title: Assistance of inhalation injury victims caused by fire in confined spaces: what we learned from the tragedy at Santa Maria.
abstract: On January 2013, a disaster at Santa Maria (RS) due to a fire in a confined space caused 242 deaths, most of them by inhalation injury. On November 2013, four individuals required intensive care following smoke inhalation from a fire at the Memorial da América Latina in São Paulo (SP). The present article reports the clinical progression and management of disaster victims presenting with inhalation injury. Patients ERL and OC exhibited early respiratory failure, bronchial aspiration of carbonaceous material, and carbon monoxide poisoning. Ventilation support was performed with 100% oxygen, the aspirated material was removed by bronchoscopy, and cyanide poisoning was empirically treated with sodium nitrite and sodium thiosulfate. Patient RP initially exhibited cough and retrosternal burning and subsequently progressed to respiratory failure due to upper airway swelling and early-onset pulmonary infection, which were treated with protective ventilation and antimicrobial agents. This patient was extubated following improvement of edema on bronchoscopy. Patient MA, an asthmatic, exhibited carbon monoxide poisoning and bronchospasm and was treated with normobaric hyperoxia,bronchodilators, and corticosteroids. The length of stay in the intensive care unit varied from four to 10 days, and all four patients exhibited satisfactory functional recovery. To conclude, inhalation injury has a preponderant role in fires in confined spaces. Invasive ventilation should not be delayed in cases with significant airway swelling. Hyperoxia should be induced early asa therapeutic means against carbon monoxide poisoning, in addition to empiric pharmacological treatment in suspected cases of cyanide poisoning.
authors.affiliation: Unidade de Terapia Intensiva de Emergência Cirúrgica e Trauma, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil.
authors.forename: Estevão
authors.initials: E
authors.lastname: Bassi
authors.affiliation: Unidade de Terapia Intensiva de Emergência Cirúrgica e Trauma, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil.
authors.forename: Leandro Costa
authors.initials: LC
authors.lastname: Miranda
authors.affiliation: Unidade de Terapia Intensiva de Emergência Cirúrgica e Trauma, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil.
authors.forename: Paulo Fernando Guimarães Morando Marzocchi
authors.initials: PF
authors.lastname: Tierno
authors.affiliation: Unidade de Terapia Intensiva de Emergência Cirúrgica e Trauma, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil.
authors.forename: César Biselli
authors.initials: CB
authors.lastname: Ferreira
authors.affiliation: Unidade de Terapia Intensiva de Emergência Cirúrgica e Trauma, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil.
authors.forename: Filipe Matheus
authors.initials: FM
authors.lastname: Cadamuro
authors.affiliation: Departamento de Broncoscopia, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil.
authors.forename: Viviane Rossi
authors.initials: VR
authors.lastname: Figueiredo
authors.affiliation: Pronto-Socorro, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil.
authors.forename: Maria Cecilia de Toledo
authors.initials: MC
authors.lastname: Damasceno
authors.affiliation: Unidade de Terapia Intensiva de Emergência Cirúrgica e Trauma, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil.
authors.forename: Luiz Marcelo Sá
authors.initials: LM
authors.lastname: Malbouisson
mesh_terms: D000328:Adult; D001938:Brazil; D002249:Carbon Monoxide Poisoning / Q000209:etiology / Q000628:therapy*; D020378:Confined Spaces; D003422:Critical Care / Q000379:methods; D005390:Fires; D006801:Humans; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000008:administration & dosage; D012121:Respiration, Artificial / Q000379:methods*; D012131:Respiratory Insufficiency / Q000209:etiology / Q000628:therapy*; D015208:Smoke Inhalation Injury / Q000628:therapy*
chemical_list: D010100:Oxygen