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January 19, 2012

Study on Recovery from Smoke Inhalation Injury Produces Unexpected Results

A study by researchers at Loyola University Chicago Stritch School of Medicine generated some surprising findings about the response of the immune system in victims of severe burns and smoke inhalation.

Contrary to expectations, patients who died from their injuries had lower inflammatory responses in their lungs than the patients who survived. "Perhaps a better understanding of this early immune dysfunction will allow for therapies that further improve outcomes in burn care," researchers reported.

The study was published in the January/February issue of the Journal of Burn Care & Research. First author of the study was Christopher S. Davis, MD, MPH, a research resident in the Loyola Burn & Shock Trauma Institute. Assisting him was Elizabeth J. Kovacs, PhD, director of research of the Burn & Shock Trauma Institute.

Researchers followed 60 burn patients in the Loyola Burn Center. As expected, patients with the worst combined severe burn and smoke inhalation injuries required more time on a ventilator, in the intensive care unit, and in the hospital. They also were more likely to die. Also in line with expectations was this finding: Patients who died were older and had larger injuries on the whole than patients who survived.

But the immune system findings were not expected. Researchers measured concentrations of 28 immune system modulators in fluid collected from the lungs of patients within 14 hours of burn and smoke inhalation injuries. These modulators are proteins produced by white blood cells and other cells such as those that line a person's airway. Some of these modulators recruit white blood cells (leukocytes) to areas of tissue damage, or activate them to begin the repair process within damaged tissue.

Based on studies conducted at Loyola and other centers, researchers had expected to find higher concentrations of modulators in the fluid of patients who died, because sicker patients tend to have greater inflammatory responses. However, researchers found the opposite: Most patients who died had lower concentrations of these modulators in their lungs.

The question is this: Why do some patients mount robust immune responses in the lungs after smoke inhalation and burn injuries, while others do not? The reason may be due to a few things working together: age, genetics, differences in patients' pre-existing health conditions, or anything that might disrupt the balance between too much and too little inflammation.

Survival of severe burn patients has significantly improved since the 1950s, due to advancements such as better wound care and treatment and prevention of infections. But progress has somewhat stalled in the last 10 years.

The immune response to lung injury from smoke or burns "remains not completely understood, and additional effort is required to improve survival of burn-injured patients," researchers wrote.

The study was presented at the 2011 meeting of the American Burn Association, where it won the 2011 Carl A. Moyer Resident Award for the best study submitted by a resident physician. The study was funded by grants from the National Institutes of Health, Department of Defense, International Association of Fire Fighters and the Dr. Ralph and Marian C. Falk Medical Research Trust.

Loyola's Burn Center is one of the busiest in the Midwest, treating more than 600 patients annually in the hospital, and another 3,500 patients each year in its clinic. It is one of only two centers in Illinois that have received verification by the American Burn Association.

The study is among the results of research over the last several years conducted in Loyola's Burn Center and its Burn & Shock Trauma Institute, the latter of which is investigating the lung's response to burn and inhalation injuries.

March 12, 2010

Mechanical Ventilator (part II)

Medications are often used when the patient is intubated in the form of sedative and analgesic drugs to reduce the anxiety and stress associated with the intubation as well as helping the patient with tolerating the constant irritation of the endotracheal tube. The patient is also given prophylaxis against Deep Vein Thrombosis Part I, II. When the patient is intubated this will affect the ability of the patient to talk or speak.

There is another form of mechanical ventilator which is the oldest form in which a negative pressure is used instead of a positive pressure to create a vacuum which forces air into the lung.

Ventilators are used to support and help people who can't breathe adequately.

Some patients need to stay on mechanical ventilators for a short period of time others may need to use it for a longer time. Some may need it for the rest of their lives. In such cases the machine can be used outside the hospital in the form of a portable machine. When the patient sufficiently recovers from the cause that led him/her to be on a ventilator, he/she will be weaned gradually. Once the patient can successfully breathe on his/her own, the ventilator will be stopped.

Complications of mechanical ventilation: they may include

  • Infection (pneumonia): patients on ventilators with a breathing tube in the airway have an increased risk of having pneumonia called ventilator associated pneumonia. This happens at least 48 hours after intubation. It is a serious and a common complication that is treated with antibiotics.
  • Infection of the sinuses (sinusitis).
  • Pnemothorax: it is a condition were air leaks out of the lungs into the space between the lungs and the chest wall.
  • Gastrointestinal complications: may include distension, stress related hemorrhage which can be prevented with using medications that decrease the acid secretion of the stomach.
  • Damage to the vocal cords.
  • Deep Venous Thrombosis Part I, II.

This information is not intended nor implied to be a substitute for professional medical advice; it should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. Call 911 for all medical emergencies.

March 11, 2010

Mechanical Ventilator (part I)

Burns can affect different parts of the body in different ways. Some patients will not be able to breathe on their own and may need the help of a breathing machine (mechanical ventilator).

Mechanical ventilator: can be defined as a device that is designed to help the patient to breathe simply by moving air into and out of the lungs.

Mechanical ventilators may be used in diseases, conditions, or factors that interfere with or impair breathing such as:

  • Burn injuries: some burn patients may need to be hooked to a mechanical ventilator depending on the cause and the severities of injury eg, in some smoke inhalation injuries.
  • Infections eg, pneumonia.
  • Lung diseases eg chronic obstructive pulmonary diseases.
  • Conditions that affect the nerves or muscles involved in breathing such as injury to the upper part of spinal cord, polio.
  • Damage to the brain's respiratory center, stroke, coma.

A mechanical ventilator may be used during surgery when general anesthesia is needed.

The mechanical ventilator system is composed of a machine (ventilator) that pushes air or mixture of other gases such as air and oxygen under a positive pressure to the lungs, the air may be delivered through:

  • A nasal or a face mask.
  • An endotracheal tube: a tube placed in the wind pipe (trachea) through the nose or mouth, this is used for patients who need the ventilator for a shorter period of time.
  • A trach tube: which is a tube inserted directly into the trachea through an opening created in the trachea by a surgical procedure called a tracheostomy; this is used when the patient needs the ventilator for a longer period of time.
This information is not intended nor implied to be a substitute for professional medical advice; it should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. Call 911 for all medical emergencies.