SESSION TITLE: Hot Topics in Pulmonary & Critical Care
SESSION TYPE: Original Investigation Slide
PRESENTED ON: Sunday, October 26, 2014 at 01:30 PM - 03:00 PM
PURPOSE: Should we prescribe home oxygen to patients who smoke? Providers often feel conflicted when writing a prescription that knowingly places the patient at risk of combustion injury. Since its first description as adjunctive therapy for pneumonia in 1922, the use of oxygen as therapy has expanded to many other disease states. Previous studies demonstrate that Home Oxygen Therapy (HOT) injuries related to cigarette smoking account for about 2% of annual burn unit admissions. We conducted a review of our burn unit to determine our annual incidence and investigate patient characteristics.
METHODS: A retrospective chart review of the Wishard/ Eskenazi Health Fairbanks Burn Center in Indianapolis, IN from 2008-2013. Burn unit database was searched for patients admitted with smoking-related HOT injuries and various clinical and epidemiologic metrics were recorded.
RESULTS: We identified 55 patients admitted to the burn unit for smoking related HOT injury representing 4% of our annual burn unit admissions. Age range was 40-84 years. Almost all patients were on home oxygen for COPD. Concomitant substance abuse was found in 27% of our cohort. Mortality rate was 13%. 49% of patients were intubated, and of those 18% had evidence of inhalation injury. Median length of stay was five days. Almost all patients who survived were discharged home with oxygen. We identified seven patients with repeat smoking-related HOT injuries.
CONCLUSIONS: We identified a higher proportion of burn admissions from smoking on HOT in our study than has been previously described in the literature. This may be secondary to the high rates of smoking in Indiana. Interestingly, we discovered a high prevalence of substance abuse in this population that had not been previously reported. This may be a marker for high-risk behavior and should be considered before HOT prescriptions are written.
CLINICAL IMPLICATIONS: Smoking while using HOT can lead to serious morbidity and mortality. Approaches are needed that reduce the risk of combustion injury in smokers who are eligible for HOT administration.
DISCLOSURE: The following authors have nothing to disclose: Mary Baker, Katie McPherson, Alexia Torke, William Carlos
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