In the United States, more than 1 million burn injuries occur every year. Although the survival from burn injury has increased in recent years with the development of effective fluid resuscitation management and early surgical excision of burned tissue, the mortality of burn injury is still high. In these fire victims, progressive pulmonary failure and cardiovascular dysfunction are important determinants of morbidity and mortality. The morbidity and mortality increases when burn injury is associated with smoke inhalation. Smoke inhalation and pneumonia increase mortality of burn patients by 20 and 40%, respectively , suggesting that the pulmonary involvement is a very important risk factor in burn trauma. Our group and others have reported various factors that are involved in pathophysiology of acute lung injury (ALI) in burn, including coagulopathy [2, 3]. It was earlier described that burn injury is associated with a hypercoagulable state . The coagulopathy seen in these burn patients is associated with marked depletion of a major endogenous regulator of blood coagulation, antithrombin -. In the present chapter, we will discuss a possible role of antithrombin in the pathophysiology of ALI induced by combined burn and smoke inhalation and review the therapeutic approaches.
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