الفهرس 
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Abstract
Pulmonary problems remain a major cause of morbidity and mortality among burned patients. Pneumonia and atelectasis, are most common. Furthermore; Pulmonary failure and pulmonary sepsis exceed burn wound sepsis as a cause of mortality. There are three major processes occurring during this period, nosocomial Pneumonia, hypermetabolism-Induced Respiratory Fatigue (Power Failure) and adult respiratory distress syndrome.
Burn patients with a combination of inhalation injury and a major body burn have the greatest risk of pneumonia, with a rate exceeding 50%. The high incidence is due to the presence of virulent organisms in the intensive care unit environment and the immunosuppressed state of the burn patient. The major events occurring in the majority of nosocomial lung infections are colonization& tracheobronchial aspiration.
Eighty patients fulfilled the criteria of the study were admitted to the Menoufiya University burn center from December 2010 to December 2011. There were 35 males (43.75%) and 45 females (54.25%).
Mortality rate among patients with pneumonia was 50% ( 6/12) compared with 22.05% (15/68) among non pneumonic patients Table (3).
The pneumonia was two times higher in the subset of the patients with inhalational injury compared with the group of patients without inhalational injury (P<0.001) Table(7).
-Mortality rate of burn patients with pneumonia in relation to burns percentage revealed that 4/5 pneumonic patients over 40% T.B.S.A. burn died Table (9).
Approximately 40% of fire related deaths are due not to the burn injury to the airway but to the nosocomeal infection (pneumonia).
Early detection and management of pneumonia are absolutely essential.
The isolation practice implemented in the burn unit included hand washing before each patient contact, washing hands and changing gloves between sequences of care, and wearing gloves in cases of contact with burn wound body substances Systemic antibiotics, cefotaxime plus an aminoglycoside , were administered empirically when clinical signs of infection developed and were adjusted according to the microbiological results.
Infection caused by Gram Positive bacteria were treated by immunotherapy with a B- lactam. Burn patients with a Gram negative infection received a conmbination of cefotaxime and an aminoglycoside. Cefotaxime was replaced by ceftazidime when the infection was caused by pseudomonas aeruginosa.