Pulmonary injury in burned patients

David Herndon, P. B. Thompson, D. L. Traber

Research output: Contribution to journalArticle

63 Citations (Scopus)

Abstract

With improvements in treatment of burn shock and wound sepsis, inhalation injury has emerged as the number one cause of fatality in the burn patient; it accounts for 20 to 84 per cent of burn mortality. Only steam is capable of inflicting direct thermal damage; most injury is caused by incomplete products of combustion, the most important being aldehydes. More accurate diagnostic techniques, including fiberoptic bronchoscopy and 133Xe scanning, have been added to the traditional clinical signs of inhalation injury, such as facial burns, singed nasal vibrissae, and closed space injury, and have led to a new estimation of a 30 per cent incidence among patients with major burns. Patients with inhalation injury typically pass through three stages, those of acute pulmonary insufficiency, pulmonary edema, and broncho-pneumonia. The major early pathophysiologic changes seen in the lungs of burned patients related to edema. With inhalation injury this is probably mediated by the products of activated neutrophils. Later changes are the result of the reduction of surfactant and thus lung compliance. Treatment consists of intubation at the first hint of respiratory distress; the issue of tracheostomy versus endotracheal intubation has not been scientifically resolved, but most centers employ prolonged nasotracheal intubation. Prophylactic antibodies or steroids are not of benefit. Further care is only supportive and includes CPAP, PEEP, vigorous pulmonary toilet, humidification of inspired air, and antibiotics for documented infection. Further advances await the development of pharmacologic methods of affecting the lung's response to injury, which includes altered capillary permeability and decreased immune function.

Original languageEnglish (US)
Pages (from-to)79-96
Number of pages18
JournalCritical Care Clinics
Volume1
Issue number1
StatePublished - 1985

Fingerprint

Lung Injury
Wounds and Injuries
Inhalation
Lung
Burns
Intubation
Lung Compliance
Vibrissae
Intratracheal Intubation
Tracheostomy
Steam
Capillary Permeability
Bronchoscopy
Pulmonary Edema
Nose
Aldehydes
Surface-Active Agents
Shock
Edema
Sepsis

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Herndon, D., Thompson, P. B., & Traber, D. L. (1985). Pulmonary injury in burned patients. Critical Care Clinics, 1(1), 79-96.

Pulmonary injury in burned patients. / Herndon, David; Thompson, P. B.; Traber, D. L.

In: Critical Care Clinics, Vol. 1, No. 1, 1985, p. 79-96.

Research output: Contribution to journalArticle

Herndon, D, Thompson, PB & Traber, DL 1985, 'Pulmonary injury in burned patients', Critical Care Clinics, vol. 1, no. 1, pp. 79-96.
Herndon D, Thompson PB, Traber DL. Pulmonary injury in burned patients. Critical Care Clinics. 1985;1(1):79-96.
Herndon, David ; Thompson, P. B. ; Traber, D. L. / Pulmonary injury in burned patients. In: Critical Care Clinics. 1985 ; Vol. 1, No. 1. pp. 79-96.
@article{edc482a72b004b12b7d09bb77a9f8c9e,
title = "Pulmonary injury in burned patients",
abstract = "With improvements in treatment of burn shock and wound sepsis, inhalation injury has emerged as the number one cause of fatality in the burn patient; it accounts for 20 to 84 per cent of burn mortality. Only steam is capable of inflicting direct thermal damage; most injury is caused by incomplete products of combustion, the most important being aldehydes. More accurate diagnostic techniques, including fiberoptic bronchoscopy and 133Xe scanning, have been added to the traditional clinical signs of inhalation injury, such as facial burns, singed nasal vibrissae, and closed space injury, and have led to a new estimation of a 30 per cent incidence among patients with major burns. Patients with inhalation injury typically pass through three stages, those of acute pulmonary insufficiency, pulmonary edema, and broncho-pneumonia. The major early pathophysiologic changes seen in the lungs of burned patients related to edema. With inhalation injury this is probably mediated by the products of activated neutrophils. Later changes are the result of the reduction of surfactant and thus lung compliance. Treatment consists of intubation at the first hint of respiratory distress; the issue of tracheostomy versus endotracheal intubation has not been scientifically resolved, but most centers employ prolonged nasotracheal intubation. Prophylactic antibodies or steroids are not of benefit. Further care is only supportive and includes CPAP, PEEP, vigorous pulmonary toilet, humidification of inspired air, and antibiotics for documented infection. Further advances await the development of pharmacologic methods of affecting the lung's response to injury, which includes altered capillary permeability and decreased immune function.",
author = "David Herndon and Thompson, {P. B.} and Traber, {D. L.}",
year = "1985",
language = "English (US)",
volume = "1",
pages = "79--96",
journal = "Critical Care Clinics",
issn = "0749-0704",
publisher = "W.B. Saunders Ltd",
number = "1",

}

TY - JOUR

T1 - Pulmonary injury in burned patients

AU - Herndon, David

AU - Thompson, P. B.

AU - Traber, D. L.

PY - 1985

Y1 - 1985

N2 - With improvements in treatment of burn shock and wound sepsis, inhalation injury has emerged as the number one cause of fatality in the burn patient; it accounts for 20 to 84 per cent of burn mortality. Only steam is capable of inflicting direct thermal damage; most injury is caused by incomplete products of combustion, the most important being aldehydes. More accurate diagnostic techniques, including fiberoptic bronchoscopy and 133Xe scanning, have been added to the traditional clinical signs of inhalation injury, such as facial burns, singed nasal vibrissae, and closed space injury, and have led to a new estimation of a 30 per cent incidence among patients with major burns. Patients with inhalation injury typically pass through three stages, those of acute pulmonary insufficiency, pulmonary edema, and broncho-pneumonia. The major early pathophysiologic changes seen in the lungs of burned patients related to edema. With inhalation injury this is probably mediated by the products of activated neutrophils. Later changes are the result of the reduction of surfactant and thus lung compliance. Treatment consists of intubation at the first hint of respiratory distress; the issue of tracheostomy versus endotracheal intubation has not been scientifically resolved, but most centers employ prolonged nasotracheal intubation. Prophylactic antibodies or steroids are not of benefit. Further care is only supportive and includes CPAP, PEEP, vigorous pulmonary toilet, humidification of inspired air, and antibiotics for documented infection. Further advances await the development of pharmacologic methods of affecting the lung's response to injury, which includes altered capillary permeability and decreased immune function.

AB - With improvements in treatment of burn shock and wound sepsis, inhalation injury has emerged as the number one cause of fatality in the burn patient; it accounts for 20 to 84 per cent of burn mortality. Only steam is capable of inflicting direct thermal damage; most injury is caused by incomplete products of combustion, the most important being aldehydes. More accurate diagnostic techniques, including fiberoptic bronchoscopy and 133Xe scanning, have been added to the traditional clinical signs of inhalation injury, such as facial burns, singed nasal vibrissae, and closed space injury, and have led to a new estimation of a 30 per cent incidence among patients with major burns. Patients with inhalation injury typically pass through three stages, those of acute pulmonary insufficiency, pulmonary edema, and broncho-pneumonia. The major early pathophysiologic changes seen in the lungs of burned patients related to edema. With inhalation injury this is probably mediated by the products of activated neutrophils. Later changes are the result of the reduction of surfactant and thus lung compliance. Treatment consists of intubation at the first hint of respiratory distress; the issue of tracheostomy versus endotracheal intubation has not been scientifically resolved, but most centers employ prolonged nasotracheal intubation. Prophylactic antibodies or steroids are not of benefit. Further care is only supportive and includes CPAP, PEEP, vigorous pulmonary toilet, humidification of inspired air, and antibiotics for documented infection. Further advances await the development of pharmacologic methods of affecting the lung's response to injury, which includes altered capillary permeability and decreased immune function.

UR - http://www.scopus.com/inward/record.url?scp=0022313164&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0022313164&partnerID=8YFLogxK

M3 - Article

C2 - 3916776

AN - SCOPUS:0022313164

VL - 1

SP - 79

EP - 96

JO - Critical Care Clinics

JF - Critical Care Clinics

SN - 0749-0704

IS - 1

ER -