OBJECTIVE
Previous studies indicate that inhalation injury (INH) is associated with increased mortality following burn injury. We sought to investigate whether there is a difference in mortality between patients with burn and INH versus burn with acute respiratory failure (ARF) requiring mechanical ventilation (MV).
METHODS
The Healthcare Cost and Utilization Project State Inpatient Database for five states was used to identify adults with burn injury and INH or ARF requiring MV. Primary outcomes included risk adjusted inpatient and 1-year mortality. Rates of chronic pulmonary insufficiency, prolonged ventilator dependence, ventilator-associated pneumonia (VAP), and tracheostomy were calculated using univariate analyses. Risk adjusted odds of mortality, length of stay (LOS), and discharge disposition were calculated with mixed-effects logistic models controlling for key covariates.
RESULTS
27,144 patients met our burn inclusion criteria. 431 (1.6%) were diagnosed with INH while 799 (2.9%) were diagnosed with ARF. Overall mortality was 3.3%. Risk-adjusted inpatient (26.5% v 29.0% p=0.336) and 1-year (26.75% v. 29.2% p=0.357) mortality were similar between groups. Burn patients with ARF had longer median LOS (24 days v.17 days p<0.001), higher rates of discharge to SNF (38.5% v. 31.8% p=0.018), and prolonged ventilator dependence (63.9% v. 55.5% p=0.004). However, patients with INH had a much greater rate of chronic pulmonary insufficiency (20.8% v.1.3% p<0.001).
CONCLUSION
Patients with combined burn and inhalation injury or burn injury with acute respiratory failure had an increased mortality than burn injury alone. Additionally, our findings suggest that acute respiratory failure following burn injury may be more significant than inhalation injury.
