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Critical Care

, 17:R95

First Online: 25 May 2013Received: 06 December 2012Revised: 11 March 2013Accepted: 25 May 2013

Abstract

IntroductionSmoke-inhalation injury is a major cause of mortality in burn patients, and therefore, it is important to determine accurately the severity of such injuries in these patients. The objective of this study was to evaluate whether chest computed tomography CT can be used for detecting early predictors of severity and complications of smoke-inhalation injury.

MethodsWe evaluated 37 patients who had sustained smoke-inhalation injuries and had undergone chest CT within a few hours of admission to a hospital. Bronchoscopy was performed according to a standardized protocol within 12 hours of admission in all smoke-inhalation injury patients. Bronchial-wall thickness BWT was measured 2 cm distal from the tracheal bifurcation with CT images, and the following data were collected: total number of ventilator days, duration of intensive care unit ICU stay, pneumonia development, and patient outcome.

ResultsThe mean age of the patients was 63 ± 18 years range, 22 to 87 years, 31 83.8% of the patients were men, and the mortality rate was 10.8%. The causes of death in these patients were smoke inhalation n = 1, hemorrhage n = 1, and other factors resulting in sepsis n = 2. The initial carboxyhemoglobin level was 13% ± 14% range, 1% to 50%. No significant correlation was found between bronchoscopic scoring and clinical factors. However, significant correlations were noted between admission BWT and development of pneumonia R = 0.41; P < 0.0001 and total number of ventilator days R = 0.56; P < 0.0001 and ICU-stay days R = 0.17; P = 0.01. Receiver operating characteristic curve analysis showed that an admission BWT cutoff value of >3.0 mm predicted pneumonia development with a sensitivity of 79%, specificity of 96%, positive predictive value of 91%, and negative predictive value of 88%.

ConclusionBWT measured by using the chest CT scans obtained within a few hours of admission was predictive of the total number of ventilator days and ICU-stay days and the development of pneumonia in patients with smoke-inhalation injuries.

Keywordssmoke-inhalation injury pneumonia bronchial-wall thickness AbbreviationsAISAbbreviated Injury Score

ARDSacute respiratory distress syndrome

BEbase excess

BPblood pressure

BWTbronchial-wall thickness

CO-Hbcarboxyhemoglobin

CTcomputed tomography

HRCThelical high-resolution computed tomography

ICUintensive care unit

PEEPpositive end-expiratory pressure

SIIsmoke-inhalation injury

SDstandard deviation

TBSAtotal burn surface area.

Electronic supplementary materialThe online version of this article doi:10.1186-cc12740 contains supplementary material, which is available to authorized users.

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Autor: Hitoshi Yamamura - Shinichiro Kaga - Kazuhisa Kaneda - Yasumitsu Mizobata

Fuente: https://link.springer.com/



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