A new approach of airway burns in severely
burned adults
Burns, Airway,infections, Antibiotics
E. L. Stanciulescu1, L. Verinceanu1
Emergency Clinical Hospital Bucharest - Bucharest (Romania)
Background and Goal of Study: Severe burns are the most complex form of trauma in humans.
Associated airway burns have a poor outcome, with increased mortality. A burned patient, as a consequence of smoke and hot air inhalation, is at increased risk of pulmonary infections. New procedures could improve outcome.
Materials and Methods: During a 7-month period (April 1st – November 1st 2017) 16 severely burned patients with airway burns documented by bronchoscopy assessment at admission were included in the study. Cultures of bronchial secretions revealed germs sensitive to Colistin (polymyxin E). Colistin was instilled in 8 patients via the bronchoscope in the trachea and the main bronchi – 1000000 IU diluted in 20
ml saline solution, followed by suction 5 – 6 seconds later; 8 patients represent the control sample (without Colistin).
Results and Discussion: In our patients, the initial lesions included tracheo-bronchial mucosal hyperemia and edema, viscous mucus, highly adherent to the airway wall, saturated with soot, necrosis of the tracheal carina or bronchial bifurcation with mucosal denudation. Various studies have shown that Colistin is absent in the lung after intravenous treatment, whilst nebulization ensures efficient concentrations. Topical administration can improve progress of the mucosal injury. Bronchoscopic assessment done 48 hours after topical administration of Colistin showed a clearly favorable progress of lesions without puss or slough vs those in the control sample.
Conclusion(s): In a world with increasing antibiotic resistance, severely burned patients have serious immunosuppression and an increased risk of infections. Our study showed that topical tracheo-bronchial „old” Colistin in airway injury of severely burned patients can contribute to the resolution of lesions and improve outcome.

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