Getzen L C, Pollak E W
Surg Gynecol Obstet. 1981 Jun;152(6):741-4.
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.
在167例重度烧伤患者中，有10例发生了致命性呼吸窘迫。5例无尿患者在入院后48小时内因液体超负荷导致致命性呼吸衰竭，而晚期死亡则是由于液体超负荷和肺部感染。4例行气管切开术的患者中有3例死于肺部感染，而10例行气管插管的患者全部存活，P<0.05。在所有10例患者中均发现了导致致命性呼吸窘迫的可预防原因。建议在烧伤休克复苏期间使用胶体输注并连续监测肺血管外水，以预防液体超负荷和呼吸窘迫综合征。建议预防吸入性肺炎并避免早期气管切开术，以预防肺部感染。建议摒弃特发性烧伤肺综合征的概念，转而积极进行病因查找，以预防、识别和治疗呼吸衰竭的可纠正原因。
