• Taylor D Coston, Devin Gaskins, Austin Bailey, Emily Minus, Saman Arbabi, T Eoin West, and Barclay T Stewart.
• Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle, WA.
• Chest. 2024 Jul 2.

BackgroundThe impact of inhalation injury on risk of nosocomial pneumonia (NP), an important complication in patients with burns, is not well established.Research QuestionIs more severe inhalation injury associated with increased risk of NP?Study Design And MethodsWe performed a retrospective cohort study of patients with suspected inhalation injury admitted to a regional burn center from 2011 to 2022 who underwent diagnostic bronchoscopy within 48 h of admission. We estimated the association of high-grade inhalation injury (Abbreviated Injury Scale grade 3 and 4) vs low-grade inhalation injury (Abbreviated Injury Scale grade 1 and 2) with NP adjusted for age, burn size, and comorbid obstructive lung disease. Death and hospital discharge were considered competing risks.ResultsOf the 245 patients analyzed, 51 (21%) had high-grade injury, 180 (73%) had low-grade injury, and 14 (6%) had no inhalation injury. Among the 236 patients hospitalized for ≥ 48 h, NP occurred in 24 of 50 patients (48%) in the high-grade group, 54 of 172 patients (31%) in the low-grade group, and two of 14 patients (14%) in the no inhalation injury group. High-grade (vs low-grade) inhalation injury was associated with higher hazard of NP in both the proportional cause-specific hazard model (cause-specific hazard ratio, 2.04; 95% CI, 1.26-3.30; P = .004) and Fine-Gray subdistribution hazard model (subdistribution hazard ratio for NP, 2.24; 95% CI, 1.38-3.64; P = .001).InterpretationIn this study, among patients with inhalation injury, more severe injury was associated with higher hazard of NP in competing risk analysis. Additional research is needed to investigate mechanisms that may explain the relationship between inhalation injury and NP and to identify more effective risk reduction strategies.Copyright © 2024 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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