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Diagnosis and management of inhalation injury: an updated review.

Walker PF, Buehner MF, Wood LA, Boyer NL, Driscoll IR, Lundy JB, Cancio LC, Chung KK - Crit Care (2015)

Bottom Line: In this article we review recent advances made in the pathophysiology, diagnosis, and treatment of inhalation injury.Adjuncts still lacking definitive evidence of efficacy include bronchodilators, mucolytic agents, inhaled anticoagulants, nonconventional ventilator modes, prone positioning, and extracorporeal membrane oxygenation.Recent research focusing on molecular mechanisms involved in inhalation injury has increased the number of potential therapies.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Walter Reed National Military Medical Center, 8901 Wisconsin Ave, Bethesda, MD, 20889, USA.

ABSTRACT
In this article we review recent advances made in the pathophysiology, diagnosis, and treatment of inhalation injury. Historically, the diagnosis of inhalation injury has relied on nonspecific clinical exam findings and bronchoscopic evidence. The development of a grading system and the use of modalities such as chest computed tomography may allow for a more nuanced evaluation of inhalation injury and enhanced ability to prognosticate. Supportive respiratory care remains essential in managing inhalation injury. Adjuncts still lacking definitive evidence of efficacy include bronchodilators, mucolytic agents, inhaled anticoagulants, nonconventional ventilator modes, prone positioning, and extracorporeal membrane oxygenation. Recent research focusing on molecular mechanisms involved in inhalation injury has increased the number of potential therapies.

No MeSH data available.


Related in: MedlinePlus

Example of radiologist’s score findings in chest computed tomography scan slice [34]
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Fig4: Example of radiologist’s score findings in chest computed tomography scan slice [34]

Mentions: Other means of evaluating the severity of inhalation injury include chest CT. First, a scoring system for severity of CT scan findings has been developed [29]. Our group studied 25 patients with inhalation injury and 19 patients without inhalation injury who received a chest CT within 24 h of admission [34]. The severity of radiographic findings was calculated by looking at 1-cm axial slices from the chest CT and these were scored by adding the highest radiologist’s score (RADS) for each quadrant. The RADS scoring system is shown in Table 2, and the various RADS findings are shown in Fig. 4. Our group assessed a composite endpoint of pneumonia, acute lung injury/ARDS, and death. We found that the detection of inhalation injury on bronchoscopy was associated with an 8.3-fold increase in the composite endpoint. A high RADS score (>8 per slice) in addition to a positive bronchoscopy was associated with a 12.7-fold increase, thus showing the potential for chest CT to complement bronchoscopy in detecting clinically significant inhalation injury [34].Table 2


Diagnosis and management of inhalation injury: an updated review.

Walker PF, Buehner MF, Wood LA, Boyer NL, Driscoll IR, Lundy JB, Cancio LC, Chung KK - Crit Care (2015)

Example of radiologist’s score findings in chest computed tomography scan slice [34]
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4624587&req=5

Fig4: Example of radiologist’s score findings in chest computed tomography scan slice [34]
Mentions: Other means of evaluating the severity of inhalation injury include chest CT. First, a scoring system for severity of CT scan findings has been developed [29]. Our group studied 25 patients with inhalation injury and 19 patients without inhalation injury who received a chest CT within 24 h of admission [34]. The severity of radiographic findings was calculated by looking at 1-cm axial slices from the chest CT and these were scored by adding the highest radiologist’s score (RADS) for each quadrant. The RADS scoring system is shown in Table 2, and the various RADS findings are shown in Fig. 4. Our group assessed a composite endpoint of pneumonia, acute lung injury/ARDS, and death. We found that the detection of inhalation injury on bronchoscopy was associated with an 8.3-fold increase in the composite endpoint. A high RADS score (>8 per slice) in addition to a positive bronchoscopy was associated with a 12.7-fold increase, thus showing the potential for chest CT to complement bronchoscopy in detecting clinically significant inhalation injury [34].Table 2

Bottom Line: In this article we review recent advances made in the pathophysiology, diagnosis, and treatment of inhalation injury.Adjuncts still lacking definitive evidence of efficacy include bronchodilators, mucolytic agents, inhaled anticoagulants, nonconventional ventilator modes, prone positioning, and extracorporeal membrane oxygenation.Recent research focusing on molecular mechanisms involved in inhalation injury has increased the number of potential therapies.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Walter Reed National Military Medical Center, 8901 Wisconsin Ave, Bethesda, MD, 20889, USA.

ABSTRACT
In this article we review recent advances made in the pathophysiology, diagnosis, and treatment of inhalation injury. Historically, the diagnosis of inhalation injury has relied on nonspecific clinical exam findings and bronchoscopic evidence. The development of a grading system and the use of modalities such as chest computed tomography may allow for a more nuanced evaluation of inhalation injury and enhanced ability to prognosticate. Supportive respiratory care remains essential in managing inhalation injury. Adjuncts still lacking definitive evidence of efficacy include bronchodilators, mucolytic agents, inhaled anticoagulants, nonconventional ventilator modes, prone positioning, and extracorporeal membrane oxygenation. Recent research focusing on molecular mechanisms involved in inhalation injury has increased the number of potential therapies.

No MeSH data available.


Related in: MedlinePlus