1
|
Stewart S, Juang D, Aguayo P. Pediatric burn review. Semin Pediatr Surg 2022; 31:151217. [PMID: 36370620 DOI: 10.1016/j.sempedsurg.2022.151217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Shai Stewart
- Department of Surgery, Children's Mercy Kansas City, Kansas City, MO USA; University of Missouri-Kansas City School of Medicine, Kansas City, MO USA
| | - David Juang
- Department of Surgery, Children's Mercy Kansas City, Kansas City, MO USA; University of Missouri-Kansas City School of Medicine, Kansas City, MO USA
| | - Pablo Aguayo
- Department of Surgery, Children's Mercy Kansas City, Kansas City, MO USA; University of Missouri-Kansas City School of Medicine, Kansas City, MO USA.
| |
Collapse
|
2
|
Qi L, Huang S, Heidari AE, Dai C, Zhu J, Zhang X, Chen Z. Automatic airway wall segmentation and thickness measurement for long-range optical coherence tomography images. OPTICS EXPRESS 2015; 23:33992-4006. [PMID: 26832057 PMCID: PMC4741311 DOI: 10.1364/oe.23.033992] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
We present an automatic segmentation method for the delineation and quantitative thickness measurement of multiple layers in endoscopic airway optical coherence tomography (OCT) images. The boundaries of the mucosa and the sub-mucosa layers are accurately extracted using a graph-theory-based dynamic programming algorithm. The algorithm was tested with sheep airway OCT images. Quantitative thicknesses of the mucosal layers are obtained automatically for smoke inhalation injury experiments.
Collapse
Affiliation(s)
- Li Qi
- Institute of Optical Communication Engineering, Nanjing University, Nanjing, Jiangsu, 210093, China
- Beckman Laser Institute, University of California, Irvine, Irvine, California 92612, USA
| | - Shenghai Huang
- Beckman Laser Institute, University of California, Irvine, Irvine, California 92612, USA
| | - Andrew E. Heidari
- Beckman Laser Institute, University of California, Irvine, Irvine, California 92612, USA
- Department of Biomedical Engineering, University of California, Irvine, Irvine, California 92697, USA
| | - Cuixia Dai
- Beckman Laser Institute, University of California, Irvine, Irvine, California 92612, USA
| | - Jiang Zhu
- Beckman Laser Institute, University of California, Irvine, Irvine, California 92612, USA
| | - Xuping Zhang
- Institute of Optical Communication Engineering, Nanjing University, Nanjing, Jiangsu, 210093, China
| | - Zhongping Chen
- Beckman Laser Institute, University of California, Irvine, Irvine, California 92612, USA
- Department of Biomedical Engineering, University of California, Irvine, Irvine, California 92697, USA
| |
Collapse
|
3
|
Aliannejad R. Comment on "Comparison of virtual bronchoscopy to fiber-optic bronchoscopy for assessment of inhalation injury severity". Burns 2015; 41:1613-5. [PMID: 26387428 DOI: 10.1016/j.burns.2015.05.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2015] [Accepted: 05/14/2015] [Indexed: 11/26/2022]
Affiliation(s)
- Rasoul Aliannejad
- Department of Pulmonary, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
4
|
Response to the Letter to the Editor by Payman Salamati MD and Rasoul Aliannejad MD. Burns 2015; 41:1615-6. [PMID: 26382828 DOI: 10.1016/j.burns.2015.08.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 08/25/2015] [Indexed: 11/22/2022]
|
5
|
Kwon HP, Zanders TB, Regn DD, Burkett SE, Ward JA, Nguyen R, Necsoiu C, Jordan BS, York GE, Jimenez S, Chung KK, Cancio LC, Morris MJ, Batchinsky AI. Comparison of virtual bronchoscopy to fiber-optic bronchoscopy for assessment of inhalation injury severity. Burns 2014; 40:1308-15. [PMID: 25112807 DOI: 10.1016/j.burns.2014.06.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Revised: 06/16/2014] [Accepted: 06/17/2014] [Indexed: 11/20/2022]
Abstract
PURPOSE Compare virtual bronchoscopy (VB) to fiberoptic bronchoscopy (FOB) for scoring smoke inhalation injury (SII). METHODS Swine underwent computerized tomography (CT) with VB and FOB before (0) and 24 and 48 h after SII. VB and FOB images were scored by 5 providers off line. RESULTS FOB and VB scores increased over time (p<0.001) with FOB scoring higher than VB at 0 (0.30±0.79 vs. 0.03±0.17), 24 h (4.21±1.68 vs. 2.47±1.50), and 48h (4.55±1.83 vs. 1.94±1.29). FOB and VB showed association with PaO2-to-FiO2 ratios (PFR) with areas under receiver operating characteristic curves (ROC): for PFR≤300, VB 0.830, FOB 0.863; for PFR≤200, VB 0.794, FOB 0.825; for PFR≤100, VB 0.747, FOB 0.777 (all p<0.001). FOB showed 80.3% specificity, 77% sensitivity, 88.8% negative-predictive value (NPV), and 62.3% positive-predictive value (PPV) for PFR≤300 and VB showed 67.2% specificity, 85.5% sensitivity, 91.3% NPV, and 53.4% PPV. CONCLUSIONS VB provided similar injury severity scores to FOB, correlated with PFR, and reliably detected airway narrowing. VB performed during admission CT may be a useful screening tool specifically to demonstrate airway narrowing induced by SII.
Collapse
Affiliation(s)
- Herbert P Kwon
- Pulmonary/Critical Care Service, Department of Medicine, Brooke Army Medical Center, Fort Sam Houston, TX 78234, United States
| | - Thomas B Zanders
- Pulmonary/Critical Care Service, Department of Medicine, Brooke Army Medical Center, Fort Sam Houston, TX 78234, United States
| | - Dara D Regn
- Pulmonary/Critical Care Service, Department of Medicine, Brooke Army Medical Center, Fort Sam Houston, TX 78234, United States
| | - Samuel E Burkett
- Pulmonary/Critical Care Service, Department of Medicine, Brooke Army Medical Center, Fort Sam Houston, TX 78234, United States
| | - John A Ward
- Department of Clinical Investigation, Brooke Army Medical Center, JBSA Fort Sam Houston, TX 78234, United States
| | - Ruth Nguyen
- Pulmonary/Critical Care Service, Department of Medicine, Brooke Army Medical Center, Fort Sam Houston, TX 78234, United States
| | - Corina Necsoiu
- Pulmonary/Critical Care Service, Department of Medicine, Brooke Army Medical Center, Fort Sam Houston, TX 78234, United States
| | - Bryan S Jordan
- U.S. Army Institute of Surgical Research, JBSA Fort Sam Houston, TX 78234-6315, United States
| | - Gerald E York
- Department of Radiology, Brooke Army Medical Center, JBSA Fort Sam Houston, TX 78234, United States
| | - Santiago Jimenez
- Department of Radiology, Brooke Army Medical Center, JBSA Fort Sam Houston, TX 78234, United States
| | - Kevin K Chung
- U.S. Army Institute of Surgical Research, JBSA Fort Sam Houston, TX 78234-6315, United States
| | - Leopoldo C Cancio
- U.S. Army Institute of Surgical Research, JBSA Fort Sam Houston, TX 78234-6315, United States
| | - Michael J Morris
- Pulmonary/Critical Care Service, Department of Medicine, Brooke Army Medical Center, Fort Sam Houston, TX 78234, United States
| | - Andriy I Batchinsky
- U.S. Army Institute of Surgical Research, JBSA Fort Sam Houston, TX 78234-6315, United States.
| |
Collapse
|
6
|
Chou L, Batchinsky A, Belenkiy S, Jing J, Ramalingam T, Brenner M, Chen Z. In vivo detection of inhalation injury in large airway using three-dimensional long-range swept-source optical coherence tomography. JOURNAL OF BIOMEDICAL OPTICS 2014; 19:36018. [PMID: 24664245 PMCID: PMC3963560 DOI: 10.1117/1.jbo.19.3.036018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Accepted: 02/28/2014] [Indexed: 05/15/2023]
Abstract
We report on the feasibility of using long-range swept-source optical coherence tomography (OCT) to detect airway changes following smoke inhalation in a sheep model. The long-range OCT system (with axial imaging range of 25 mm) and probe are capable of rapidly obtaining a series of high-resolution full cross-sectional images and three-dimensional reconstructions covering 20-cm length of tracheal and bronchial airways with airway diameter up to 25 mm, regardless of the position of the probe within the airway lumen. Measurements of airway thickness were performed at baseline and postinjury to show mucosal thickness changes following smoke inhalation.
Collapse
Affiliation(s)
- Lidek Chou
- University of California, Beckman Laser Institute, 1002 Health Sciences Road East, Irvine, California 92612
- OCT Medical Imaging Inc., 1002 Health Sciences Road East, Irvine, California 92612
| | - Andriy Batchinsky
- US Army Institute of Surgical Research, San Antonio Military Medical Center, Fort Sam Houston, San Antonio, Texas 78234
| | - Slava Belenkiy
- US Army Institute of Surgical Research, San Antonio Military Medical Center, Fort Sam Houston, San Antonio, Texas 78234
| | - Joseph Jing
- University of California, Beckman Laser Institute, 1002 Health Sciences Road East, Irvine, California 92612
- University of California, Department of Biomedical Engineering, Irvine, California 92697
| | | | - Matthew Brenner
- University of California, Beckman Laser Institute, 1002 Health Sciences Road East, Irvine, California 92612
- University of California, Irvine Medical Center, Division of Pulmonary and Critical Care, Orange, California 92868
| | - Zhongping Chen
- University of California, Beckman Laser Institute, 1002 Health Sciences Road East, Irvine, California 92612
- University of California, Department of Biomedical Engineering, Irvine, California 92697
- Address all correspondence to: Zhongping Chen, E-mail:
| |
Collapse
|
7
|
Huzar TF, Cross JM. Ventilator-associated pneumonia in burn patients: a cause or consequence of critical illness? Expert Rev Respir Med 2012; 5:663-73. [PMID: 21955236 DOI: 10.1586/ers.11.61] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Infectious complications are a constant threat to thermally injured patients during hospitalizations and are a predominant cause of death. Most of the infections that develop in burn patients are nosocomial and of a pulmonary etiology. The bacteria that cause ventilator associated pneumonia (VAP) take advantage of the fact that uniquely among intensive care unit patients endotracheal intubation allows them a 'free' passage to the sterile lower airways; however, the combination of severe thermal injury (systemic immunosuppression) and inhalation injury (local immunosuppression and tissue injury) create an ideal environment for development of VAP. Thus, strategies directed at preventing and treating VAP in burn patients must address not only rapid extubation and VAP prevention bundles known to work in other intensive care unit populations, but therapies directed to more rapid wound healing and restoration of pulmonary patency.
Collapse
Affiliation(s)
- Todd F Huzar
- Department of Surgery, University of Texas Medical School, Houston, TX, USA.
| | | |
Collapse
|
8
|
Comparison of airway pressure release ventilation to conventional mechanical ventilation in the early management of smoke inhalation injury in swine. Crit Care Med 2011; 39:2314-21. [PMID: 21705889 DOI: 10.1097/ccm.0b013e318225b5b3] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE The role of airway pressure release ventilation in the management of early smoke inhalation injury has not been studied. We compared the effects of airway pressure release ventilation and conventional mechanical ventilation on oxygenation in a porcine model of acute respiratory distress syndrome induced by wood smoke inhalation. DESIGN Prospective animal study. SETTING Government laboratory animal intensive care unit. PATIENTS Thirty-three Yorkshire pigs. INTERVENTIONS Smoke inhalation injury. MEASUREMENTS AND MAIN RESULTS Anesthetized female Yorkshire pigs (n = 33) inhaled room-temperature pine-bark smoke. Before injury, the pigs were randomized to receive conventional mechanical ventilation (n = 15) or airway pressure release ventilation (n = 12) for 48 hrs after smoke inhalation. As acute respiratory distress syndrome developed (PaO2/Fio2 ratio <200), plateau pressures were limited to <35 cm H2O. Six uninjured pigs received conventional mechanical ventilation for 48 hrs and served as time controls. Changes in PaO2/Fio2 ratio, tidal volume, respiratory rate, mean airway pressure, plateau pressure, and hemodynamic variables were recorded. Survival was assessed using Kaplan-Meier analysis. PaO2/Fio2 ratio was lower in airway pressure release ventilation vs. conventional mechanical ventilation pigs at 12, 18, and 24 hrs (p < .05) but not at 48 hrs. Tidal volumes were lower in conventional mechanical ventilation animals between 30 and 48 hrs post injury (p < .05). Respiratory rates were lower in airway pressure release ventilation at 24, 42, and 48 hrs (p < .05). Mean airway pressures were higher in airway pressure release ventilation animals between 6 and 48 hrs (p < .05). There was no difference in plateau pressures, hemodynamic variables, or survival between conventional mechanical ventilation and airway pressure release ventilation pigs. CONCLUSIONS In this model of acute respiratory distress syndrome caused by severe smoke inhalation in swine, airway pressure release ventilation-treated animals developed acute respiratory distress syndrome faster than conventional mechanical ventilation-treated animals, showing a lower PaO2/Fio2 ratio at 12, 18, and 24 hrs after injury. At other time points, PaO2/Fio2 ratio was not different between conventional mechanical ventilation and airway pressure release ventilation.
Collapse
|
9
|
Yip LY, Lim YF, Chan HN. Safety and potential anticoagulant effects of nebulised heparin in burns patients with inhalational injury at Singapore General Hospital Burns Centre. Burns 2011; 37:1154-60. [DOI: 10.1016/j.burns.2011.07.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2011] [Revised: 06/28/2011] [Accepted: 07/04/2011] [Indexed: 12/01/2022]
|
10
|
High-frequency percussive ventilation and low tidal volume ventilation in burns: a randomized controlled trial. Crit Care Med 2010; 38:1970-7. [PMID: 20639746 DOI: 10.1097/ccm.0b013e3181eb9d0b] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVES In select burn intensive care units, high-frequency percussive ventilation is preferentially used to provide mechanical ventilation in support of patients with acute lung injury, acute respiratory distress syndrome, and inhalation injury. However, we found an absence of prospective studies comparing high-frequency percussive ventilation with contemporary low-tidal volume ventilation strategies. The purpose of this study was to prospectively compare the two ventilator modalities in a burn intensive care unit setting. DESIGN Single-center, prospective, randomized, controlled clinical trial, comparing high-frequency percussive ventilation with low-tidal volume ventilation in patients admitted to our burn intensive care unit with respiratory failure. SETTING A 16-bed burn intensive care unit at a tertiary military teaching hospital. PATIENTS Adult patients ≥ 18 yrs of age requiring prolonged (> 24 hrs) mechanical ventilation were admitted to the burn intensive care unit. The study was conducted over a 3-yr period between April 2006 and May 2009. This trial was registered with ClinicalTrials.gov as NCT00351741. INTERVENTIONS Subjects were randomly assigned to receive mechanical ventilation through a high-frequency percussive ventilation-based strategy (n = 31) or a low-tidal volume ventilation-based strategy (n = 31). MEASUREMENTS AND MAIN RESULTS At baseline, both the high-frequency percussive ventilation group and the low-tidal volume ventilation group had similar demographics to include median age (interquartile range) (28 yrs [23-45] vs. 33 yrs [24-46], p = nonsignificant), percentage of total body surface area burn (34 [20-52] vs. 34 [23-50], p = nonsignificant), and clinical diagnosis of inhalation injury (39% vs. 35%, p = nonsignificant). The primary outcome was ventilator-free days in the first 28 days after randomization. Intent-to-treat analysis revealed no significant difference between the high-frequency percussive ventilation and the low-tidal volume ventilation groups in mean (± sd) ventilator-free days (12 ± 9 vs. 11 ± 9, p = nonsignificant). No significant difference was detected between groups for any of the secondary outcome measures to include mortality except the need for "rescue" mode application (p = .02). Nine (29%) in the low-tidal volume ventilation arm did not meet predetermined oxygenation or ventilation goals and required transition to a rescue mode. By contrast, two in the high-frequency percussive ventilation arm (6%) required rescue. CONCLUSIONS A high-frequency percussive ventilation-based strategy resulted in similar clinical outcomes when compared with a low-tidal volume ventilation-based strategy in burn patients with respiratory failure. However, the low-tidal volume ventilation strategy failed to achieve ventilation and oxygenation goals in a higher percentage necessitating rescue ventilation.
Collapse
|
11
|
Abstract
Smoke inhalation injury, a unique form of acute lung injury, greatly increases the occurrence of postburn morbidity and mortality. In addition to early intubation for upper-airway protection, subsequent critical care of patients who have this injury should be directed at maintaining distal airway patency. High-frequency ventilation, inhaled heparin, and aggressive pulmonary toilet are among the therapies available. Even so, immunosuppression, intubation, and airway damage predispose these patients to pneumonia and other complications.
Collapse
|
12
|
Burn Center Treatment of Patients With Severe Anhydrous Ammonia Injury: Case Reports and Literature Review. J Burn Care Res 2007; 28:922-8. [DOI: 10.1097/bcr.0b013e318159a44e] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
13
|
Cancio LC, Batchinsky AI, Dubick MA, Park MS, Black IH, Gómez R, Faulkner JA, Pfannenstiel TJ, Wolf SE. Inhalation injury: Pathophysiology and clinical care. Burns 2007; 33:681-92. [PMID: 17532146 DOI: 10.1016/j.burns.2006.11.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2006] [Accepted: 11/15/2006] [Indexed: 11/28/2022]
Affiliation(s)
- Leopoldo C Cancio
- U.S. Army Institute of Surgical Research, Fort Sam Houston, TX 78234-6315, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Batchinsky AI, Weiss WB, Jordan BS, Dick EJ, Cancelada DA, Cancio LC. Ventilation-perfusion relationships following experimental pulmonary contusion. J Appl Physiol (1985) 2007; 103:895-902. [PMID: 17569766 DOI: 10.1152/japplphysiol.00563.2006] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Ventilation-perfusion changes after right-sided pulmonary contusion (PC) in swine were investigated by means of the multiple inert gas elimination technique (MIGET). Anesthetized swine (injury, n = 8; control, n = 6) sustained a right-chest PC by a captive-bolt apparatus. This was followed by a 12-ml/kg hemorrhage, resuscitation, and reinfusion of shed blood. MIGET and thoracic computed tomography (CT) were performed before and 6 h after injury. Three-dimensional CT scan reconstruction enabled determination of the combined fractional volume of poorly aerated and non-aerated lung tissue (VOL), and the mean gray-scale density (MGSD). Six hours after PC in injured animals, Pa(O(2)) decreased from 234.9 +/- 5.1 to 113.9 +/- 13.0 mmHg. Shunt (Q(S)) increased (2.7 +/- 0.4 to 12.3 +/- 2.2%) at the expense of blood flow to normal ventilation/perfusion compartments (97.1 +/- 0.4 to 87.4 +/- 2.2%). Dead space ventilation (V(D)/V(T)) increased (58.7 +/- 1.7% to 67.2 +/- 1.2%). MGSD increased (-696.7 +/- 6.1 to -565.0 +/- 24.3 Hounsfield units), as did VOL (4.3 +/- 0.5 to 33.5 +/- 3.2%). Multivariate linear regression of MGSD, VOL, V(D)/V(T), and Q(S) vs. Pa(O(2)) retained VOL and Q(S) (r(2) = .835) as independent covariates of Pa(O(2)). An increase in Q(S) characterizes lung failure 6 h after pulmonary contusion; Q(S) and VOL correlate independently with Pa(O(2)).
Collapse
Affiliation(s)
- Andriy I Batchinsky
- U.S. Army Institute of Surgical Research, 3400 Rawley E. Chambers Ave., Fort Sam Houston, Texas 78234-6315, USA.
| | | | | | | | | | | |
Collapse
|
15
|
Abstract
This article makes some introductory comments on the histology of the skin and the pathophysiology of burn injury as these topics pertain to the estimation of the depth of the burn injury. The definition of a major burn and the salient points of its treatment are covered. In addition, some general comments are made about several special injuries for which burn center referral usually is sought. Finally, guidance is given in the selection and treatment of patients who have burns that may be treated on an outpatient basis.
Collapse
Affiliation(s)
- Rubén Gómez
- US Army Institute of Surgical Research, 3600 Rawley E. Chambers Avenue, Fort Sam Houston, San Antonio, TX 78234-6315, USA
| | | |
Collapse
|