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Severity of Inhalation Injury and Risk of Nosocomial Pneumonia: A Retrospective Cohort Study.
Coston, Taylor D; Gaskins, Devin; Bailey, Austin; Minus, Emily; Arbabi, Saman; West, T Eoin; Stewart, Barclay T.
Afiliación
  • Coston TD; Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle, WA.
  • Gaskins D; University of Washington School of Medicine, Seattle, WA.
  • Bailey A; University of Washington School of Medicine, Seattle, WA.
  • Minus E; Department of Biostatistics, University of Washington School of Public Health, Seattle, WA.
  • Arbabi S; Division of Trauma, Critical Care, and Burn, Department of Surgery, University of Washington, Seattle, WA.
  • West TE; Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle, WA.
  • Stewart BT; Division of Trauma, Critical Care, and Burn, Department of Surgery, University of Washington, Seattle, WA. Electronic address: barclays@uw.edu.
Chest ; 2024 Jul 02.
Article en En | MEDLINE | ID: mdl-38964672
ABSTRACT

BACKGROUND:

The impact of inhalation injury on risk of nosocomial pneumonia (NP), an important complication in patients with burns, is not well established. RESEARCH QUESTION Is more severe inhalation injury associated with increased risk of NP? STUDY DESIGN AND

METHODS:

We performed a retrospective cohort study of patients with suspected inhalation injury admitted to a regional burn center from 2011 to 2022 who underwent diagnostic bronchoscopy within 48 h of admission. We estimated the association of high-grade inhalation injury (Abbreviated Injury Scale score 3 and 4) vs low-grade inhalation injury (Abbreviated Injury Scale score 1 and 2) with NP adjusted for age, burn size, and comorbid obstructive lung disease. Death and hospital discharge were considered competing risks.

RESULTS:

Of the 245 patients analyzed, 51 (21%) had high-grade injury, 180 (73%) had low-grade injury, and 14 (6%) had no inhalation injury. Among the 236 patients hospitalized for ≥ 48 h, NP occurred in 24 of 50 patients (48%) in the high-grade group, 54 of 172 patients (31%) in the low-grade group, and two of 14 patients (14%) in the no inhalation injury group. High-grade (vs low-grade) inhalation injury was associated with higher hazard of NP in both the proportional cause-specific hazard model (cause-specific hazard ratio, 2.04; 95% CI, 1.26-3.30; P = .004) and Fine-Gray subdistribution hazard model (subdistribution hazard ratio for NP, 2.24; 95% CI, 1.38-3.64; P = .001).

INTERPRETATION:

Among patients with inhalation injury, more severe injury was associated with higher hazard of NP in competing risk analysis. Additional research is needed to investigate mechanisms that may explain the relationship between inhalation injury and NP and to identify more effective risk reduction strategies.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Chest Año: 2024 Tipo del documento: Article Pais de publicación: Estados Unidos
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Chest Año: 2024 Tipo del documento: Article Pais de publicación: Estados Unidos