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Burn- and Trauma-Associated Pulmonary Infection

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Burn and Trauma Associated Lung Injury

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Abstract

Cutaneous thermal injury is commonly combat-related and is the most destructive form of trauma. Severe extensive burns and trauma increase patient’s sensitivity to infection, which may further develop into sepsis. Though modern resuscitation strategies continue to shrink the number of death resulted from ischemic shock, sepsis-related mortality has not declined in recent years. Actually, among the patients with burn injuries, infection has the highest mortality. Pathophysiology of burn- and trauma-associated pulmonary infection is complicated and multifold. Damage to defense mechanism is one important factor, which includes inhibition of cough reflex, increase of mucous secretion, compromised mucociliary clearance, and even injuries to tracheal epithelium. In severe cases, systemic inflammatory response syndrome (SIRS) is usually reported, which may contribute to multiple organ dysfunction syndrome (MODS) or even multiple organ failure. Meanwhile, SIRS is always complicated with immunosuppression. Nosocomial pneumonia is a commonly seen complication among burned and other patients with life-threatening conditions. Several routes have been identified, through which pathogens break defensive barriers and into burn patients’ body. Burn wound infection or sepsis is the primary route; opportunistic infection occurs when innate or adaptive host immune responses are compromised; gastrointestinal tract is sensitive to cutaneous thermal injury and may serve as another pool of pathogens, with subsequent bacterial translocation to the blood stream, burn wound, and even other systemic organs.

For severe trauma or extensive burn patients, diagnosis of pulmonary infection is difficult, mainly due to the onset of SIRS. Culture of bronchoalveolar samples is of great help to diagnosis. However, early diagnoses of some opportunistic pulmonary infections remain frustrating. It has been documented that integrated comprehension of a series of examinations is necessary, including blood and urine tests, serologic test especially for determination of Pseudomonas aeruginosa, chest imaging tests (X-ray and CT), bronchoscopy and alveolar lavage, culture of respiratory samples, and pulmonary function tests. For a definitive diagnosis of pathogenic infection, invasive biopsy is needed in certain cases. Biomarkers may be helpful to increase the specificity of screen tests and decrease false-positive results. Prevention is an effective method to reduce trauma and burn-related pulmonary infection. However, for these patients, specific prevention measures have not been frequently and extensively investigated and reported. At least, these measures should include the prevention of ventilator-associated infection, digestive tract-originated infection, microaspiration, dysfunction of intestinal barrier, and infection of environmental pathogens. Treatment of pulmonary infection should be started promptly when an early diagnosis is suspected. The most important method is antimicrobial therapy, initially beginning with the empirical selection of antimicrobial agents and subsequently modified by culture or other confirmative results. Immunomodulation, nutritional support, and other measures such as passive immunization have been investigated as potential elements in treatment strategies.

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Authors and Affiliations

  1. Department of Burn Surgery, The First Affiliated Hospital of Naval Medical University, Shanghai, PR China

    Yu Sun & Zhao-fan Xia

  2. Department of Respiratory Medicine, The Second Affiliated Hospital, Naval Medical University, Shanghai, PR China

    Hao Tang

  3. Trauma Research Center, Fourth Medical Center of the Chinese PLA General Hospital, Beijing, PR China

    Tiantian Wu & Yongming Yao

  4. Department of Burn Surgery, The First Affiliated Hospital, Navy Medical University, Shanghai, PR China

    Kangan Wang

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  1. Yu Sun
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  6. Zhao-fan Xia
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  1. Department of Burn Surgery, The First Affiliated Hospital of Naval Medical University, Shanghai, China

    Zhao-fan Xia

  2. Department of Burn Surgery, The First Affiliated Hospital of Naval Medical University, Shanghai, China

    Feng Zhu

  3. Department of Burn Surgery, The First Affiliated Hospital of Naval Medical University, Shanghai, China

    Yu Sun

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Sun, Y., Tang, H., Wu, T., Yao, Y., Wang, K., Xia, Zf. (2020). Burn- and Trauma-Associated Pulmonary Infection. In: Xia, Zf., Zhu, F., Sun, Y. (eds) Burn and Trauma Associated Lung Injury. Springer, Singapore. https://doi.org/10.1007/978-981-15-7056-8_7

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