Klifto Kevin M, Quiroga Luis, Hultman C Scott
Department of Plastic and Reconstructive Surgery, Johns Hopkins Burn Center, The Johns Hopkins Hospital, 4940 Eastern Avenue, Baltimore, 21224 USA.
Burns Trauma. 2019 Jun 4;7:15. doi: 10.1186/s41038-019-0152-5. eCollection 2019.
Substance use, alcohol use, and smoking use have all been associated with burn injury. Few studies have investigated associations with substances, alcohol, smoking, inhalational only burns, and patient outcomes. The purpose of the study was to identify risk factors for pulmonary failure in patients suffering inhalation injury, focusing on the impact of substance, alcohol, and cigarette use.
This is a single-center retrospective analysis of 115 patients admitted to the Johns Hopkins Bayview Burn Center with inhalational injury from January 1, 2010, through September 30, 2018. Patients were excluded if they were under the age of 18 years or had burn involvement of the skin > 5%. Primary outcome variables measured were if patients were intubated, length of total time intubated, substance use, alcohol use, and smoking use. Secondary outcome variables measured were types of substances used (amphetamines, barbiturates, benzodiazepines, cannabinoids, cocaine, methadone, codeine/morphine), total number of substances used, intensive care unit (ICU) length of stay (LOS), hospital LOS, secondary complications, and patient mortality. Analysis was performed with Fisher's exact test and the Mann-Whitney test. A sub-group analysis for each substance, alcohol, smoking, and control sub-group was compared to its respective sub-group without substance, alcohol, smoking, and control within the no intubation and intubation group. A sub-group analysis of substance use, alcohol use, smoking use, and control was further analyzed with binomial logistic regression within the intubation group.
Following inhalation injury, 50/115 (43%) patients required intubation. Forty-two of the 50 (84%) patients intubated had substance use ( < 0.001). Thirty-one of the 50 (62%) patients intubated had history of smoking ( = 0.038). Among the specific substances used, 26/50 (52%) patients intubated were using benzodiazepines ( < 0.001) and 7/50 (14%) patients were using cocaine ( = 0.022). The lengths of intubation, ICU LOS, and hospital LOS with no substance use were shorter than with substance use ( < 0.001). Following the adjusted sub-group analysis, patients with substance use (odds ratio (OR) 6.4, 95% confidence interval (CI) [2.5-16.3]; < 0.001) and smoking use (OR 2.5, 95% CI [1.2-5.1]; = 0.013) were more likely to be intubated on admission than those without substance or smoking use.
In patients admitted with an inhalational injury with less than or equal to 5% external burns, the presence of a substance and smoking use on admission provides a further risk of intubation and respiratory compromise. Substance use on admission poses a greater risk of longer intubation, ICU LOS, and hospital LOS. A higher potential for substance use should be suspected in this patient population with prompt treatment.
物质使用、酒精使用和吸烟都与烧伤有关。很少有研究调查物质、酒精、吸烟、仅吸入性烧伤与患者预后之间的关联。本研究的目的是确定吸入性损伤患者发生肺功能衰竭的危险因素，重点关注物质、酒精和吸烟的影响。
这是一项对2010年1月1日至2018年9月30日入住约翰霍普金斯湾景烧伤中心的115例吸入性损伤患者进行的单中心回顾性分析。如果患者年龄在18岁以下或皮肤烧伤面积>5%，则将其排除。测量的主要结局变量包括患者是否插管、总插管时间、物质使用、酒精使用和吸烟情况。测量的次要结局变量包括使用的物质类型（苯丙胺、巴比妥类、苯二氮卓类、大麻素、可卡因、美沙酮、可待因/吗啡）、使用的物质总数、重症监护病房（ICU）住院时间（LOS）、医院住院时间、继发性并发症和患者死亡率。采用Fisher精确检验和Mann-Whitney检验进行分析。对每种物质、酒精、吸烟和对照组进行亚组分析，并将其与未插管组和插管组中各自无物质、酒精、吸烟和对照的亚组进行比较。在插管组中，对物质使用、酒精使用、吸烟使用和对照进行亚组分析，并进一步采用二项逻辑回归分析。
吸入性损伤后，50/115（43%）例患者需要插管。插管的50例患者中有42例（84%）有物质使用（<0.001）。插管的50例患者中有31例（62%）有吸烟史（=0.038）。在使用的特定物质中，插管的50例患者中有26例（52%）使用苯二氮卓类（<0.001），7例（14%）使用可卡因（=0.022）。无物质使用患者的插管时间、ICU住院时间和医院住院时间短于有物质使用患者（<0.001）。经过调整的亚组分析后，有物质使用（优势比（OR）6.4，95%置信区间（CI）[2.5-16.3]；<0.001）和吸烟（OR 2.5，95%CI[1.2-5.1]；=0.013）的患者入院时比无物质或吸烟使用的患者更有可能插管。
对于入院时伴有小于或等于5%体表烧伤的吸入性损伤患者，入院时存在物质使用和吸烟会增加插管和呼吸功能不全的风险。入院时物质使用会带来更长插管时间、ICU住院时间和医院住院时间的更大风险。对于该患者群体，应怀疑有更高的物质使用可能性并及时治疗。
