室内火灾和烟雾暴露后的吸入性损伤：巴西的灾难经验。
Inhalation injury after exposure to indoor fire and smoke: The Brazilian disaster experience.
作者信息
Rech Tatiana Helena, Boniatti Márcio Manozzo, Franke Cristiano Augusto, Lisboa Thiago, Wawrzeniak Iuri Christmann, Teixeira Cassiano, Maccari Juçara Gasparetto, Schaich Felipe, Sauthier Angelica, Schifelbain Luciele Medianeira, Riveiro Diego Fontoura Mendes, da Fonseca Deisi Leticia Oliveira, Berto Paula Pinheiro, Marques Leonardo, Dos Santos Moreno Calcagnotto, de Oliveira Vanessa Martins, Dornelles Carlos Fernando Drumond, Vieira Sílvia Regina Rios
机构信息
Department of Intensive Care Medicine, Hospital de Clínicas de Porto Alegre, Ramiro Barcelos, 2350, Porto Alegre, Brazil.
Department of Intensive Care Medicine, Hospital de Clínicas de Porto Alegre, Ramiro Barcelos, 2350, Porto Alegre, Brazil.
出版信息
Burns. 2016 Jun;42(4):884-90. doi: 10.1016/j.burns.2016.02.017. Epub 2016 Mar 11.
OBJECTIVE
To describe the pre-hospital, emergency department, and intensive care unit (ICU) care and prognosis of patients with inhalation injury after exposure to indoor fire and smoke.
MATERIALS AND METHODS
This is a prospective observational cohort study that includes patients admitted to seven ICUs after a fire disaster. The following data were collected: demographic characteristics; use of fiberoptic bronchoscopy; degree of inhalation injury; percentage of burned body surface area; mechanical ventilation parameters; and subsequent events during ICU stay. Patients were followed to determine the ICU and hospital mortality rates.
RESULTS
Within 24h of the incident, 68 patients were admitted to seven ICUs. The patients were young and had no comorbidities. Most patients (n=35; 51.5%) only had an inhalation injury. The mean ventilator-free days for patients with an inhalation injury degree of 0 or I was 12.5±8.1 days. For patients with an inhalation injury degree of II or III, the mean ventilator-free days was 9.4±5.8 days (p=0.12). In terms of the length of ICU stay for patients with degrees 0 or I, and patients with degrees II or III, the median was 7.0 days (5.0-8.0 days) and 12.0 days (8.0-23.0 days) (p<0.001), respectively. In addition, patients with a larger percentage of burned surface areas also had a longer ICU stay; however, no association with ventilator-free days was found. The patients with <10% of burned body surface area showed a mean of 9.2±5.4 ventilator-free days. The mean ventilator-free days for patients who had >10% burned body surface area was 11.9±9.5 (p=0.26). The length of ICU stay for the <10% and >10% burned body surface area patients was 7.0 days (5.0-10.0 days) and 23.0 days (11.5-25.5 days) (p<0.001), respectively.
CONCLUSIONS
We conclude that burn patients with inhalation injuries have different courses of disease, which are mainly determined by the percentage of burned body surface area.
目的
描述室内火灾和烟雾暴露后吸入性损伤患者的院前、急诊科及重症监护病房（ICU）护理情况及预后。
材料与方法
这是一项前瞻性观察性队列研究，纳入火灾灾难后入住7个ICU的患者。收集以下数据：人口统计学特征；纤维支气管镜的使用情况；吸入性损伤程度；烧伤体表面积百分比；机械通气参数；以及ICU住院期间的后续事件。对患者进行随访以确定ICU死亡率和医院死亡率。
结果
事件发生后24小时内，68例患者被收入7个ICU。患者较为年轻，无合并症。大多数患者（n = 35；51.5%）仅有吸入性损伤。吸入性损伤程度为0或I级的患者无呼吸机天数平均为12.5±8.1天。吸入性损伤程度为II或III级的患者，无呼吸机天数平均为9.4±5.8天（p = 0.12）。就吸入性损伤0或I级患者与II或III级患者的ICU住院时长而言，中位数分别为7.0天（5.0 - 8.0天）和12.0天（8.0 - 23.0天）（p < 0.001）。此外，烧伤体表面积百分比更大的患者ICU住院时间也更长；然而，未发现与无呼吸机天数有关联。烧伤体表面积<10%的患者无呼吸机天数平均为9.2±5.4天。烧伤体表面积>10%的患者无呼吸机天数平均为11.9±9.5天（p = 0.26）。烧伤体表面积<10%和>10%的患者ICU住院时长分别为7.0天（5.0 - 10.0天）和23.0天（11.5 - 25.5天）（p < 0.001）。
结论
我们得出结论，伴有吸入性损伤的烧伤患者病程各异，主要由烧伤体表面积百分比决定。
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