Fatal respiratory distress in burned patients.

Of 167 patients with major burns, fatal respiratory distress developed in ten. Fluid overload caused fatal respiratory failure within 48 hours of admission in five patients with anuria, whereas late deaths were due to fluid overload and pulmonary sepsis. Three of the four patients who had a tracheostomy died of pulmonary sepsis, whereas all ten patients who had endotracheal intubation survived, p less than 0.05. Preventable causes of fatal respiratory distress were found in all ten patients. The use of colloid infusions during burn shock resuscitation and serial monitoring of pulmonary extravascular water was suggested for prophylaxis of fluid overload and respiratory distress syndrome. Aspiration pneumonia prophylaxis and avoidance of an early tracheostomy were suggested for prophylaxis of pulmonary sepsis. It is suggested that the concept of idiopathic burn lung syndrome be abandoned, and instead, a vigorous etiologic search to be instituted in order to prevent, to identify and to treat correctable causes of respiratory failure.