Early Complications and Value of Initial Clinical and Paraclinical Observations in Victims of Smoke Inhalation Without Burns

doi:10.1378/chest.111.3.671

Chest

Volume 111, Issue 3, March 1997, Pages 671-675

https://doi.org/10.1378/chest.111.3.671 Get rights and content

Objective

To evaluate the incidence of early pulmonary complications and the value of initial clinical signs and paraclinical investigations in victims of smoke inhalation not suffering from burns following structural fires.

Design

Retrospective chart review.

Setting

Thirteen-bed ICU.

Patients

Sixty-four victims of smoke inhalation following household fires were admitted to the ICU between January 1987 and December 1992. Exclusion criteria from the study were patients with cutaneous burns or multiple trauma or blast injury, and patients found in cardiac arrest.

Methods

Clinical, biological, and radiologic parameters were collected over a 5-day period.

Results

The mortality rate in relation to progressive respiratory failure was 3.1%. Mean ICU stay was 5.8 days (range, 1 to 33 days), and was longer in the patients presenting with soot deposits in the oropharynx (p=0.02), dysphonia (D) (p=0.05), or ronchi (R) (p=0.0004) at the first examination, and in those having a positive sputum bacteriologic analysis (p=0.003) or requiring parenteral bronchodilator agents for more than 24 h (p=0.04). Thirty-five patients underwent mechanical ventilation (MV) for a mean of 101.2 h (range, 8 to 648 h). Mean MV duration was higher in the patients presenting initially with R (p=0.003), high carbon monoxide (but not cyanide) levels (p=0.02), or a positive bacteriologic sample (p=0.0001). Positive bacteriologic sampling correlated with the presence of D (p=0.02) or R (p=0.04) and with immediate intubation (p=0.0003). No correlation was found with chest radiograph.

Conclusions

In this selected series of fire victims without cutaneous burns, respiratory injury was frequent. The initial clinical signs may be helpful to predict pulmonary complications.

Section snippets

MATERIALS AND METHODS

This retrospective study was conducted on patients who were admitted to the ICU (Réanimation Toxicologique, Hopital Fernand Widal) from January 1987 to December 1992. Patients included in this study were victims of smoke inhalation following household fires who were taken in charge by the emergency medical squad of the Paris Fire Brigade. Patients with cutaneous burns or multiple trauma or those affected by a blast were excluded. A cardiac arrest at the scene was also a cause of exclusion.

RESULTS

Sixty-four consecutive patients were included in this study. The population included 36 men and 28 women; their mean age was 47.3 years (range, 20 to 94 years). For the 64 victims, the mean ICU stay was 5.8 days (range, 1 to 33 days). Thirty-five of the 64 victims required mechanical ventilation for a mean duration of 101.2 h (range, 8 to 648 hours). Two patients died, respectively, on day 6 and 7, from progressive respiratory failure.

During the same period, 10 patients were found in cardiac

DISCUSSION

Numerous pulmonary complications have been reported following smoke inhalation, but most studies concerned victims with burns. Inhalation injury is present in approximately one third of the burned patients and increases mortality in relation to age and extent of burn.⁴^,⁵ In a review of 239 patients hospitalized in a burn unit, Teixidor et al⁵ found that more than 30% of the patients developed pulmonary complications and, of these, 75% died. Tracheobronchitis, pneumonia, pulmonary congestion,

ACKNOWLEDGMENT

We thank S. Borron for his help in preparing this article.

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: Reprint requests: Dr. Hantson, Department of Intensive Care, Cliniques Universitaires St-Luc, Avenue Hippocrate, 10, 1200 Brussels, Belgium. E-mail: [email protected]

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Chest

Clinical Investigations in Critical CareEarly Complications and Value of Initial Clinical and Paraclinical Observations in Victims of Smoke Inhalation Without Burns

Objective

Design

Setting

Patients

Methods

Results

Conclusions

Section snippets

MATERIALS AND METHODS

RESULTS

DISCUSSION

ACKNOWLEDGMENT

J Thorac Cardiovasc Surg

Toxicol Lett

J Emerg Med

Lancet

Ann Emerg Med

Diseases of the airways

Diagnosis of diseases of the chest.

Evaluation and management of patients with inhalation injury

J Trauma

Mortality probability in victims of fire trauma: revised equation to include inhalation injury

BMJ

Pulmonary complications in burn patients

J Can Assoc Radiol

Elevated blood cyanide concentrations in victims of smoke inhalation

N Engl J Med