title: Inhalation injury after exposure to indoor fire and smoke: The Brazilian disaster experience.
abstract: OBJECTIVE
  To describe the pre-hospital, emergency department, and intensive care unit (ICU) care and prognosis of patients with inhalation injury after exposure to indoor fire and smoke.
  
  
  METHODS
  This is a prospective observational cohort study that includes patients admitted to seven ICUs after a fire disaster. The following data were collected: demographic characteristics; use of fiberoptic bronchoscopy; degree of inhalation injury; percentage of burned body surface area; mechanical ventilation parameters; and subsequent events during ICU stay. Patients were followed to determine the ICU and hospital mortality rates.
  
  
  RESULTS
  Within 24h of the incident, 68 patients were admitted to seven ICUs. The patients were young and had no comorbidities. Most patients (n=35; 51.5%) only had an inhalation injury. The mean ventilator-free days for patients with an inhalation injury degree of 0 or I was 12.5±8.1 days. For patients with an inhalation injury degree of II or III, the mean ventilator-free days was 9.4±5.8 days (p=0.12). In terms of the length of ICU stay for patients with degrees 0 or I, and patients with degrees II or III, the median was 7.0 days (5.0-8.0 days) and 12.0 days (8.0-23.0 days) (p<0.001), respectively. In addition, patients with a larger percentage of burned surface areas also had a longer ICU stay; however, no association with ventilator-free days was found. The patients with <10% of burned body surface area showed a mean of 9.2±5.4 ventilator-free days. The mean ventilator-free days for patients who had >10% burned body surface area was 11.9±9.5 (p=0.26). The length of ICU stay for the <10% and >10% burned body surface area patients was 7.0 days (5.0-10.0 days) and 23.0 days (11.5-25.5 days) (p<0.001), respectively.
  
  
  CONCLUSIONS
  We conclude that burn patients with inhalation injuries have different courses of disease, which are mainly determined by the percentage of burned body surface area.
authors.affiliation: Department of Intensive Care Medicine, Hospital de Clínicas de Porto Alegre, Ramiro Barcelos, 2350, Porto Alegre, Brazil.
authors.forename: Tatiana Helena
authors.initials: TH
authors.lastname: Rech
authors.affiliation: Department of Intensive Care Medicine, Hospital de Clínicas de Porto Alegre, Ramiro Barcelos, 2350, Porto Alegre, Brazil. Electronic address: mboniatti@hcpa.edu.br.
authors.forename: Márcio Manozzo
authors.initials: MM
authors.lastname: Boniatti
authors.affiliation: Department of Intensive Care Medicine, Hospital de Clínicas de Porto Alegre, Ramiro Barcelos, 2350, Porto Alegre, Brazil.
authors.forename: Cristiano Augusto
authors.initials: CA
authors.lastname: Franke
authors.affiliation: Department of Intensive Care Medicine, Hospital de Clínicas de Porto Alegre, Ramiro Barcelos, 2350, Porto Alegre, Brazil.
authors.forename: Thiago
authors.initials: T
authors.lastname: Lisboa
authors.affiliation: Department of Intensive Care Medicine, Hospital de Clínicas de Porto Alegre, Ramiro Barcelos, 2350, Porto Alegre, Brazil.
authors.forename: Iuri Christmann
authors.initials: IC
authors.lastname: Wawrzeniak
authors.affiliation: Department of Intensive Care Medicine, Hospital Moinhos de Vento, Ramiro Barcelos, 910, Porto Alegre, Brazil.
authors.forename: Cassiano
authors.initials: C
authors.lastname: Teixeira
authors.affiliation: Department of Intensive Care Medicine, Hospital Moinhos de Vento, Ramiro Barcelos, 910, Porto Alegre, Brazil.
authors.forename: Juçara Gasparetto
authors.initials: JG
authors.lastname: Maccari
authors.affiliation: Department of Intensive Care Medicine, Hospital Moinhos de Vento, Ramiro Barcelos, 910, Porto Alegre, Brazil.
authors.forename: Felipe
authors.initials: F
authors.lastname: Schaich
authors.affiliation: Department of Intensive Care Medicine, Hospital de Pronto Socorro de Porto Alegre, Largo Teodoro Herzl, Porto Alegre, Brazil.
authors.forename: Angelica
authors.initials: A
authors.lastname: Sauthier
authors.affiliation: Department of Intensive Care Medicine, Hospital de Caridade Dr. Astrogildo de Azevedo, Presidente Vargas, 2291, Santa Maria, Brazil.
authors.forename: Luciele Medianeira
authors.initials: LM
authors.lastname: Schifelbain
authors.affiliation: Department of Intensive Care Medicine, Hospital Cristo Redentor, Domingos Rubbo, 20, Porto Alegre, Brazil.
authors.forename: Diego Fontoura Mendes
authors.initials: DF
authors.lastname: Riveiro
authors.affiliation: Department of Intensive Care Medicine, Hospital Cristo Redentor, Domingos Rubbo, 20, Porto Alegre, Brazil.
authors.forename: Deisi Leticia Oliveira
authors.initials: DL
authors.lastname: da Fonseca
authors.affiliation: Department of Intensive Care Medicine, Santa Casa de Misericórdia, Professor Annes Dias, 295, Porto Alegre, Brazil.
authors.forename: Paula Pinheiro
authors.initials: PP
authors.lastname: Berto
authors.affiliation: Department of Intensive Care Medicine, Santa Casa de Misericórdia, Professor Annes Dias, 295, Porto Alegre, Brazil.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Marques
authors.affiliation: Department of Intensive Care Medicine, Hospital Nossa Senhora da Conceição, Francisco Trein, 596, Porto Alegre, Brazil.
authors.forename: Moreno Calcagnotto
authors.initials: MC
authors.lastname: Dos Santos
authors.affiliation: Department of Intensive Care Medicine, Hospital Nossa Senhora da Conceição, Francisco Trein, 596, Porto Alegre, Brazil.
authors.forename: Vanessa Martins
authors.initials: VM
authors.lastname: de Oliveira
authors.affiliation: Department of Intensive Care Medicine, Hospital de Pronto Socorro de Porto Alegre, Largo Teodoro Herzl, Porto Alegre, Brazil.
authors.forename: Carlos Fernando Drumond
authors.initials: CF
authors.lastname: Dornelles
authors.affiliation: Department of Intensive Care Medicine, Hospital de Clínicas de Porto Alegre, Ramiro Barcelos, 2350, Porto Alegre, Brazil.
authors.forename: Sílvia Regina Rios
authors.initials: SR
authors.lastname: Vieira
mesh_terms: D000328:Adult; D000368:Aged; D001938:Brazil; D001999:Bronchoscopy / Q000706:statistics & numerical data; D002056:Burns / Q000150:complications* / Q000473:pathology; D004190:Disasters; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012720:Severity of Illness Index; D015208:Smoke Inhalation Injury / Q000628:therapy*
keywords: Burn; Disaster; Fire victims; Inhalation injury