Pathology of the lung in fatally burned patients

Abstract

Respiratory complications are a common fatal factor in patients sustaining thermal injury. The incidence and course of pulmonary complications were studied by autopsy in 27 adult burn victims. Patients over 60 years tended to survive longer than younger adults, but older patients had less extensive burns. The burns covered a mean total body surface area of 57.7±23%. The mean survival time was 17.6±14.3 days. Airway lesions reflected the length of survival and showed the following sequence of changes: mucosal necrosis and denudation, acute inflammation and ulceration, and squamous metaplasia. Tracheobronchitis was manifest at autopsy in 14 patients, almost half of all autopsies. In two, the erosion was deeply invaded with bacteria, with peritracheitis and positive antemortem blood. Laryngeal ulcerations were found in 7 autopsies. Bacterial infection of these lesions was demonstrated in 2 of the 7 autopsies. In all of the autopsies the lungs showed the most abnormality of any visceral organ. Pulmonary edema, often pink and frothy was found in 4 cases. Diffuse alveolar damage was observed in 6 patients. Bronchopneumonia bilateral, usually purulent and confluent, was found in all cases. Respiratory complications occur more aggressive in patients with facial burns. Postmortem bacteriological cultures of lungs yielded Staphylococcus aureus and Pseudomonas sp. as the most frequent pathogens, but other gram-negative organisms were frequently present. Mixed gram-negative infections were commonly. The major cause of death was sepsis. Conclusion: Pulmonary complications cause or contribute to the death of all patients who die after thermal injury.