title: Brother, have you got a light? Assessing the need for intubation in patients sustaining burn injury secondary to home oxygen therapy.
abstract: Home oxygen therapy use has steadily increased for the past 30 years. A majority of these patients suffer from chronic obstructive pulmonary disease secondary to smoking. Although warned of the danger of smoking while on oxygen, patients continue to do so, potentially resulting in cutaneous burns and suspected inhalation injury. Those suspected of inhalation injury are intubated for airway control. In the English literature, there is a paucity of data discussing the need for intubation. To date, this is the largest study to determine whether intubated patients had inhalation injury as observed by bronchoscopy and whether intubation was necessary. All patient's charts who sustained burns while on home oxygen therapy from May 2000 to May 2010 were retrospectively reviewed (n = 86). Data collected were age, sex, TBSA, ventilator days, length of stay (LOS), and presence or absence of inhalation. Of those patients intubated, a subset analysis was performed to determine whether intubation in the "Field" or "Outside Hospital" correlated with inhalation injury compared with intubation in our Emergency Department. Eighty-six patients (mean age 64 years, mean %TBSA 2.6) were included. Before transfer to the burn unit, 32 patients (37%) were intubated and 52 patients (61%) were not intubated. Of the 32 intubated patients, bronchoscopy confirmed inhalation injury in 12 patients (39%). No significant difference was seen in %TBSA between intubated vs nonintubated patients (3.5 vs 2.0, respectively). However, there was a difference in LOS between the two groups (12.7 vs 2.8, respectively). No difference was found in incidence of inhalation injury between patients intubated in the "Field/Outside Hospital" compared with patients intubated in our Emergency Department (39% and 37.5%, respectively). Between the subgroups, no difference was found in %TBSA, ventilator days, or LOS. One patient admitted for airway observation required intubation and one patient failed extubation, postoperatively. Patients on home oxygen therapy suspected of inhalation injury should ideally be observed for signs of airway compromise before intubation is performed.
authors.affiliation: Lehigh Valley Regional Burn Center, Allentown, Pennsylvania, USA.
authors.forename: Hamed
authors.initials: H
authors.lastname: Amani
authors.forename: Daniel D
authors.initials: DD
authors.lastname: Lozano
authors.forename: Sigrid
authors.initials: S
authors.lastname: Blome-Eberwein
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001999:Bronchoscopy; D002056:Burns / Q000209:etiology*; D002059:Burns, Inhalation / Q000209:etiology* / Q000628:therapy*; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010102:Oxygen Inhalation Therapy / Q000009:adverse effects*; D012189:Retrospective Studies; D012907:Smoking / Q000009:adverse effects; D018709:Statistics, Nonparametric; D016896:Treatment Outcome