Inhalation injury after exposure to indoor fire and smoke: The Brazilian disaster experience.

OBJECTIVE: To describe the pre-hospital, emergency department, and intensive care unit (ICU) care and prognosis of patients with inhalation injury after exposure to indoor fire and smoke. MATERIALS AND METHODS: This is a prospective observational cohort study that includes patients admitted to seven ICUs after a fire disaster. The following data were collected: demographic characteristics; use of fiberoptic bronchoscopy; degree of inhalation injury; percentage of burned body surface area; mechanical ventilation parameters; and subsequent events during ICU stay. Patients were followed to determine the ICU and hospital mortality rates. RESULTS: Within 24h of the incident, 68 patients were admitted to seven ICUs. The patients were young and had no comorbidities. Most patients (n=35; 51.5%) only had an inhalation injury. The mean ventilator-free days for patients with an inhalation injury degree of 0 or I was 12.5±8.1 days. For patients with an inhalation injury degree of II or III, the mean ventilator-free days was 9.4±5.8 days (p=0.12). In terms of the length of ICU stay for patients with degrees 0 or I, and patients with degrees II or III, the median was 7.0 days (5.0-8.0 days) and 12.0 days (8.0-23.0 days) (p<0.001), respectively. In addition, patients with a larger percentage of burned surface areas also had a longer ICU stay; however, no association with ventilator-free days was found. The patients with <10% of burned body surface area showed a mean of 9.2±5.4 ventilator-free days. The mean ventilator-free days for patients who had >10% burned body surface area was 11.9±9.5 (p=0.26). The length of ICU stay for the <10% and >10% burned body surface area patients was 7.0 days (5.0-10.0 days) and 23.0 days (11.5-25.5 days) (p<0.001), respectively. CONCLUSIONS: We conclude that burn patients with inhalation injuries have different courses of disease, which are mainly determined by the percentage of burned body surface area.

Prognostic value of the calling criteria in patients receiving a medical emergency team review.

AIM: To describe the reasons for medical emergency team (MET) activation, and to verify the association of the MET score with 30-day mortality. METHODS: This retrospective observational study took place in a 794-bed university-affiliated hospital. The population included all adult admissions reviewed by the MET during the period between January 2007 and June 2008. MET score was defined as the sum of each of the physiological triggers, and score zero was considered the calls made due to concern about the patient, without any physiological alteration. RESULTS: During the period of the study, 1051 calls were generated for 901 patients. Respiratory distress and hypotension accounted for most of MET calls. The triggers that showed an independent association with mortality were threatened airway, systolic blood pressure <90 mmHg, decrease in Glasgow Coma Scale score > or =2 points and respiratory frequency >36 breaths/min. Logistic regression analysis revealed MET score, age, medical patient, documented do not resuscitate orders and MET decision to transfer to the intensive care unit to be significant predictors of 30-day mortality. CONCLUSIONS: MET score presents a strong association with 30-day mortality in patients seen on the ward.