PubMed HealthSearch

Biomedical subjects

P A Petroff

Publications and source records attributed to P A Petroff.

6 recordsLinked to original sources

Prospective trials of dexamethasone and aerosolized gentamicin in the treatment of inhalation injury in the burned patient.

The addition of an inhalation injury to a cutaneous burn results in a significant increase in patient mortality rates, both from early pulmonary edema and, later, Gram-negative pneumonitis. Steroids have been shown to decrease mortality in an inhalation injury model. Aerosolization of gentamicin has been used successfully to treat severe bronchial infections. Therefore, a prospective, randomized trial was undertaken to evaluate both these drugs. Sixty burned patients, with inhalation injury confirmed by bronchoscopy and 133Xenon scan, were studied: 30 patients received either dexamethasone or saline placebo for 3 days; serial pulmonary functions were measured on those able to cooperate; another 30 patients received either aerosolized gentamicin or placebo for 10 days. Both drug-treated groups were comparable to their controls in age and mean burn size. Results of the steroid trial showed no major differences in mortality, pulmonary complications, or changes in pulmonary functions. Results of the gentamicin trial showed no major differences in mortality, time of death, or pulmonary and septic complications between treated and control groups.

Adult

The use of steroids in inhalation injury.

Steroids exert no beneficial effect upon acute pulmonary dysfunction created by nitrogen tetroxide inhalation and may worsen small airway obstruction in the early phases of injury. Treatment, therefore, is still largely symptomatic and supportive.

Animals

Pulmonary function studies after smoke inhalation.

Pulmonary function studies were performed within 72 hours of injury in seven patients with smoke inhalation injury diagnosed by positive 133Xe scintiphotographs and in eight patients with burns of similar size but with negative 133Xenon scans. The former patients showed decreased peak flow, decreased flow at 25, 50, and 75 per cent of vital capacity, and an elevated pulmonary resistance. In addition, single breath nitrogen tests revealed evidence of maldistribution of ventilation/perfusion abnormalities. Total lung capacity, functional residual capacity, and compliance (both dynamic and static) were similar in the two groups. Pulmonary function studies can be of assistance in evaluating smoke inhalation, estimating the severity, and following the course of patients with this disorder.

Adolescent

Use of 133xenon in early diagnosis of inhalation injury.

133Xenon lung scanning post-thermal injury was used to detect inhalation injury in 86 patients admitted to the United States Army Institute of Surgical Research during 1974. Inhalation injury was indicated by the 37 (43%) positive scans. Based on all available clinicopathologic evidence, 11 (13%) of the scans were erroneous with seven (8%) falsely positive and four (5%) falsely negative. Eighty-six per cent of the scans were "appropriate." Addition of bronchoscopy and/or pulmonary function testing appeared to improve diagnostic accuracy. By using any pair of tests, falsely negative diagnoses were virtually eliminated. Inhalation injury, as expected, had an adverse effect on survival rates. The group of patients whose expected mortality lay between 40 and 59% were most notably affected. One hundred per cent (five of five) of those with inhalation injury died; only one of eight without inhalation injury died.

Bronchoscopy

Ventilatory patterns following burn injury and effect of sulfamylon.

Seven burn patients treated with silver nitrate dressings were studied during the first 10 days after injury. Minute ventilation, oxygen consumption, and ventilatory equivalent were measured. Minute ventilation was increased two- to threefold, as was oxygen consumption. Ventilatory equivalent was only slightly increased. THree patients were initially treated with silver nitrate, and then, when clinically stable, were switched to Sulfamylon. They showed a 50% rise in ventilation, tidal volume, ventilatory equivalent, and a slight increase in respiratory rate and VD/VT. In addition, their PO2 increased and base excess fell. Five normal subjects were then given Diamox, and their minute ventilation, O2 consumption, and ventilatory equivalent were measured at rest, with a standard exercise, and with an added dead space. Diamox produced only a 25% increase in minute ventilation and ventilatory equivalent. The results suggest that, although some of the increased ventilation of Sulfamylon is due to carbonic anhydrase inhibition, another factor, such as pain casued by the topical agent, also plays a role.

Acetazolamide