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Tracheobronchial Protease Inhibitors, Body Surface Area Burns, and Mortality in Smoke Inhalation

Authors :
Kevin N Foster
Karen J Richey
Duane L. Sherrill
Jefferey L. Burgess
Scott Boitano
Beth M. Clark
Sally R. Littau
Margaret Kurzius-Spencer
Daniel M. Caruso
Source :
Journal of Burn Care & Research. 30:824-831
Publication Year :
2009
Publisher :
Oxford University Press (OUP), 2009.

Abstract

The objective of this study was to assess tracheobronchial protease inhibitor concentrations longitudinally and determine whether initial concentrations predict subsequent lung injury and mortality in intubated burn victims. Tracheobronchial suction fluid was collected every 2 hours for 36 hours. Alpha-1-antitrypsin (AAT), secretory leukocyte peptidase inhibitor (SLPI), alpha-2-macroglobulin (A2M), and cell and differential counts were assayed. Partial pressure of oxygen in arterial blood/fraction of inspired oxygen (PaO2/FIO2) and peak airway pressure (PAP) were recorded for 72 hours. Standard statistics were used to evaluate cross-sectional relationships; random coefficient (mixed) models were used to evaluate temporal trends in marker concentrations and relation to clinical outcomes. Among 29 patients, 24 (83%) developed hypoxemia (PaO2/FIO2 35% TBSA burn (P = .010 and .033, respectively), when compared with patients with less severe burns. However, patients with increased A2M in combination with >35% TBSA burn had a 6-fold (95% CI: 1.8–20) increased relative risk of death. Tracheobronchial AAT and A2M levels were significantly lower in patients with more severe burns and increased over time. Initial SLPI levels predicted subsequent PAP. Increased early A2M in combination with extensive burn predicted early mortality.

Details

ISSN :
1559047X
Volume :
30
Database :
OpenAIRE
Journal :
Journal of Burn Care & Research
Accession number :
edsair.doi.dedup.....08fe95fae455b369fb77ff3c63c8cb98
Full Text :
https://doi.org/10.1097/bcr.0b013e3181b47ee8