Methamphetamine Lab Explosion: A Pediatric Emergency Medicine Case.

Children exposed to the manufacture of illegal drugs are at risk for multiple medical problems. Providers need to be able to recognize and manage the complications from these exposures because early intervention can be crucial to decreasing morbidity and mortality. In this simulation case, a 3-year-old patient is brought to the emergency department (ED) after a house fire due to a methamphetamine lab explosion. The goals of this case are to provide the learners with the training and opportunity to manage a toxic chemical exposure by applying principles and methods of decontamination, and to manage an inhalational injury with rapidly progressive airway edema. These events being rare, this simulation gives learners crucial experience with a high-stakes medical condition.

Medical and Surgical Care of Critical Burn Patients: A Comprehensive Review of Current Evidence and Practice.

Critically ill burn patients pose several unique challenges to care providers. The concepts of fluid resuscitation, nutritional management, organ support and wound care are rapidly evolving. There is a pressing need to review emerging evidence and incorporate these into practice for the effective management of burn patients. We have searched the PubMed and Google Scholar databases to review the current evidence on the acute care management of adult as well as paediatric burn patients. The rationales for current practices have been integrated into the review. The management of critically ill burn patients requires an in-depth knowledge of the pathophysiology of burn injury, a tailored approach for timely resuscitation, timely diagnosis of organ specific problems, and comprehensive wound care. This review will help the doctors and healthcare providers involved in the management of critical burn patients in their day-to-day practice.

Mortality and Survival Analysis of Burn Patients Admitted in a Critical Care Burn Unit, Saudi Arabia.

Background: Burn injury is associated with a high mortality risk. Recent epidemiological data on burn injury and mortality rate from Saudi Arabia is lacking. Objective: This study aimed to analyze the survival rates and its predictability using the Baux score in patients with burn injury at a tertiary care hospital in Saudi Arabia. Materials and Methods: This retrospective study included all patients admitted to the burn unit at King Fahd Hospital of the University, Al Khobar, between March 2014 and February 2020. Patients' burn characteristics and calculated revised Baux scores were collected. The age, burn wound size, type of burn, burn extension, and Baux score of the survivors and non-survivors were compared. Results: A total number of 102 patients were included, and their mean age was 24.2 years (range: 9 months to 78 years). The mean affected total body surface area was 26.4%. Ninety patients (88%) suffered from flame/scald burn. The mortality rate was 17.6% (18 patients); all these patients had flame burns. No patient with a revised Baux score ≥110 survived (n = 14; 77% of the total deaths), while there was no mortality at score <36. Inhalational injuries were reported in 18 patients, of which 13 (72%) died. Patients with patent airway and no inhalation injury were 19 times more likely to survive than those with a compromised airway (P < 0.001). In terms of the depth of burn, partial thickness increased the likeliness of survival by 10 times compared with full thickness (P < 0.003). Conclusion: Inhalational injury and burn size were the most prognostic factors of burn injury in this study. As all cases of mortality were from flame burns, regulation on flammable materials and safety measures should be promoted to the public.

Outcomes of Patients with Burns Associated with Home Oxygen Therapy: An Institutional Retrospective Review.

Home oxygen therapy (HOT) burns carry high morbidity and mortality. Many patients are active smokers, which is the most frequent cause of oxygen ignition. We conducted a retrospective review at our institution to characterize demographics and outcomes in this patient population. An IRB-approved single-institution retrospective review was conducted for home oxygen therapy burn patients between July 2016 and January 2021. Demographic and clinical outcome data were compared between groups. We identified 100 patients with oxygen therapy burns. Mean age was 66.6 years with a male to female ratio of 1.3:1 and median burn surface area of 1%. In these patients, 97% were on oxygen for COPD and smoking caused 83% of burns. Thirteen were discharged from the emergency department, 35 observed for less than 24 hours, and 52 admitted. For admitted patients, 69.2% were admitted to the ICU, 37% required intubation, and 11.5% required debridement and grafting. Inhalational injury was found in 26.9% of patients, 3.9% underwent tracheostomy, and 17.3% experienced hospital complications. In-hospital mortality was 9.6% and 7.7% were discharged to hospice. 13.5% required readmission within 30 days. Admitted patients had significantly higher rates of admission to the ICU, intubation, and inhalational injury compared to those that were not admitted (P < .01). Most HOT-related burns are caused by smoking and can result in significant morbidity and mortality. Efforts to educate and encourage smoking cessation with more judicious HOT allocation would assist in preventing these unnecessary highly morbid injuries.

Inhalational injury and use of heparin & N-acetylcysteine nebulization: A case report.

Inhalational injury to the upper and lower airway occurs due to thermal or chemical irritation causing airway edema, capillary leak, mucin, and fibrin debris forming clots and soot. The use of unfractionated heparin (UFH) nebulization was found to be effective by dissolving airway clots. We report a case of inhalational burn injury where UFH nebulization led to a better outcome. A healthy male was trapped in a residential room during a fire in the building. He sustained facial, neck, upper chest, and left upper extremity burns accounting for 25% of body surface area. He was intubated at the site and started on supportive care. In the surgical intensive care unit, bronchoscopy showed severe tracheobronchial burn injury; a thorough lavage was done, started on UFH and N-acetylcysteine nebulization (NAC). The patient improved, and his trachea was extubated on day 6. In our patient, unfractionated heparin nebulization was beneficial as the patient was extubated early without landing to acute respiratory distress syndrome.

The utility of arterial blood gas parameters and chest radiography in predicting appropriate intubations in burn patients with suspected inhalation injury-A retrospective cohort study.

BACKGROUND: This study evaluates the utility of arterial blood gas (ABG) parameters and chest radiography in predicting intubation need in patients with burn injuries with suspected inhalation injury. METHODS: Patients with suspected inhalation injury admitted to a single centre, Burn Intensive Care Unit, between April 4th 2016 and July 5th 2019, were included. Admission ABG parameters and chest radiograph opacification were compared with whether the patient received an appropriate intubation: defined as intubation for a duration of over 48 h. Area under the receiver operator characteristic curve was calculated (AUROC). RESULTS: Eighty-nine patients were included. The majority (84%; n = 75) were intubated, of which 81% (n = 61) received appropriate intubations. pH had an AUROC of 0.88 and a pH of <7.30 had an 80% sensitivity and specificity for detecting appropriate intubation. P/F ratio had an AUROC of 0.81 and a P/F ratio of <40 had a 70% sensitivity and specificity for appropriate intubation. Chest radiograph opacification had poor utility in this regard (AUROC = 0.69). Adding pH and P/F ratio to the ABA criteria improved their sensitivity in detecting appropriate intubations (sensitivity: ABA + pH + P/F = 0.97 vs ABA = 0.86; p = 0.013), without altering their specificity. CONCLUSIONS: In patients suspected inhalation injury, pH and P/F ratio were good predictors for appropriate intubations. Incorporating the parameters into the ABA criteria improved their clinical utility.

E-cigarette, or vaping, product use-associated lung injury: a review.

BACKGROUND: E-cigarette, or Vaping, Product Use-Associated Lung Injury (EVALI) is a disease entity related to the use of battery-operated or superheating devices that create an aerosolized form of nicotine and tetrahydrocannabinol (THC) and/or other substances for inhalation. METHODS: We performed a literature review to document epidemiology, pathogenesis and risk factors, diagnosis, clinical presentation, evaluation and management of EVALI. RESULTS: In the summer of 2019, an outbreak of EVALI cases brought this disease entity into the national spotlight. Since being recognized as a serious pulmonary disease with public health implications, more than 2600 cases have been reported to CDC with 68 deaths as of February 2020. The pathophysiology of EVALI remains unknown. Substances such as Vitamin E acetate have been implicated as a possible causes of lung injury. The CDC has established case definitions of "confirmed EVALI" cases to help guide identification of the disease and assist in surveillance. While clinical judgement by healthcare providers is imperative in the identification of EVALI cases, the heterogeneous presentations of EVALI make this difficult as well. Ultimately most investigative studies should be aimed at ruling out other disease processes that can present similarly. Treatment is centered around removing the offending substance and providing supportive care. CONCLUSIONS: EVALI is a serious pulmonary disease with public health implications. Diagnosis requires a high degree of suspicion to diagnose and exclusion of other possible causes of lung disease. It may be beneficial to involve a pulmonary specialist early in the management of this disease which is generally supportive care.

Recent advances in the understanding of bronchiolitis in adults.

Bronchiolitis is injury to the bronchioles (small airways with a diameter of 2 mm or less) resulting in inflammation and/or fibrosis. Bronchioles can be involved in pathologic processes that involve predominantly the lung parenchyma or large airways, but, in some diseases, bronchioles are the main site of injury ("primary bronchiolitis"). Acute bronchiolitis caused by viruses is responsible for most cases of bronchiolitis in infants and children. In adults, however, there is a wide spectrum of bronchiolar disorders and most are chronic. Many forms of bronchiolitis have been described in the literature, and the terminology in this regard remains confusing. In clinical practice, a classification scheme based on the underlying histopathologic pattern (correlates with presenting radiologic abnormalities) facilitates the recognition of bronchiolitis and the search for the inciting cause of the lung injury. Respiratory bronchiolitis is the most common form of bronchiolitis in adults and is usually related to cigarette smoking. Currently, the diagnosis of respiratory bronchiolitis is generally achieved based on the clinical context (smoking history) and chest CT findings. Constrictive (obliterative) bronchiolitis is associated with airflow obstruction and is seen in various clinical contexts including environmental/occupational inhalation exposures, transplant recipients (bronchiolitis obliterans syndrome), and many others. Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) is increasingly recognized and can be associated with progressive airflow obstruction related to constrictive bronchiolitis ("DIPNECH syndrome"). Diffuse aspiration bronchiolitis is a form of aspiration-related lung disease that is often unsuspected and confused for interstitial lung disease. Novel forms of bronchiolitis have been described, including lymphocytic bronchiolitis and alveolar ductitis with emphysema recently described in employees at a manufacturing facility for industrial machines. Bronchiolitis is also a component of vaping-related lung injury encountered in the recent outbreak.

Cooking Gas Explosions As Cause Of Burns Among Patients Admitted To A Regional Burn Centre In Nigeria.

Burn injury has become a major source of mortality and morbidity in countries with low socioeconomic status. World energy consumption is mainly based on fossil fuels. This source of energy, if not properly handled, can be a source of major accident to lives and properties. The aim of this study is to highlight cases and the outcome of management of burns from cooking gas explosions in Lagos, Nigeria. The study involved all patients who sustained burns following cooking gas explosion within the study period. The parameters considered included demography, spread, anatomical locations and presence of inhalational injury, and outcome of management. A total of 347 patients were treated for burns during the study period, and 49 had burns from cooking gas explosion. Male to female ratio was 1.04:1. Patients between the ages of 21-40 years were the most affected. Extremities were involved in nearly all the patients. The presence of inhalational injury and larger burn surface area were found to be poor prognostic indices. Mortalities occurred within the first two weeks of injury. Cooking gas is becoming increasingly popular in Nigeria. Prevalence of burns from gas explosion is also on the increase. People are however not aware of its safe handling. More public enlightenment is required.

Les brûlures représentent une cause de morbidité et de mortalité considérables dans les pays à IDH faible. L'énergie consommée dans le monde est principalement d'origine fossile et son mésugeage est la cause d'accidents aux conséquences humaines et matérielles graves. Cette étude s'est penchée les caractéristiques et l'évolution de 49 patients (sur 347) hospitalisés dans le CTB de Lagos après explosion de réchaud à gaz. Nous avons relevé la démographie des patients, la surface et la localisation des brûlures, l'existence éventuelle d'une inhalation de fumées et le devenir. Le sex-ratio M/F était de 1,04/1, la tranche d'âge 21-40 ans était la plus fréquemment touchée. Les extrémités de presque tous les patients étaient brûlées. L'augmentation de la surface brûlée et la présence d'une inhalation de fumées étaient des facteurs de mauvais pronostic. En cas de décès, la mort survenait dans la première quinzaine. L'augmentation de la prévalence des brûlures lors d'une explosion de réchaud à gaz est parallèle à l'augmentation de leur utilisation, ce qui montre que des campagnes d'information sont nécessaires.

Non-necrotizing granulomatous pneumonitis and chronic pleuritis in soldiers deployed to Southwest Asia.

AIMS: Reports of respiratory illnesses among soldiers returning from Southwest Asia have been described. During deployment to Southwest Asia, soldiers are exposed to various respiratory hazards, including dust storms, smoke from burn pits and industrial air pollutants. A few studies have reported increased rates of constrictive bronchiolitis and asthma in these patients. We sought to expand upon the pathological findings in this cohort. METHODS AND RESULTS: Lung biopsies from veterans of Southwest Asia were identified and re-reviewed. All patients had undergone pulmonary function tests and chest high-resolution CT imaging with no significant findings. Overall, 59 patients with a history of inhalational exposure to at least one of the following were identified: smoke from burn pit, dust storm and sulphur plant fire. Samples included video-assisted thoracoscopic lung biopsies (57 of 59, 96.6%) and cryobiopsies (two of 59, 3.4%). Patients were predominantly male (54 of 59, 91.5%) with an age range of 24-55 years (mean and median = 35). Non-necrotising, poorly formed granulomas were identified in 22 cases (22 of 59, 37.2%). The granulomas were mainly bronchiolocentric and were associated with chronic lymphoplasmacytic bronchiolitis, similar to hypersensitivity pneumonitis (HP). Pleural reaction in the form of focal chronic lymphocytic pleuritis and/or focal pleural adhesions were seen in 43 of 57 (75.4%) biopsies. CONCLUSIONS: To our knowledge, this is the first study to report pleural reaction as well as features of HP in this population, suggesting that pleural reaction and HP may be part of the spectrum of Southwest Asia deployment-related lung diseases.

Endothelial glycocalyx shedding in patients with burns.

Shedding of syndecan-1 from the endothelial glycocalyx layer (EGL), referred to as endotheliopathy of trauma (EoT), is associated with poorer outcomes. This study aims to determine if EoT is also present in the burn population. We enrolled 458 burn and non-burn trauma patients at a Level 1 trauma center and defined EoT by a syndecan-1 level of ≥40 ng/mL. Sixty-eight of the enrolled patients had burns with a median TBSA of 19%, with 27.9% also suffering inhalational injury (II). Mortality was similar between the burn and non-burn group, also for patients with EoT. The incidence of II was significantly greater in the EoT+ burn group compared to the EoT- group (p = 0.038). Patients with II received significantly larger amounts of i.v. fluids (p = 0.001). The incidence of EoT was significantly different between the II-groups, as was mortality (pEoT = 0.038, pmortality < 0.001). EoT is attributed to the shock rather than the mechanism of trauma and may in burns be associated to II rather than TBSA. Patients with burns and II had worse outcomes and higher mortality compared to patients with burns alone. Burn injury induces EGL shedding similar to that in non-burn patients with EoT, and results in similar higher rate of mortality.

Inhalation injury: A two-year pilot assessment on the adherence to the clinical pathway for adult burn patients at high risk for inhalation injury in the Philippine General Hospital

OBJECTIVE@#This study determined the mean overall adherence to the clinical pathway formulated by the Section of Pulmonology together with the Division of Burns for adult burn patients at high risk for inhalation injury admitted at the UP-PGH ATR Burn Center in a two-year period@*METHODOLOGY@#A retrospective cohort study regarding adherence to the clinical pathway of acutely burned adult patients at high risk for inhalation injury admitted at the UP-PGH ATR Burn Center between August 2016 to July 2018 was conducted. Medical records were reviewed and an adherence checklist was used to assess each item in the clinical pathway. For the adherence and patient profile, descriptive statistics were used.@*RESULTS@#This pilot assessment study showed acceptable rates of adherence and implementation of the clinical pathway. Overall, 60% of the cases followed the clinical pathway completely. While 26.67% had acceptable rates of compliance (more than half of items adhered), while 13% of the cases scored adhered to less than half of the items.@*CONCLUSION@#The pathway has been shown to be a feasible clinical pathway that can be implemented in a tertiary hospital setting.

Early resuscitation and management of severe pediatric burns.

Pediatric burns are a leading cause of injury and mortality in children in the United States. Prompt resuscitation and management is vital to survival in severe pediatric burns. Although management principles are similar to their adult counterparts, children have unique pathophysiologic responses to burn injury thus an understanding of the differences in fluid resuscitation requirements, airway management, burn and wound care is essential to optimize their outcomes.

Spontaneous pneumothorax as a complication of chronic Jet propulsion fuel-8 exposure.

Jet Propulsion Fuel 8 (JP-8) is a kerosene based fuel commonly used in aviation. Occupational exposure to JP-8 may lead to negative health outcomes, which were described in a small number of studies. We report a case of 33-year-old Caucasian male veteran with a history of JP-8 exposure who presented with chronic dyspnea and recurrent spontaneous pneumothorax. To our knowledge, this is the first case of chronic inhalation injury from JP-8 exposure complicated with recurrent secondary spontaneous pneumothorax.

Inhalational injury and the larynx: A review.

OBJECTIVE: To review and discuss the existing research on the pathophysiology, impact and management of inhalational injury on the larynx and lower respiratory tract. DATA SOURCES: A literature search was conducted on the PubMed, MedLine, Embase, Web of Science and Google Scholar databases based on the keywords "airway burn", "inhalational injury" and "larynx". REVIEW METHODS: Inclusion criteria included English language studies containing original and review data on airway injury. Data was reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. CONCLUSIONS: Abnormal laryngeal and lower airway findings are common in burns patients and the incidence tends to increase with severity of the burns. Most patients with abnormal findings remain dysphonic decades after the initial injury. Larynx, the inlet to the airway, is exposed to the most intense thermal damage and highest concentration of chemical in inhalational injury. Airway injury is common and may result in long term morbidity. Healing of this tissue architecture is prolonged and different from cutaneous burn. Many patients receive prolonged intubation for medical complications that arise due to the burn injury. The degree of subglottic damage, however, is more extensive and occurs sooner compared with those without inhalational injuries. IMPLICATIONS FOR PRACTICE: With advances in acute medical and surgical management of burn and inhalational injury, airway injury is an important secondary outcome with lasting impact. Awareness of these potential complications and early involvement of medical and allied health team are important steps in improving patient care. A multi-disciplinary approach to management will optimise the short and long-term morbidity management and ultimately our patients' quality of life.

Defining the criteria for intubation of the patient with thermal burns.

OBJECTIVES: Recent studies demonstrate that burn patients are undergoing unnecessary intubations. We sought to determine the clinical criteria that predict intubations with benefit. METHODS: This was a retrospective review of intubated adults admitted to our center with thermal burns 2008-2013. Criteria for intubation were defined as traditional criteria (suspected smoke inhalation, oropharynx soot, hoarseness, dysphagia, singed facial hair, oral edema, oral burn, non-full thickness facial burns), or ABA criteria as defined by the 2011 ABA guidelines (full thickness facial burns, stridor, respiratory distress, swelling on laryngoscopy, upper airway trauma, altered mentation, hypoxia/hypercarbia, hemodynamic instability). Patients with <26days free from mechanical ventilation (ventilator-free days (VFD)) out of 28, were deemed indicated long-term intubations. Those with ≥26 VFD were deemed unnecessary short-term intubations. RESULTS: Of 218 patients, 151 had long-term and 67 had short-term intubations. Long-term intubation was strongly associated with ABA criteria (77.5%) compared to traditional criteria (22.5%) (p<0.001). Sensitivity of ABA criteria for long-term intubation was 77% and specificity 46%. Traditional criteria associated with long-term intubation included suspected smoke inhalation (OR 2.45 [95% CI, 1.18-5.11]), and singed facial hair (OR 2.53 [95% CI, 1.25-5.09]). The addition of these to ABA criteria created the Denver criteria, which exhibited an increased sensitivity for long-term intubations (95%), but decreased specificity (24%). CONCLUSIONS: Intubation should be considered for patients displaying the Denver criteria, which includes full thickness facial burns, stridor, respiratory distress, swelling on laryngoscopy, upper airway trauma, altered mentation, hypoxia/hypercarbia, hemodynamic instability, suspected smoke inhalation, and singed facial hair. Patients lacking these criteria should not be intubated.

Inhalational injury: The Philippine General Hospital experience (2008-2013)

OBJECTIVE@#Profiling of burn patients with inhalational injury will lead to better practices in the immediate and supportive management of their injuries. The goal of this study was to determine demographic and clinical factors associated with mortality in burn patients with inhalational injury admitted at Philippine General Hospital - Alfredo T. Ramirez (PGH - ATR) Burn Center from 2008 to 2013.@*METHODS@#All patients who were admitted from 2008 to 2013 were included in the study. The patient database was searched for cases of burn patients with inhalation injury. Medical records were reviewed for further analysis. This study was exempted from review by the University of the Philippines Manila Research Ethics Board.@*RESULTS@#Out of 1900 burn patients included in the study, 134 presented with concomitant inhalation injury with a prevalence rate of 7.0% and with a mortality rate of 38.06%. The study showed that the following variables: 1) percent total body surface area (%TBSA), 2) length of time from injury to resuscitation, 3) nebulization with N-acetylcysteine, 4) development of pneumonia, 5) administration of systemic antibiotics, and 6) performance of bronchoscopy correlated significantly with patient outcomes (p<0.05). Other variables did not show significant correlations with outcomes. The study also revealed that most of the patients were males with a mean age of 30.62, who sustained severe burns usually greater than 39% TBSA.@*CONCLUSION@#Poorer prognostic indicators include: 1) larger burnt body surface area, 2) delayed intubation, 3) delayed resuscitation, and 4) development of pneumonia.

Ivy Loop Wiring: A Useful Form of Endotracheal Tube Stabilization in Burn Patients.

The stabilization of endotracheal tubes in the burn population presents many problems. Access to the face for dressings, debridements, and the use of topical antimicrobials prevent adequate stabilization of the endotracheal tube with commonly used methods. Conventional methods have an increased risk of shifting, which can lead to injury to the friable burned tissue or unplanned extubation. To prevent these complications, alternative methods using the dentition to stabilize the endotracheal tube have been described. Here, we present our technique of using Ivy loops to secure the endotracheal tube. It is a simple method with low complications that provides a strong stabilization of the tube while giving access to the face.

La stabilisation de la sonde trachéale au sein de la population des grands brûlés s'associe à de nombreux problèmes. Il est impossible d'utiliser les méthodes habituelles pour la stabiliser, afin de conserver l'accès au visage pour les pansements, les débridements et l'application d'antimicrobiens topiques. La méthode classique accroît le risque de délogement, qui peut susciter des blessures aux tissus brûlés friables et une extubation non planifiée. Afin de prévenir ces complications, il existe une autre méthode de stabilisation de la sonde trachéale, qui fait appel à la dentition. Dans la présente étude, les chercheurs exposent leur technique d'utilisation des ligatures d'Ivy pour sécuriser la sonde trachéale. C'est une méthode simple, au faible taux de complications, qui assure une stabilisation élevée de la sonde tout en maintenant l'accès au visage.

Management and outcomes of children with severe burns in New South Wales: 1995-2013.

BACKGROUND: As a result of improvements in injury prevention, severe burns appear increasingly uncommon in Australian children. Such injuries continue to have devastating impacts, with major consequences for the patient, their family, treating clinicians and the caring institution. METHODS: A retrospective review was undertaken of Australian children who presented to our institution between 1995 and 2013 with burn injuries ≥30% total body surface area (TBSA). RESULTS: Ninety children were identified. Their median age was 3.9 years and 57% (n = 52) were male. Most injuries occurred at home (n = 63) due to fires (n = 49). The majority received inadequate first aid (n = 56) and 40 became hypothermic during initial resuscitation. A total of 79% were transferred from other institutions. The median TBSA burnt was 40% and the majority of burns were full thickness (n = 51). All but nine were managed in the Paediatric Intensive Care Unit with a mean initial hospital admission of 43.5 days. Two thirds of children were intubated, over half of those prior to transfer, with 26 having an inhalational injury and 33 escharotomies. Compared with estimated fluid requirements, most children were over-resuscitated by a median of 26.9 mL/kg. There were seven mortalities. Wound infections were common (n = 65) and 36 suffered sepsis. The median number of dressing changes was 13 (range 0-100), operations were six and packed cells transfused was 95.7 mL/kg. Overall, 54 developed hypertrophic scarring and 45 scar contractures that have required subsequent reconstructive surgery. CONCLUSION: Severe burn injuries in children have significant morbidity and mortality. They would appear expensive to manage and impact substantially on health care resources.

Association between early airway damage-associated molecular patterns and subsequent bacterial infection in patients with inhalational and burn injury.

Bacterial infection is a major cause of morbidity affecting outcome following burn and inhalation injury. While experimental burn and inhalation injury animal models have suggested that mediators of cell damage and inflammation increase the risk of infection, few studies have been done on humans. This is a prospective, observational study of patients admitted to the North Carolina Jaycee Burn Center at the University of North Carolina who were intubated and on mechanical ventilation for treatment of burn and inhalational injury. Subjects were enrolled over a 2-yr period and followed till discharge or death. Serial bronchial washings from clinically indicated bronchoscopies were collected and analyzed for markers of tissue injury and inflammation. These include damage-associated molecular patterns (DAMPs) such as hyaluronic acid (HA), double-stranded DNA (dsDNA), heat-shock protein 70 (HSP-70), and high-mobility group protein B-1 (HMGB-1). The study population was comprised of 72 patients who had bacterial cultures obtained for clinical indications. Elevated HA, dsDNA, and IL-10 levels in bronchial washings obtained early (the first 72 h after injury) were significantly associated with positive bacterial respiratory cultures obtained during the first 14 days postinjury. Independent of initial inhalation injury severity and extent of surface burn, elevated levels of HA dsDNA and IL-10 in the central airways obtained early after injury are associated with subsequent positive bacterial respiratory cultures in patients intubated after acute burn/inhalation injury.