Epidemiology and management of respiratory burns in National Burns Centre, Singapore

Respiratory burns constitute one of the two leading causes of burns mortality today, the other being infection. When cutaneous burns are complicated by co-existent respiratory or inhalational injury, the mortality remains high in most reported series. We began our prospective study of respiratory burns in 1982 as a multi-disciplinary team effort involving respiratory physicians, anaesthetists and our burns physicians. Between 1982 until February 1990, we treated a total of 240 patients with respiratory burns. During the same period, a total of 4041 patients were admitted to our Burns Centre at Singapore General Hospital. Respiratory burns cases therefore constituted 5.4% of the total burns admissions. In our series, there were 44 deaths out of 240 patients, giving an overall mortality of 18.3%. The average size of burns in the patients who died was 57.4% BSA in Group A patients, 65.0% BSA in Group B and 57.7% BSA in Group C. Our management protocol has gradually evolved over the eight years of the study. Systemic antibiotics and steroids are no longer used routinely. Fiberoptic bronchoscopy is done early in the ward as a bedside procedure once a patient is clinically assessed to have suffered a respiratory burns and repeat bronchoscopic examination done when deemed necessary. An aggressive regime of respiratory support measures with early intubation and PEEP ventilation is recommended.