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Postburn pulmonary injury is a common and frequently overlooked concomitant of burn injury. The lesion may be secondary to direct damage to the respiratory apparatus from the inhalation of smoke or of toxic or superheated chemicals or from mechanical mechanisms or it may be secondary to indirect damage from hypovolemia, shock, central nervous system disturbances, or drug usage. Therapy comprises establishment of a clear airway and administration of humidity and oxygen in amounts appropriate to maintain adequate blood oxygen tension and pH. Sequential monitoring of oxygen and pH status is required. The diagnosis of postburn pulmonary injury is made on clinical grounds, and sequential management of the patient, closely supported by laboratory studies, is essential. Surface decompression of the thorax, antibiotics given systemically, and sequentially increasing respiratory support (with later de-escalation) may be needed.

Because of the Medical College of Georgia Burn Treatment Center frequently received patients with extensive burns who had been badly managed locally, we devised an Algorithm to provide health care professionals a logical method for assessment, triage and obtaining help. Limited experience suggests that the Algorithm does, in fact, accomplish these ends but that continued evaluation of its efficacy is necessary.

A common and frequently overlooked concommitant of burn injury is postburn pulmonary damage. The lesion may be secondary to inhalation or mechanical obstructive or toxic problems; or it may be associated with indirect damage from hypovolemia, shock, central nervous system disturbances or drugs. Therapy comprises establishing a clear airway; administration of sufficient humidity and oxygen to maintain adquate arterial pO2; sequential pO2 monitoring; surface decompression of the thorax; systemic antibiotics and sequentially increasing--and later decreasing--airway support. The diagnosis of postburn pulmonary injury is clinical. Aggressive, sequential management of the patient, supported vigorously by laboratory evaluation, is essential.

Studies of the efficacy, in terms of burned wound healing, of a mixture of Ethyl Linoleate (ethyl 9-12 (cis, cis) octadecadienoate) with alpha-1-histidine, alpha-tocopherol, and TBHQ (hELate) was undertaken in 12 swine. The species was selected so as to study an animal with skin anatomy similar to the human. Statistically significantly greater healing occurred in 730 C/7sec contact burns (20% BSA) treated with hELate than in untreated burns in pigs. Further, there was no contracture noted in the hELate treated lesions, while marked contracture occurred in the untreated burns. Additionally, we noted that there was a proportional increase in weight gain amongst swine studied as their burn lesions epithelialized. In order to evaluate the compatibility of hELate with selected, currently-used topical antibacterial agents, 154 rabbits with 20% 730 C/7 sec contact burns were studied. The lipid was applied (0.01 ml/cm2 burn) at 1 hour postburning; the topical agent was applied at 2 hours post-burn and every 24-hours. All animals were washed once daily. hELate was applied only once. We found no statistical difference in the number of subjects healed or in the mortality between animals treated with hELate alone and those treated with the agent plus Gentamycin cream, Neosporin cream, and silver sulfadiazine 1% in Unibase USP (compounded at Medical College of Georgia specifically and only for this study.) We suggest that Ethyl Linoleate agent (hELate) may be used safely in combination with selected antibacterial substances. Further, these selected combinations seem to be non-toxic and appear to allow the calorie-saving and healing effects of the lipid to proceed unimpeded.

Sixty patients were selected from the 24-month burn population admitted to the Medical College of Georgia. Selection was on the basis of age, size of burn, and survival beyond 120 hours. Thirty-one of these patients were treated with ethyl linoleate agent (hELate) in addition to the modalities we routinely use for burn care. hELate was applied in a dose of 25 mg/kg only once in the period after burn. Significant pain relief and enhancement of wound healing (with return of hair and pigment) occurred in the hELate-treated patient. Less narcotic was needed, fewer grafts and reconstructive procedures were required, and hospital stay was reduced significantly. It is suggested that hELate is a safe and useful adjunctive to burn care.