Journal of burn care & research : official publication of the American Burn Association
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The purpose of this study was to screen burn patients for alcohol use disorders to identify those at increased risk for repeat injury and adverse effects of alcohol use. We examined associations of at-risk drinking and dependence symptoms as measured by a formal screening tool and blood alcohol concentration (BAC) to guide further screening, treatment, and research. We hypothesized that the majority of drinkers would not have symptoms of alcohol dependence, that BAC would be inadequate to screen for alcohol disorders, and that at-risk drinkers would be more likely to be unemployed and uninsured than healthy drinkers. ⋯ Formal screening identified more at-risk drinkers than BAC. Implications of the screening findings are 1) because most burn patients who drink are binge but not dependent drinkers, alcohol withdrawal should be infrequent, and 2) animal models of alcohol use and burn injury should study acute intoxication and binge exposure. In addition, 3) we would expect burn patients to respond to brief interventions for alcohol use disorders similar to trauma and primary care patients.
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Review
Low-tidal-volume ventilation as a strategy to reduce ventilator-associated injury in ALI and ARDS.
One of the most hotly debated aspect of inhalation injury is the "best" method of mechanical ventilation. Mechanical ventilation protocols differ between both physicians and burn centers, and multiple different strategies for mechanical ventilation are currently being used to support the burn patient with inhalation injury. These strategies range from applying recent advances in acute respiratory distress syndrome to conventional mechanical ventilation to the use of alternative modes of ventilation such as the volumetric diffusive respirator. The articles in this section describe recent changes in philosophy with respect to mechanical ventilation, the various modes of ventilation being used to support the patient with inhalation injury, and the rationale behind each strategy.
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Patients with inhalation injury frequently require mechanical ventilation. Multiple different methods of establishing and maintaining the airway, both non-surgical (endotracheal intubation) and surgical (tracheostomy), are employed. The debate over the "best" method of airway access in the patient with inhalation injury has been raging for decades. The purpose of this section of the compendium is to discuss commonly used airway access methods, including their benefits and risks, and to determine what studies are needed to help clarify which type of airway is the safest and most effective after smoke inhalation injury.