BACKGROUND: The Berlin definition of Acute Respiratory Distress Syndrome (ARDS) has been applied to military burns resulting from combat-related trauma, but has not been widely studied among civilian burns. This study's purpose was to use the Berlin definition to determine the incidence of ARDS, and its associated respiratory morbidity, and mortality among civilian burn patients. METHODS: Retrospective study of burn patients mechanically ventilated for ≥48h at an American Burn Association-verified burn center. The Berlin criteria identified patients with mild, moderate, and severe ARDS. Logistic regression was used to identify variables predictive of moderate to severe ARDS, and mortality. The outcome measures of interest were duration of mechanical ventilation and in-hospital mortality. Values are shown as the median (Q1-Q3). RESULTS: We included 162 subjects [24% female, age 48 (35-60), % total body surface area (TBSA) burn 28 (19-40), % body surface area (BSA) full thickness (FT) burn 13 (0-30), and 62% with inhalation injury]. The incidence of ARDS was 43%. Patients with ARDS had larger %TBSA burns [30.5 (23.1-47.0) vs. 24.8 (17.1-35), p=0.007], larger FT burns [20.5(5.4-35.5) vs. 7 (0-22.1), p=0.001], but had no significant difference in the incidence of inhalation injury (p=0.216), compared to those without ARDS. The % FT burn predicted the development of moderate to severe ARDS [OR 1.034, 95%CI (1.013-1.055), p=0.001]. ARDS developed in the 1st week after burn in 86% of cases. Worsening severity of ARDS was associated with increased days of mechanical ventilation in survivors (p=0.001), a reduction in ventilator-free days/1st 30 days in all subjects (p=0.004), and a strong indication of increased mortality (0% in mild ARDS vs. 50% in severe ARDS, unadjusted p=0.02). Neither moderate ARDS nor severe ARDS were significant predictors of death. CONCLUSIONS: ARDS is common among mechanically ventilated civilian burn patients, and develops early after burn. The extent of full thickness burn predicted development of moderate to severe ARDS. Increasing severity of ARDS based upon the Berlin definition was associated with a significantly greater duration of mechanical ventilation and a trend toward higher mortality.
BACKGROUND: The Berlin definition of Acute Respiratory Distress Syndrome (ARDS) has been applied to military burns resulting from combat-related trauma, but has not been widely studied among civilian burns. This study's purpose was to use the Berlin definition to determine the incidence of ARDS, and its associated respiratory morbidity, and mortality among civilian burn patients. METHODS: Retrospective study of burn patients mechanically ventilated for ≥48h at an American Burn Association-verified burn center. The Berlin criteria identified patients with mild, moderate, and severe ARDS. Logistic regression was used to identify variables predictive of moderate to severe ARDS, and mortality. The outcome measures of interest were duration of mechanical ventilation and in-hospital mortality. Values are shown as the median (Q1-Q3). RESULTS: We included 162 subjects [24% female, age 48 (35-60), % total body surface area (TBSA) burn 28 (19-40), % body surface area (BSA) full thickness (FT) burn 13 (0-30), and 62% with inhalation injury]. The incidence of ARDS was 43%. Patients with ARDS had larger %TBSA burns [30.5 (23.1-47.0) vs. 24.8 (17.1-35), p=0.007], larger FT burns [20.5(5.4-35.5) vs. 7 (0-22.1), p=0.001], but had no significant difference in the incidence of inhalation injury (p=0.216), compared to those without ARDS. The % FT burn predicted the development of moderate to severe ARDS [OR 1.034, 95%CI (1.013-1.055), p=0.001]. ARDS developed in the 1st week after burn in 86% of cases. Worsening severity of ARDS was associated with increased days of mechanical ventilation in survivors (p=0.001), a reduction in ventilator-free days/1st 30 days in all subjects (p=0.004), and a strong indication of increased mortality (0% in mild ARDS vs. 50% in severe ARDS, unadjusted p=0.02). Neither moderate ARDS nor severe ARDS were significant predictors of death. CONCLUSIONS: ARDS is common among mechanically ventilated civilian burn patients, and develops early after burn. The extent of full thickness burn predicted development of moderate to severe ARDS. Increasing severity of ARDS based upon the Berlin definition was associated with a significantly greater duration of mechanical ventilation and a trend toward higher mortality.
Authors: Majid Afshar; Ellen L Burnham; Cara Joyce; Robin Gagnon; Robert Dunn; Joslyn M Albright; Luis Ramirez; John E Repine; Giora Netzer; Elizabeth J Kovacs Journal: Ann Surg Date: 2019-12 Impact factor: 12.969
Authors: Marcos T Tanita; Meriele M Capeletti; Tomás A Moreira; Renan P Petinelli; Lucienne T Q Cardoso; Cintia M C Grion Journal: Int J Burns Trauma Date: 2020-02-15
Authors: Marcus J Schultz; Janneke Horn; Markus W Hollmann; Benedikt Preckel; Gerie J Glas; Kirsten Colpaert; Manu Malbrain; Ary Serpa Neto; Karim Asehnoune; Marcello Gamma de Abreu; Ignacio Martin-Loeches; Paolo Pelosi; Folke Sjöberg; Jan M Binnekade; Berry Cleffken; Nicole P Juffermans; Paul Knape; Bert G Loef; David P Mackie; Perenlei Enkhbaatar; Nadia Depetris; Anders Perner; Eva Herrero; Lucia Cachafeiro; Marc Jeschke; Jeffrey Lipman; Matthieu Legrand; Johannes Horter; Athina Lavrentieva; Gerie Glas; Alex Kazemi; Anne Berit Guttormsen; Frederik Huss; Mark Kol; Helen Wong; Therese Starr; Luc De Crop; Wilson de Oliveira Filho; João Manoel Silva Junior; Cintia M C Grion; Marc G Jeschke; Marjorie Burnett; Frederik Mondrup; Francois Ravat; Mathieu Fontaine; Karim Asehoune; Renan Le Floch; Mathieu Jeanne; Morgane Bacus; Maïté Chaussard; Marcus Lehnhardt; Bassem Daniel Mikhail; Jochen Gille; Aidan Sharkey; Nicole Trommel; Auke C Reidinga; Nadine Vieleers; Anna Tilsley; Henning Onarheim; Maria Teresa Bouza; Alexander Agrifoglio; Filip Fredén; Tina Palmieri; Lynda E Painting Journal: Burns Trauma Date: 2021-12-16