الفهرس 
Introduction.Only 14 pages are availabe for public view
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Abstract
A burn is a type of injury to flesh or skin caused by heat, electricity, chemicals, friction, or radiation.
Several factors influence outcome among patients including age, surface area, and presence of inhalation injury, previous medical conditions, infections, pneumonia, septicemia and depth of burn wound. Outcome in terms of survival is a main objective of much of the research on burn care.
The survivability of burn patients continues to improve across all age groups. The literature however indicates that this improvement may be less for the elderly segment of population (> 60yr of age). The mortality rate of burn injury is still high, especially for patients with large burned areas. With an improved understanding of post burn physiological factors and fluid requirements, infection has emerged as the most frequently recognized problem in burned patients.
Respiratory complications associated with burn injury are responsible for significant morbidity and mortality and occur in up to 41% of patients admitted to hospital after thermal injury.
Pulmonary problems remain a major cause of morbidity and mortality during inflammation-infection phase of the burn (7 days from the wound closure). Respiratory 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 acute respiratory distress syndrome.
This study was performed in Burn Unit in Menoufia University Hospital to assess incidence of early& late pulmonary complications
among burn victims with major burn and to study their effect on outcome of the patients.
The present study included 42 burned patients; 26 males (61.9%) and 16 females (38.1%). They were twenty seven children (64.2 %) and 15 adults (35.7 %).
After exclusion of other diseases, all patients underwent:
1- Medical history taking.
2- General examination.
3- Local examination (respiratory and burn examination).
4- Upper air way examination to assess inhalational injury.
5- Laboratory investigations:
- CBC (white blood cells, hemoglobin& platelet count).
- Biochemistry profile, including liver function tests (ALT, AST, Albumin, PT concentrations), kidney function tests (BUN and Creatinine level) and electrolyte testing (sodium, potassium, chloride and calcium).
6- Plain chest x-ray films (CXRs)
7- Serial arterial blood gas analysis (initially after admission then after 48hours and 72hours in all patients).
8- Definitive treatment
The results obtained in this study showed that; 29 patients out of 42 (69%) passed into pulmonary complications. Eleven patients out of 42(26.2%) died, ten of them (90.9%) died due to pulmonary complications and one patient (9.1%) died due to wound sepsis.
The incidence of inhalational injury in our study was 42.8% (18 out of 42 patients), overall mortality in patients with inhalation injury was 50%.
Acute respiratory distress syndrome, inhalational injury, pneumonia, acute bronchitis and lung contusion& haemothorax were early phase pulmonary complications, while pneumonia, lung collapse and pulmonary embolism were late phase pulmonary complications.
The mean age of the patients who passed into pulmonary complications was 19.75±16.87 years , those patients showed significantly higher burn extent (39.38±23.65%TBSA) , more deep burn were exposed to direct flame more than patients who did not pass into pulmonary complications and they were burned mainly in the face and neck. While patients who did not pass into pulmonary complications underwent more operations and burned mainly in the trunk.
Serum albumin was significantly lower in patients with pulmonary complications.
Patients without pulmonary complications showed significantly higher level of pH, PaO2, SaO2 and base deficit (after 48, 72 hours of burn), higher level of HCO3(after72 hours of burn), while PaCO2 was significantly lower in the same group (after 48,72 hours of burn).
All patients who passed into pulmonary complications and patients who died had radiological abnormalities.
There was no significant difference between patients who passed into pulmonary complications and who did not pass into pulmonary complications regarding blood pressure, temperature, respiratory rate and pulse.
Burn depth and serum albumin were independent risk factors for pulmonary complications.
This study showed that; burn extent was significantly higher in non survived group. 81.8% of non survived patients had burns in face and neck, while survived patients underwent more operations than non survived.
Respiratory rate, pulse and temperature were significantly higher among patients who died.
Platelet count, PT concentration and albumin were significantly lower among non survived group, while BUN and Creatinine were significantly higher among the same group.
Non survived patients had respiratory acidosis, hypercapenia (after 48hours of admission), hypoxemia, lower oxygen saturation after (48hours &72 hours of admission), low bicarbonate level (initially, after 48hours&72 hours of admission) lower anion gap and base deficit after (48hours&72 hours of admission) .
In the present study 81.8% of patients who died had inhalational injury.
This study showed that; burn extent, PT concentration and pulmonary complications were independent risk factors for mortality in patients with major burn.