Inhalation injury severity scoring system: a quantitative method.

Inhalation injury, a major contributor to burn-related mortality, has been difficult to quantify. A scoring system paralleling current adult respiratory distress syndrome systems has the potential to distinguish survivors from nonsurvivors. The utility of the PaO2/FiO2 (P/F) ratio in predicting injury severity was first examined. In a review of 120 patients with inhalation injury, those with P/F ratios greater than or equal to 300 after resuscitation were more likely to survive than those with ratios less than 300. The P/F ratio had no value when obtained before resuscitation. Next, a scoring system was developed to assist in comparing the severity of injury in ventilator-dependent patients with burns. Measurements were recorded prospectively in four categories: chest x-ray evaluation, P/F ratio, peak inspiratory pressure, and bronchoscopy. When comparing survivors (20) versus nonsurvivors (6), significant differences were found early (day 0, day 1, and week 1) for P/F ratio and overall severity score. Differences were seen later (week 1 and week 2) for chest x-ray evaluation and peak inspiratory pressure values. Because of low numbers the value of bronchoscopy could not be evaluated. The role of an inhalation injury severity scoring system for predicting survival should be examined in larger prospective trials.

Use of a helium-oxygen mixture in the treatment of postextubation stridor in pediatric patients with burns.

A mixture of helium and oxygen is less dense than room air. This property allows the gas to flow with less turbulence past airway narrowings, thereby decreasing airway resistance and increasing the volume of gas exchange. Previous studies demonstrated that airway obstruction that is manifested by stridor was present in 92% of patients requiring reintubation. Eight pediatric patients with burns in whom postextubation stridor or retractions unresponsive to racemic epinephrine developed, were treated with "heliox" (helium and oxygen) for 28 +/- 5 hours with an initial helium concentration between 50% and 70%. Of the eight patients treated with heliox, only two experienced respiratory distress and required reintubation. Both patients had stridor for a longer time before the initiation of heliox therapy compared with those patients who did not require reintubation. After initiation of heliox therapy, patients experienced a significant decrease in respiratory distress scores (6.8 +/- 0.7 vs 2.0 +/- 0.7). Heliox was able to relieve persistent stridor and thereby aid in the prevention of respiratory distress and reintubation.