title: Utility and outcomes of hydroxocobalamin use in smoke inhalation patients.
abstract: BACKGROUND
  Hydroxocobalamin has been available for use for suspected cyanide toxicity in smoke inhalation patients in the United States since 2006. Our study compares outcomes of patients who received hydroxocobalamin to historical controls who did not.
  
  
  METHODS
  In this retrospective review, patients administered hydroxocobalamin (2008-2014) were compared to historical controls (2002-2008). Patients <18 years, patients who received an alternate antidote, and patients without suspicion of smoke inhalation injury were excluded. Mortality was the primary outcome. Secondary outcomes evaluated were 7-day change in creatinine, culture-proven pneumonia, days on mechanical ventilation, ventilator- free days (VFD), ICU length of stay (ICU LOS), and hospital length of stay (HLOS).
  
  
  RESULTS
  A total of 138 patients in the hydroxocobalamin group and 135 in the control group were identified. Mortality rate was similar between both groups (29% vs. 28%, p=0.90). Hydroxocobalamin was associated with lower pneumonia rate (23% vs. 49%, p<0.01), less ventilator days (4 days vs. 7 days, p<0.01), and increased VFD (20 days vs. 11 days, p=0.01) compared to controls. Shorter ICU LOS (6 days vs. 10 days, p=0.03) and a trend toward lower HLOS (7 day vs. 11 days, p=0.06) were also found in patients who received hydroxocobalamin.
  
  
  CONCLUSIONS
  Routine administration was associated with lower rate of pneumonia, faster liberation from the ventilator, and reductions in intensive care unit stay. Burn centers should consider its empiric use in suspected smoke inhalation patients.
authors.affiliation: Vanderbilt University Medical Center, Department of Plastic Surgery, 1161 21st Avenue S, S2221, Nashville, TN 37232, United States; Morristown Medical Center, Department of Surgery, 100 Madison Ave, Morristown, NJ 07960, United States. Electronic address: lyly.nguyen@vanderbilt.edu.
authors.forename: Lyly
authors.initials: L
authors.lastname: Nguyen
authors.affiliation: Vanderbilt University Medical Center, Department of Plastic Surgery, 1161 21st Avenue S, S2221, Nashville, TN 37232, United States; Unversity of South Carolina, Department of Surgery, 2 Medical Park Suite 306, Columbia, SC 29203, United States. Electronic address: ashkan.afshari@vanderbilt.edu.
authors.forename: Ashkan
authors.initials: A
authors.lastname: Afshari
authors.affiliation: University of South Alabama, Department of Surgery, Division of Trauma/Critical Care, 2451 Fillingim St., Mobile, AL 36617, United States. Electronic address: skahn@health.southalabama.edu.
authors.forename: Steven A
authors.initials: SA
authors.lastname: Kahn
authors.affiliation: Vanderbilt University Medical Center, Department of Anesthesiology, Division of Critical Care, 1211 21st Ave S, 526 MAB, Nashville, TN 37212, United States. Electronic address: stuart.mcgrane@vanderbilt.edu.
authors.forename: Stuart
authors.initials: S
authors.lastname: McGrane
authors.affiliation: Vanderbilt University Medical Center, Department of Plastic Surgery, 1161 21st Avenue S, S2221, Nashville, TN 37232, United States. Electronic address: blair.summitt@vandbilt.edu.
authors.forename: Blair
authors.initials: B
authors.lastname: Summitt
mesh_terms: D000328:Adult; D000368:Aged; D000931:Antidotes / Q000627:therapeutic use; D002053:Burn Units; D016022:Case-Control Studies; D003486:Cyanides / Q000506:poisoning; D005260:Female; D005390:Fires; D006801:Humans; D006879:Hydroxocobalamin / Q000627:therapeutic use*; D007362:Intensive Care Units; D007902:Length of Stay / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000453:epidemiology*; D012121:Respiration, Artificial / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D015208:Smoke Inhalation Injury / Q000628:therapy*; D014803:Vitamin B Complex / Q000627:therapeutic use*
chemical_list: D000931:Antidotes; D003486:Cyanides; D014803:Vitamin B Complex; D006879:Hydroxocobalamin
keywords: Burn; Cyanokit; Hydroxocobalamin; Inhalation injury; Pneumonia; Smoke inhalation