Elif Sarı, , Ali Teoman Tellioğlu

3327

İnhalasyon Yaralanmalarının Tanı ve Tedavisi: Literatürün Gözden Geçirilmesi

Yanık hastaları tıp literatüründe en karmaşık hasta profillerinden biri olmuştur. Kapalı ortamlarda cilt yanığına eklenen inhalasyon yaralanması morbidite ve mortaliteyi arttırmaktadır. Duman yaralanmasının denetimi medikal takım için zorlu ve kompleks bir konudur. Bu, anestezi uzmanından cerrahına kadar multidisipliner bir iştir. Çünkü, inhalasyon yaralanması solunum sisteminden kardiyovasküler ve nörolojik sisteme kadar tüm vücudu etkilemektedir. Ayrıca inhalasyon yaralanmalı yanık hastalarının tedavisi de basit deri yanıklı kurbanların tedavilerinden farklıdır. İnhalasyon yaralanmalı hastada erken teşhis ve tedavi önemlidir. Bu nedenle inhalasyon hasarının belirteçleri acil servis çalışanları tarafından bilinmeli ve hastanın başvurusu anında tedavi başlatılmalıdır. Bu derlemede, patolojinin denetimi ve tedavisi için bir kılavuz oluşturmak için inhalasyon yaralanmasıyla ilgili literatürü topladık.
Anahtar Kelimeler:

İnhalasyon hasarı, duman hasarı, yanık

Pages 23-39

Burn patients are one of the most challenging patient profiles at medical literature. At indoor enviroment, inhalation injury adds to the accompanying skin injury and increases the morbidity and mortality. The management of the smoke injury is difficult and complex issue for medical teams. It requires a multidisciplinary work from anesthesiologists to surgeons as inhalation injury affects whole body systems, from respiratory to cardiovascular and neurologic systems. Accordingly, the treatment of burn patients with inhalation injury is different from simple skin burn victims. Early diagnosis and treatment of inhalation injury is mandatory as it can be life saving. Therefore, markers of inhalation injury should be known by emergency sevice workers and the treatment should be started immediately after the admission of the patient. In this rewiev, we collected the medical literature about inhalation injury to create a guide for the diagnosis and the treatment of this pathology.
Keywords:

Inhalation injury, smoke injury, burn,

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  • Fraser JF, Mullany D,Traber D. Inhalational Lung Injury in Patients With Severe Thermal Burns. Contemporary Critical Care. 2007; http://espace.library.uq.edu.au/view/UQ:132081.
  • Smith DL, Cairns BA, Ramadan F, Dalston JS, Fakhry SM, Rutledge R, Meyer AA, Peterson HD. Effect of inhalation injury, burn size, and age on mortality: a study of 1447 consecutive burn patients. J Trauma. 1994; 37: 655 PMID:7932899.
  • Thompson PB, Herndon DN, Traber DL, Abston S. Effect on mortality of inhalation injury. J Trauma. 1986; 26: 163- 5. PMID:3944839.
  • Ruddy RM. Smoke inhalation injury. Pediatr Clin North Am. 1994 A; 41(2): 317-36. PMID:8139878.
  • Weiss SM, Lakshminarayan S. Acute inhalation injury. Clin Chest Med. 1994; 15(1): 103-16. PMID:8200187.
  • Herndon DN, Traber LD, Linares H, Flynn JD, Niehaus G, Kramer G, Traber DL Etiology of the pulmonary pathophysiology associated with inhalation injury. Resuscitation. 1986; 14: 43- 59. PMID:3024279.
  • Ward PA, Till GO. Pathophysiologic events related to thermal injury of skin. J Trauma. 1990;30:75- 9. PMID:2254996.
  • Herndon DN, Traber DL, Traber LD. The effect of resuscitation on inhalation injury. Surgery. 1986;100:248- 51. PMID:3738753.
  • Inoue T, Okabayashi K, Ohtani M, Yamanoue T, Wada S, Iida K. Effect of smoke inhalation injury on fluid requirement in burn resuscitation. Hiroshima J Med Sci. 2002; 51: 1-5. PMID: 11999455.
  • Arakawa A, Fukamizu H, Hashizume I, Kasamatsu N, Nagayoshi M, Shinozuka N, Yasuda T, Ozawa T Macroscopic and histological findings in the healing process of inhalation injury. Burns. 2007 ;33(7):855-9. PMID: 17521820.
  • Herndon D. Total Burn Care. 2nd ed. London: Elsevier; 200 http://www.gobookee.org/totalburn-care-herndon/. Traber DL, Herndon DN, Stein MD, Traber LD, Flynn JT, Niehaus GD. The pulmonary lesion of smoke inhalation in an ovine model. Circ Shock. 1986; 18: 311-23. PMID:2421939.
  • Herndon DN, Traber DL, Niehaus GD, Linares HA, Traber LD. The pathophysiology of smoke inhalation injury in a sheep model. J Trauma. 1984; 24: 1044- 51. PMID:6512897.
  • Abdi S, Herndon D, McGuire J, Traber L, Traber DL. Time course of alterations in lung lymph and bronchial blood flows after inhalation injury. J Burn Care Rehabil. 1990; 11: 510- 5. PMID:2286604.
  • Traber DL, Hawkins HK, Enkhbaatar P, Cox RA, Schmalstieg FC, Zwischenberger JB, Traber LD. The role of the bronchial circulation in the acute lung injury resulting from burn and smoke inhalation. Pulm Pharmacol Ther. 2007; 20: 163- 6. PMID: 16798035.
  • Prien T, Traber LD, Herndon DN, Stothert JC Jr, Lubbesmeyer HJ, Traber DL. Pulmonary edema with smoke inhalation, undetected by indicatordilution technique. J Appl Physiol. 1987; 63: 907
  • Soejima K, Schmalstieg FC, Traber LD, Szabo C, Salzman A, Traber DL. Role of nitric oxide in myocardial dysfunction after combined burn and smoke inhalation injury. Burns. 2001; 27: 809- 15. PMID:11718983.
  • Soejima K, McGuire R, Snyder N 4th, Uchida T, Szabó C, Salzman A, Traber LD, Traber DL. The effect of inducible nitric oxide synthase (iNOS) inhibition on smoke inhalation injury in sheep. Shock. 2000; 13: 261- 6. PMID: 10774613.
  • Abdi S, Traber LD, Herndon DN, Rogers CS, Traber DL. Effects of ibuprofen on airway vascular response to cotton smoke injury. Eur J Pharmacol. 1995; 293: 475- 81. PMID:8748701.
  • Laffon M, Pittet JF, Modelska K, Matthay MA, Young DM. Interleukin-8 mediates injury from smoke inhalation to both the lung endothelial and the alveolar epithelial barriers in rabbits. Am J Respir Crit Care Med. 1999; 160: 1443- 9. PMID:10556103.
  • Ricciardolo FL, Di Stefano A, Sabatini F, Folkerts G. Reactive nitrogen species in the respiratory tract. Eur J Pharmacol. 2006; 533: 240 PMID:16464450.
  • Soejima K, Traber LD, Schmalstieg FC, Hawkins H, Jodoin JM, Szabo C, Szabo E, Virag L, Salzman A, Traber DL. Role of nitric oxide in vascular permeability after combined burns and smoke inhalation injury. Am J Respir Crit Care Med. 2001;163:745- 52. PMID:11254534.
  • Shimoda K, Murakami K, Enkhbaatar P, Traber LD, Cox RA, Hawkins HK, Schmalstieg FC, Komjati K, Mabley JG, Szabo C, Salzman AL, Traber DL. Effect of poly(ADP ribose) synthetase inhibition on burn and smoke inhalation injury in sheep. Am J Physiol Lung Cell Mol Physiol. 2003; 285: L240- 9. PMID:12626333.
  • Youn YK, Lalonde C, Demling R. Oxidants and the pathophysiology of burn and smoke inhalation injury. Free Radic Biol Med. 1992; 12: 409-15. PMID:1592275.
  • Herndon DN, Barrow RE, Traber DL, Rutan TC, Rutan RL, Abston S. Extravascular lung water changes following smoke inhalation and massive burn injury. Surgery. 1987;102:341 PMID:3303400.
  • Basadre JO, Sugi K, Traber DL, Traber LD, Niehaus GD, Herndon DN. The effect of leukocyte depletion on smoke inhalation injury in sheep. Surgery. 1988; 104: 208- 15. PMID:3400056.
  • Idell S. Coagulation, fibrinolysis, and fibrin deposition in acute lung injury. Crit Care Med. 2003;31:213-20. PMID:12682443.
  • Ware LB, Conner ER, Matthay MA. Von Willebrand factor antigen is an independent marker of poor outcome in patients with early acute lung injury. Crit Care Med. 2001; 29: 2325- 31. PMID:11801836.
  • Bastarache JA, Ware LB, Bernard GR. The role of the coagulation cascade in the continuum of sepsis and acute lung injury and acute respiratory distress syndrome. Semin Respir Crit Care Med. 2006; 27: 365- PMID:16909370.
  • Prabhakaran P, Ware LB, White KE, Cross MT, Matthay MA, Olman MA. Elevated levels of plasminogen activator inhibitor-1 in pulmonary edema fluid are associated with mortality in acute lung injury. Am J Physiol Lung Cell Mol Physiol. 2003; 285: 20- 8. PMID:12730079.
  • Gando S, Kameue T, Matsuda N, Hayakawa M, Morimoto Y, Ishitani T, Kemmotsu O. Imbalances between the levels of tissue factor and tissue factor pathway inhibitor in ARDS patients. Thromb Res. 2003; 109: 119- 24. PMID:12706640.
  • Maybauer MO, Maybauer DM, Fraser JF, Traber LD, Westphal M, Enkhbaatar P, Cox RA, Huda R, Hawkins HK, Morita N, Murakami K, Mizutani A, Herndon DN, Traber DL. Recombinant human activated protein C improves pulmonary function in ovine acute lung injury resulting from smoke inhalation and sepsis. Crit Care Med. 2006; 34: 2432- PMID:16810106.
  • Enkhbaatar P, Traber D, Traber D, Herndon D, Herndon D, Cox R, Huda R, Joncam C, Esechie A, Traber L, Nakano Y. Effects of intravenously administered recombinant human antithrombin (rhAT) and aerosolized heparin on burn and smoke inhalation-induced acute lung injury. Burns. 2007; 33(1): 144- 5. Doi:10.1016/j.burns.2006.10.337.
  • Desai MH, Mlcak R, Richardson J, Nichols R, Herndon DN. Reduction in mortality in pediatric patients with inhalation injury with aerosolized heparin/N-acetylcystine [correction of acetylcystine] therapy. J Burn Care Rehabil. 1998; 19: 210- 2. PMID:9622463.
  • Murakami K, Enkhbaatar P, Shimoda K, Mizutani A, Cox RA, Schmalstieg FC, Jodoin JM, Hawkins HK, Traber LD, Traber DL. High-dose heparin fails to improve acute lung injury following smoke inhalation in sheep. Clin Sci (Lond). 2003; 104: 349- PMID:12653676.
  • Thom SR. Antagonism of carbon monoxidemediated brain lipid peroxidation by hyperbaric oxygen. Toxicol Appl Pharmacol. 1990;105: 340PMID:2219124.
  • McCord JM. Oxygen-derived radicals: a link between reperfusion injury and inflammation. Fed Proc. 1987; 46: 2402- 6. PMID:3032690.
  • Myers RA, Snyder SK, Linberg S, Cowley RA. Value of hyperbaric oxygen in suspected carbon monoxide poisoning. JAMA. 1981;246:2478- 80. PMID:7299973.
  • Weaver LK, Hopkins RO, Chan KJ, Churchill S, Elliott CG, Clemmer TP, Orme JF Jr, Thomas FO, Morris AH. Hyperbaric oxygen for acute carbon monoxide poisoning. N Engl J Med. 2002;347:1057- 67. PMID:12362006.
  • Juurlink DN, Buckley NA, Stanbrook MB, Isbister GK, Bennett M, McGuigan MA. Hyperbaric oxygen for carbon monoxide poisoning. Cochrane Database Syst Rev. 2005; 25(1):2041. PMID:15674890.
  • Clark CJ, Campbell D, Reid WH. Blood carboxyhaemoglobin and cyanide levels in fire survivors. Lancet. 1981; 1: 1332 PMID:6113310.
  • Baud FJ, Barriot P, Toffis V, Riou B, Vicaut E, Lecarpentier Y, Bourdon R, Astier A, Bismuth C. Elevated blood cyanide concentrations in victims of smoke inhalation. N Engl J Med. 1991;325:1761- 6. PMID:1944484.
  • Becker CE. The role of cyanide in fires. Vet Hum Toxicol. 1985; 27: 487- 90. PMID:4082458.
  • Prien T, Traber DL. Toxic smoke compounds and inhalation injury–a review. Burns Incl Therm Inj. 1988; 14: 451- 60. PMID:2855039.
  • Edelman DA, White MT, Tyburski JG, Wilson RF. Factors affecting prognosis of inhalation injury. J Burn Care Res. 2006;27(6):848-53. PMID:17091081.
  • Edelman DA, Khan N, Kempf K, White MT. Pneumonia after inhalation injury. J Burn Care Res. 2007;28(2):241-6. PMID:17351439.
  • Pruitt BA Jr, Erickson DR, Morris A. Progressive pulmonary insufficiency and other pulmonary complications of thermal injury. J Trauma. 1975;5: 369-79 PMID:1092877.
  • Soejima K, Schmalstieg FC, Traber LD, Szabo C, Salzman A, Traber DL. Role of nitric oxide in myocardial dysfunction after combined burn and smoke inhalation injury. Burns. 2001 ;27(8):809 PMID:11718983.
  • Quezado ZM, Karzai W, Danner RL, Freeman BD, Yan L, Eichacker PQ, Banks SM, Cobb JP, Cunnion RE, Quezado MJ, Sevransky JE, Natanson C. Effects of L-NMMA and fluid loading on TNFinduced cardiovascular dysfunction in dogs. Am J Respir Crit Care Med. 1998;157:1397-405. PMID:9603114.
  • Soejima K, Schmalstieg FC, Traber LD, Szabo C, Salzman A, Traber DL. Role of nitric oxide in myocardial dysfunction after combined burn and smoke inhalation injury. Burns. 2001; 27(8):809 PMID:11718983.
  • Rorison DG, McPherson SJ. Acute toxic inhalations. Emerg Med Clin North Am. 1992; 10(2): 409-35. PMID:1559478.
  • Clark CJ, Campbell D, Reid WH. Blood carboxyhaemoglobin and cyanide levels in fire survivors. Lancet. 1981; 1(8234): 1332PMID:6113310.
  • Witten ML, Quan SF, Sobonya RE, Richard JL. New developments in the pathogenesis of smoke inhalation-induced pulmonary edema. West J Med. 1988 ; 148(1): 33-6. PMID: PMC1026006.
  • Thom SR, Keim LW. Carbon monoxide poisoning: a review epidemiology, pathophysiology, clinical findings, and treatment options including hyperbaric oxygen therapy. J Toxicol Clin Toxicol. 1989; 27(3): 141-56. PMID:2681810.
  • Rorison DG, McPherson SJ: Acute toxic inhalations. Emerg Med Clin North Am. 1992; 10(2): 409-35. PMID:1559478.
  • Riedel T, Fraser JF, Dunster K, Fitzgibbon J, Schibler A. Effect of smoke inhalation on viscoelastic properties and ventilation distribution in sheep. J Appl Physiol. 2006;101:763- 70. PMID:16627672.
  • Koljonen V, Maisniemi K, Virtanen K, Koivikko M. Multi-detector computed tomography demonstrates smoke inhalation injury at early stage. Emerg Radiol. 2007;14(2):113-6. Epub 2007 Feb 7. PMID:17285330.
  • Marek K, Piotr W, Stanisław S, Stefan G, Justyna G, Mariusz N, Andriessen A. Fibreoptic bronchoscopy in routine clinical practice in confirming the dia gnosis and treatment of inhalation burns. Burns. 2007; 33(5): 554-60. PMID:17376597.
  • Gore MA, Joshi AR, Nagarajan G, Iyer SP, Kulkarni T, Khandelwal A. Virtual bronchoscopy for diagnosis of inhalation injury in burnt patients. Burns. 2004; 30(2):165- 8. PMID:15019127.
  • Agee RN, Long JM 3rd, Hunt JL, Petroff PA, Lull RJ, Mason AD Jr, Pruitt BA Jr. Use of 133 xenon in early diagnosis of inhalation injury. J Trauma. 1976 ; 16(3): 218-24. PMID:1255837.
  • Roberts I. Smoke alarm use: prevalence and household predictors. Inj Prev. 1996; 2: 263-5. PMID:9346105.
  • Baxter CR. Fluid volume and electrolyte changes of the early postburn period. Clin Plast Surg. 1974; 1: 693-70 PMID:4609676.
  • Baxter CR. Problems and complications of burn shock resuscitation. Surg Clin North Am. 1978; 58: 1313- 22. PMID:734611.
  • Mlcak RP, Suman OE, Herndon DN. Respiratory management of inhalation injury. Burn.s 2007; 33(1): 2-13. PMID:17223484.
  • No author listed. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. The Acute Respiratory Distress Syndrome Network. N Engl J Med. 2000;342:1301PMID:10793162.
  • Cartotto R, Ellis S, Smith T. Use of high-frequency oscillatory ventilation in burn patients. Crit Care Med. 2005;33:175- 81. PMID:15753725.
  • Cartotto R. High frequency oscillatory ventilation in burn patients. Acta Anaesthesiol Scand. 2003; 47: 495; author reply 496. PMID:12694159.
  • Cooper AB, Islur A, Gomez M, Goldenson GL, Cartotto RC. Hypercapnic respiratory failure and partial upper airway obstruction during high frequency oscillatory ventilation in an adult burn patient. Can J Anaesth. 2002; 49: 724- 8. PMID:12193493.
  • Cartotto R, Cooper AB, Esmond JR, Gomez M, Fish JS, Smith T. Early clinical experience with high-frequency oscillatory ventilation for ARDS in adult burn patients. J Burn Care Rehabil. 2001; 22: 325- PMID:11570532.
  • Hall JJ, Hunt JL, Arnoldo BD, Purdue GF. Use of high-frequency percussive ventilation in inhalation injuries. J Burn Care Res. 2007;28(3):396-400. PMID:17438509.
  • Shao-gen Wang, Guang-hua Guo, Zhong-hua Fu and Si-fang Zhou. Comparison of conventional mandatory ventilation and high frequency oscillatory ventilation for treatment of acute lung injury induced by steam inhalation injury. Burns. 2006; 32(8): 951-6. PMID:17045404.
  • Cook DJ, Walter SD, Cook RJ, Griffith LE, Guyatt GH, Leasa D, Jaeschke RZ, Brun-Buisson C. Incidence of and risk factors for ventilatorassociated pneumonia in critically ill patients. Ann Intern Med. 1998;129:433- 40. PMID:9735080.
  • Byerly FL, Haithcock JA, Buchanan IB, Short KA, Cairns BA. Use of high flow nasal cannula on a pediatric burn patient with inhalation injury and post-extubation stridor. Burns. 2006; 32(1):121- 5. PMID:16019146.
  • Whitelock-Jones L, Bass DH, Millar AJ, Rode H. Inhalation burns in children. Pediatr Surg Int. 1999; 15(1): 50-5. PMID:9914356.
  • Cha SI, Kim CH, Lee JH, Park JY, Jung TH, Choi WI, Han SB, Jeon YJ, Shin KC, Chung JH, Lee KH, Kim YJ, Lee BK. Isolated smoke inhalation injuries: Acute respiratory dysfunction, clinical outcomes, and short-term evolution of pulmonary functions with the effects of steroids. Burns. 2007;33(2):200- 8. PMID:17169496.
  • Irrazabal CL, Capdevila AA, Revich L, Del Bosco CG, Luna CM, Vujacich P, Villa R, Jorge MA. Early and late complications among 15 victims exposed to indoor fire and smoke inhalation. Burns. 2008;34(4):533-8. Epub 2007 Oct PMID:17950537.
  • Haponik EF, Crapo RO, Herndon DN, Traber DL, Hudson L, Moylan J. Smoke inhalation. Am Rev Respir Dis. 1988 ; 138(4): 1060-3. PMID:3202436.
  • Heimbach DM, Waeckerle JF. Inhalation injuries. Ann Emerg Med. 1988; 17(12): 1316-20. PMID:3057948.
  • Schmalstieg FC, Chow J, Savage C, Rudloff HE, Palkowetz KH, Zwischenberger JB. Interleukin-8, aquaporin-1, and inducible nitric oxide synthase in smoke and burn injured sheep treated with percutaneous carbon dioxide removal. ASAIO J. 2001;47(4):365-71. PMID:11482488.
  • Morita N, Traber D, Traver M, Enkhbaatar P, Westphal M, Leonard S, Munakani K, Herndon D. Comparison of efficacy aerosolized and oral Vit. E therapy in sheep subjected to burn and smoke inhalation. Journal of Surgical Research. 2004;121(2):335. Doi:10.1016/j.jss.2004.07.220.
  • Maybauer MO, Maybauer DM, Fraser JF, Traber LD, Westphal M, Cox RA, Huda R, Nakano YY, Enkhbaatar P, Hawkins HK, Herndon DN, Traber DL. Ceftazidime improves hemodynamics and oxygenation in ovine smoke inhalation injury and septic shock. Intensive Care Med. 2007;33(7):1219Epub 2007 May 15. PMID:17503018.
  • Pedreros C, Parada L, Said JC, Longton C. Systemic pentoxifylline decreases mortality in severe burn patients with inhalation injury: Preliminary report of a randomized controlled trial. Burns.2007;33(1):58. Doi:1016/j.burns.2006.10.140.
  • Murakami K, Enkhbaatar P, Yu YM, Traber LD, Cox RA, Hawkins HK, Tompkins RG, Herndon D, Traber DL. L-arginine attenuates acute lung injury after smoke inhalation and burn injury in sheep. Shock. 2007;28(4):477-83. PMID:17558346.
  • Inoue Y, Tanaka H, Ogura H, Ukai I, Fujita K, Hosotsubo H, Shimazu T, Sugimoto H. A neutrophil elastase inhibitor, sivelestat, improves leukocyte deformability in patients with acute lung injury. J Trauma. 2006;60(5):936-43. PMID:16688053.
  • Alexander G, Saldanha J, Ebrahim MK, Ghoneim I. Late secondary spontaneous pneumothorax occurring in a major burn patient with inhalation injury following MRSA pneumonia. Burns. 2004;30(5):488-90. PMID:15225918.
  • Casper JK, Clark WR, Kelley RT, Colton RH. Laryngeal and phonatory status after burn/inhalation injury: a long term follow-up study. J Burn Care Rehabil. 2002;23(4):235-43. PMID:12142575. Yazışma Adresi
  • Dr. Elif Sarı Kırıkkale Üniversitesi Tıp Fakültesi, Plastik, Rekonstrüktif ve Estetik Cerrahi Anabilim Dalı, Yahşihan, Kırıkkale. Telefon: +90 506 381 37 0 E-posta: drelifsanli@hotmail.com
Kırıkkale Üniversitesi Tıp Fakültesi Dergisi-Cover
  • ISSN: 2148-9645
  • Yayın Aralığı: Yılda 3 Sayı
  • Başlangıç: 1999
  • Yayıncı: KIRIKKALE ÜNİVERSİTESİ KÜTÜPHANE VE DOKÜMANTASYON BAŞKANLIĞI
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