Yanýk merkezimizde takip ettiðimiz inhalasyon yanýðý olgularýnda, klinik, radyolojik ve bronkoskopik deðerlendirme

Amaç: Ýnhalasyon yanýðý olgularýnda,klinik,radyolojik ve bronkoskopik bulgular temelinde inhalasyon hasarýný,pulmoner komplikasyonlarý ve mortalite ile iliþkili faktörleri ortaya koymak.Gereç ve yöntem: 2009 Ocak-2010 Ocak tarihlerinde,hastanemiz yanýk merkezi yoðun bakým ünitesinde yatan,bronkoskopi ile inhalasyon yanýðý tanýsý konulan olgular dahil edildi.Hastalarýn demografik bulgularý,yanýk þekli,yanýk yüzdesi,klinik ve laboratuvar özellikleri,1.ve 5.yatýþ günündeki akciðer grafisi bulgularý ve bronkoskopik lezyon türleri dosyalarýndan elde edildi.Bronkoskopik bulgular sýnýflandýrýldý,her hastadaki bronkoskopik skor hesaplandý.Kaybedilen hastalar ile iyileþerek taburcu olan hastalardaki klinik,laboratuar,radyolojik bulgularýn özellikleri ve sýklýðý,yoðun bakýmdaki yatýþ süresi,bronkoskopik skorlar birbirleriyle karþýlaþtýrýlarak mortalite iliþkili olabilecek faktörler araþtýrýldý.Ýstatistiksel deðerlendirmeler için ki-kare, fisher exact test ve Mann Whitney-U testi kullanýldý.Bulgular: Yaþ ortalamalarý 40.1±3.4 olan,4’ü kadýn toplam 29 hasta çalýþmaya alýndý.Hastaneye yatýþ gününde olgularýmýzýn %41.3’ünde,yatýþýn 5.gününde ise %65.5’inde radyolojik anormallik saptanmýþtýr.Bronkoskopi,olgularýn %100’ünde taný koydurucu olmuþtur.Bronkoskopik bulgular deðerlendirildiðinde 29 olgunun 25’inde hiperemi,ödem,erozyon,ülserasyon,nekroz gibi mukozal lezyonlar,7’sinde ise trakeobronþial aðaçta karbon partikülü(is) birikimi saptanmýþtýr.Çalýþmamýzda bronkoskopiye baðlý komplikasyon görülmedi.Kaybedilen 24 hasta ile iyileþen hastalar karþýlaþtýrýldýðýnda kaybedilen hastalarda yanýk yüzdesinin daha yüksek(%20.4-%48.5,p=0.003),yoðun bakým yatýþ süresinin daha uzun(ort.7.0–13.7 gün,p= 0.037)olduðu saptanmýþtýr.Kaybedilen hastalarda 5.günde radyolojik anormallik ve ARDS %79.1 ve %50 oranýnda görülürken,iyileþen hastalarýn hiçbirinde ARDS ve 5.gün akciðer grafisinde patoloji olmadýðý saptanmýþtýr(p<0.05).Sonuç: Kutanöz yanýk olgularýnda birlikte var olan inhalasyon yanýðý yüksek oranda pulmoner komplikasyonlara neden olmakta ve mortaliteyi arttýrmaktadýr.Taný için erken dönemde bronkoskopi yapýlmasý ve bu hastalarýn yakýn takibi gereklidir.

Clinical, radiological and bronchoscopic evaluation of inhalation injury cases treated at the burn center

Aim: To introduce inhalation injury,pulmonary complications and mortality related factors on the basis of clinical,radiological and bronchoscopic findings at patients with inhalation burns.Material-method: Between January2009-January2010,patients hospitalized at intensive care unit of burn center,who were diagnosed as inhalation burn and bronchoscopy was performed were included.Demographic findings,burn type,burn percentage,clinical-laboratory features,chest x-ray findings on the first and fifth day,bronchoscopic lesions were obtained from files.Bronchoscopic findings were classified,bronchoscopic score for each patient was calculated.Clinical,laboratory,radiological findings,length of stay at intensive care unit,bronchoscopic score of patients who were discharged and were exitus were compared with each other and mortality related factors were investigated.Results: 29patients with mean age of 40.1±3.4were included.Radiological abnormalities were found at 41.3% and 65.5% of patients at first day and fifth day of hospitalization,respectively.There were no complications related to bronchoscopy. Percentage of burn and duration of stay in intensive care were higher at patients who were died than discharged patients;(%20.4-%48.5,p=0.003)(mean: 7.0-13.7days,p=0.037),respectively.Patients who were died showed 79.1% radiological abnormality and 50% ARDS on fifth day of hospitalization.There were no pathologic findings on chest x-ray and ARDS wasn’t observed on fifth day at patients who were discharegd(p<0.05).Conclusion: Inhalation burns existing in patients with cutaneous burns, causes high percentage of pulmonary complications and increases mortality.Bronchoscopy has to be performed early for diagnosis and close follow-up of these patients is necessary.