EPIDEMIOLOGY AND OUTCOME OF INHALATION INJURY DUE TO FLAME BURN INJURIES IN IRAN

Hamid Karimi M.D.*, Abbas Motevalian M.D., Mahnoush Momeni M.D., Mahtab Vasigh M.D.

ABSTRACT

Introduction: smoke inhalation injury has significant morbidity and mortality. Inhalation injury increase fluid resuscitation requirements, incidence of pulmonary complications and overall mortality of thermal injury. The purpose of this study is to survey the epidemiology, risk factors, outcome and treatment cost of inhalation injury. Methods: The burn registry program data of our country were analyzed during two years for inhalation injury. Those who had only flame burn or explosion were selected. All of data regarding emergency department admission , treatments before reaching to hospital, Demographic data, pregnancy, types of treatments , respiratory care treatments , frequency of intubation and ICU admission , Length of stay in ICU, length of stay in hospital , complications , infection ,total parentral nutrition(TPN), Albumin infusion ,cost of treatment , outcome and mortality rates were gathered in a special designed questionnaire. Pearson chi square was used for analysis of descriptive statistics and ANOVA and Independent-samples T test for analysis of numeric statistics. Results: 1721 burn patients were admitted to hospital in a 2 year period. 719 patients were flame burn victims and 381(52.9%) of them were diagnosed with inhalation injury of whom 12.5% were admitted in intensive care unit (ICU) and 17% died. We found correlation between cardiovascular disorders, diabetes mellitus, chronic obstructive pulmonary disorders, asthma, pregnancy, psychotic disorders, age and total burned surface area with the outcome of the patients. Also there was a significant correlation between intubation, total parenteral nutrition and the outcome. There were correlation between closed space injury, smoke inhalation, face burn, drug abuse (inhalation abuse) and inhalation injury. Mortality was higher among patients with inhalation injury. The ventilator support days was significantly higher in patients with inhalation injury. The average cost of treatment for inhalation injury patients was 545 $ (19,000,000 Rials) per one day of intensive care, where one day of treatment of other burn patients was 155 $ (5,400.000 Rials).The difference was highly significant (p<0.001). Conclusion: in burn patients with inhalation injuries the mortality can increase up to 11% more (from 6% to 17%). TBSA, age, ventilator support, TPN had high influence on outcome of our patients. And diabetes mellitus, pregnancy and cardiovascular disorders could influence the final outcome.

Keywords: Burns; inhalation injury; Flame burn; Mortality; Parenteral nutrition; Pediatric.