Extracorporeal membrane oxygenation in the treatment of respiratory failure in pediatric patients with burns.
ABSTRACT Extracorporeal membrane oxygenation (ECMO) as a treatment for pulmonary failure from postshock respiratory distress in burned children recently has been shown to salvage patients who were thought to have more than a 90% chance of dying. We describe five burned children in whom severe respiratory failure--not responsive to medical management and maximal ventilatory support--developed, and who underwent ECMO treatment. Three (60%) cases involved flame burns, with significant inhalation injury as diagnosed after a bronchoscopy; mean age was 3 years (2 to 4 years), with a mean total body surface area (TBSA) burn of 32% (15% to 53%), mean third-degree burns of 25% (5% to 53%). Two (40%) cases involved scald burns; mean age was 6 years (7 months to 11 years), with a mean TBSA burn of 56.5% (43% to 70%), mean third-degree burns of 40% (10.5% to 70%). Outcome was poor for those burned children who received ECMO therapy after prolonged ventilatory support for smoke inhalation injury. Children who experience perfusion/reperfusion shock injury to the lungs as a result of delayed resuscitation of scald burns may have an improved chance of survival with short courses of ECMO regardless of the burn size.
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ABSTRACT: Lung injury in trauma patients can occur because of direct injury to lung or due to secondary effects of injury elsewhere for example fat embolism from a long bone fracture, or due to response to a systemic insult such as; acute respiratory distress syndrome (ARDS) secondary to sepsis or transfusion related lung injury. There are certain special situations like head injury where the primary culprit is not the lung, but the brain and the ventilator strategy is aimed at preserving the brain tissue and the respiratory system takes a second place. The present article aims to delineate the strategies addressing practical problems and challenges faced by intensivists dealing with trauma patients with or without healthy lungs. The lung protective strategies along with newer trends in ventilation are discussed. Ventilatory management for specific organ system trauma are highlighted and their physiological base is presented.Journal of Emergencies Trauma and Shock 01/2014; 7(1):25-31.
Article: Thermal injury[Show abstract] [Hide abstract]
ABSTRACT: This article addresses the pathophysiology of thermal burns, focusing on the complex inflammatory component, potential complications, and treatment strategies. Thermal injury is a relatively uncommon presentation in veterinary medicine. Contact with an electric heating pad, a hot muffler of a motor vehicle, or an open flame is the most common inciting cause. Severe thermal injuries, particularly full-thickness burns exceeding 30% of total body surface area, provoke a profound systemic inflammatory response characterized by leukocyte activation and plasma leakage in the microvasculature of tissues or organs remote from the wound. Burns may be caused by exposure to heat (thermal burns), electricity, chemicals, or radiation.Journal of Air Medical Transport 07/1997; 16(3):81–88.
Article: Lésions respiratoires et brûlures[Show abstract] [Hide abstract]
ABSTRACT: Introduction Smoke inhalation and respiratory complications are still the major causes of mortality in severely burned patients. State of the art The diagnosis is suspected clinically on the basis of history and physical examination and can be confirmed bronchoscopically. Respiratory failure in burned patients occurs through a number of associated mechanisms. Pneumonitis and adult respiratory distress syndrome (ARDS) are common early complications. New pulmonary treatments and advances in ventilation have reduced the incidence of both barotrauma and infectious complications. Tracheal stenosis can occur as a late complication of prolonged mechanical ventilation. Perspectives Clinical and experimental studies have shown that damage to the mucosal barrier and the release of inflammatory mediators are the most important pathophysiological events following smoke inhalation. Manipulation of the inflammatory response following inhalation may be a treatment option in the distant future. Conclusion Inhalation injury occurring in burned patients can produce severe respiratory and systemic complications.Revue Des Maladies Respiratoires - REV MAL RESPIR. 01/2005; 22(3):449-460.