Morbidity and mortality in respiratory burns--a prospective study of 240 cases

Abstract

A prospective study of 240 consecutive admissions with respiratory burns over an eight-year period beginning 1982 was carried out at the National Burns Centre, Singapore General Hospital. Diagnosis of respiratory burns was based on clinical criteria and a clinical score was then computed to grade the severity. Investigations included chest x-rays, blood gases, carboxyhaemoglobin level, lung scan and fibreoptic bronchoscopy. Treatment was carried out according to a standard protocol where a policy of early intervention in the form of endotracheal intubation was emphasised. Other respiratory support measures were chest physiotherapy, tracheobronchial suction, mucolytics and bronchoscopic lavage where indicated. We found that respiratory burns was a significant cause of mortality in burns patients. The influence on mortality was most marked in patients with large body surface area burns of more than 40%. Age was also an important determinant of survival with patients older than 50 years faring significantly worse. The routine steroids and prophylactic antibiotics did not influence the survival rate. Carbon monoxide poisoning was not a significant cause of mortality. We achieved an overall mortality rate of 18.3%, with 44 deaths out of 240 patients. The main causes of deaths at post-mortem were bronchopneumonia, septicaemia and extensive burns.