title: Pulmonary complications in inhalation injuries with associated cutaneous burn.
abstract: This retrospective study of 100 consecutive patients with inhalation injury documents that adult respiratory distress syndrome (ARDS) and pneumonia are common complications. Pulmonary complications cause or directly contribute to death in 77% of patients with combined inhalation and cutaneous burn injury. Additionally, the high fluid requirements of these patients worsens their pulmonary injury and is associated with adverse outcome. Independent factors predictive of death include ARDS and expected fluid requirements as well as age and percentage of total body surface area burned. An abnormal chest roentgenogram in the first 48 hours after injury is also associated with death. The development of ARDS is predicted by the actual volume of fluid resuscitation, despite normal pulmonary wedge pressure or normal central venous pressure reflecting increased microvascular permeability. These findings indicate a need for reevaluation of fluid resuscitation of patients with inhalation injury.
authors.affiliation: Division of Thoracic Surgery, Mount Sinai Hospital, Toronto, Ontario, Canada.
authors.forename: G E
authors.initials: GE
authors.lastname: Darling
authors.forename: M A
authors.initials: MA
authors.lastname: Keresteci
authors.forename: D
authors.initials: D
authors.lastname: Ibañez
authors.forename: R A
authors.initials: RA
authors.lastname: Pugash
authors.forename: W J
authors.initials: WJ
authors.lastname: Peters
authors.forename: P C
authors.initials: PC
authors.lastname: Neligan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002056:Burns / Q000150:complications*; D002059:Burns, Inhalation / Q000150:complications*; D005260:Female; D005440:Fluid Therapy / Q000009:adverse effects; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000209:etiology* / Q000401:mortality; D011237:Predictive Value of Tests; D011379:Prognosis; D012128:Respiratory Distress Syndrome / Q000209:etiology* / Q000401:mortality; D012151:Resuscitation / Q000009:adverse effects; D012189:Retrospective Studies; D012307:Risk Factors