia did not.ConclusionsSevere burns inhalation injury is a significant risk factor for mortality in critically ill burns patients. However, pneumonia did not increase mortality from burns inhalation injury. This work confirms prior implications of bronchoscopically graded burns inhalation injury. Further study is suggested, through registries, into the diagnostic accuracy and reliability of bronchoscopy in burns related lung injury. |
| |
| Keywords: | Burns Inhalation injury Mortality Bronchoscopy Grading |
| 本文献已被 ScienceDirect 等数据库收录！ |
|
