Amani Hamed, Lozano Daniel D, Blome-Eberwein Sigrid
Lehigh Valley Regional Burn Center, Allentown, Pennsylvania, USA.
J Burn Care Res. 2012 Nov-Dec;33(6):e280-5. doi: 10.1097/BCR.0b013e31824d1b3c.
Home oxygen therapy use has steadily increased for the past 30 years. A majority of these patients suffer from chronic obstructive pulmonary disease secondary to smoking. Although warned of the danger of smoking while on oxygen, patients continue to do so, potentially resulting in cutaneous burns and suspected inhalation injury. Those suspected of inhalation injury are intubated for airway control. In the English literature, there is a paucity of data discussing the need for intubation. To date, this is the largest study to determine whether intubated patients had inhalation injury as observed by bronchoscopy and whether intubation was necessary. All patient's charts who sustained burns while on home oxygen therapy from May 2000 to May 2010 were retrospectively reviewed (n = 86). Data collected were age, sex, TBSA, ventilator days, length of stay (LOS), and presence or absence of inhalation. Of those patients intubated, a subset analysis was performed to determine whether intubation in the "Field" or "Outside Hospital" correlated with inhalation injury compared with intubation in our Emergency Department. Eighty-six patients (mean age 64 years, mean %TBSA 2.6) were included. Before transfer to the burn unit, 32 patients (37%) were intubated and 52 patients (61%) were not intubated. Of the 32 intubated patients, bronchoscopy confirmed inhalation injury in 12 patients (39%). No significant difference was seen in %TBSA between intubated vs nonintubated patients (3.5 vs 2.0, respectively). However, there was a difference in LOS between the two groups (12.7 vs 2.8, respectively). No difference was found in incidence of inhalation injury between patients intubated in the "Field/Outside Hospital" compared with patients intubated in our Emergency Department (39% and 37.5%, respectively). Between the subgroups, no difference was found in %TBSA, ventilator days, or LOS. One patient admitted for airway observation required intubation and one patient failed extubation, postoperatively. Patients on home oxygen therapy suspected of inhalation injury should ideally be observed for signs of airway compromise before intubation is performed.
在过去30年中，家庭氧疗的使用稳步增加。这些患者中的大多数患有继发于吸烟的慢性阻塞性肺疾病。尽管被告知吸氧时吸烟的危险，但患者仍继续吸烟，这可能导致皮肤烧伤和疑似吸入性损伤。那些疑似吸入性损伤的患者会被插管以控制气道。在英文文献中，讨论插管必要性的数据很少。迄今为止，这是确定插管患者是否存在支气管镜检查所观察到的吸入性损伤以及插管是否必要的最大规模研究。对2000年5月至2010年5月期间在家庭氧疗时发生烧伤的所有患者病历进行了回顾性分析（n = 86）。收集的数据包括年龄、性别、烧伤总面积、呼吸机使用天数、住院时间（LOS）以及是否存在吸入性损伤。在那些插管的患者中，进行了亚组分析，以确定在“现场”或“医院外”插管与在我们急诊科插管相比，是否与吸入性损伤相关。纳入了86例患者（平均年龄64岁，平均烧伤总面积2.6%）。在转至烧伤科之前，32例患者（37%）进行了插管，52例患者（61%）未插管。在32例插管患者中，支气管镜检查证实12例患者（39%）存在吸入性损伤。插管患者与未插管患者的烧伤总面积无显著差异（分别为3.5%和2.0%）。然而，两组的住院时间存在差异（分别为12.7天和2.8天）。在“现场/医院外”插管的患者与在我们急诊科插管的患者之间，吸入性损伤的发生率没有差异（分别为39%和37.5%）。在亚组之间，烧伤总面积、呼吸机使用天数或住院时间均无差异。一名因气道观察入院的患者需要插管，一名患者术后拔管失败。对于疑似吸入性损伤的家庭氧疗患者，理想情况下应在插管前观察气道受损的迹象。
