The Early Prognosis of Burn Patients with Elevated Initial Arterial Carboxyhemoglobin Level

Choi, Chang Soon; Kim, Cheol Hong; Kim, Keun Sook; Lee, Tae Yu; Chung, Youn Son; Eom, Kwang Seok; Park, Young Bum; Jang, Seung Hun; Kim, Dong Gyu; Park, Myung Jae; Lee, Myung Goo; Hyun, In Gyu; Jung, Ki Suck; Kim, Jong Hyun

Abstract

BACKGROUND: Smoke inhalation injury is an important determinant of mortality in burn patients. The early detection of inhalation injury in burn patients is important because the incidence of respiratory failure after inhalation injury was known to be high, with hypoxemia, pneumonia, and prolonged ventilatory support being commonplace. Acute carbon monoxide poisoning was one feature of smoke inhalation. The purpose of our study were to investigate the clinical characteristics of burn patients whose initial arterial carboxyhemoglobin (COHb) level had been elevated, to assess the clinical impact of COHb for smoke inhalation injury.
METHODS
Among 1,416 burn patients had been admitted at our institution from August 1, 2001 to July 31, 2002, 39 patients whose initial arterial COHb level have been more than 5% were included. We compared clinical scoring system for inhalation injury, percent total body surface area (%TBSA) burn, initial chest X-ray findings, APACHE II scores and SAPS II scores between survivors (n=27) and non-survivors (n=12) retrospectively.
RESULTS
COHb level were 9.7(5.71% and 10.3(8.81% in survivors and in non-survivors (p>0.05). Mean %TBSA burn of survivors and non-survivors were 16.6+/-17.8% and 60.7+/-28.8% (p<0.001). We did not find any difference in clinical scoring system, initial chest X-ray findings in survivors and in non-survivors. But %TBSA burn, APACHE II and SAPS II scores were high in non-survivors than in survivors significantly. Important factors associated with death were %TBSA burn, APACHE II scores, SAPS II scores, and the most important factor in predicting mortality was %TBSA burn.
CONCLUSION
Burn patients with elevated initial arterial COHb level showed poor prognosis, but further study may be performed to know that the effect of COHb on prognosis in burn patients accompanying smoke inhalation.