{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T18:45:17Z","timestamp":1789497917325,"version":"build-2803163510"},"reference-count":43,"publisher":"Public Library of Science (PLoS)","issue":"4","license":[{"start":{"date-parts":[[2024,4,23]],"date-time":"2024-04-23T00:00:00Z","timestamp":1713830400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Funda\u00e7\u00e3o de Ensino e Pesquisa em Ci\u00eancias da Sa\u00fade - FEPECS","award":["70701-907"],"award-info":[{"award-number":["70701-907"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\"><jats:title>Introduction<\/jats:title><jats:p>Burns are tissue traumas caused by energy transfer and occur with a variable inflammatory response. The consequences of burns represent a public health problem worldwide. Inhalation injury (II) is a severity factor when associated with burn, leading to a worse prognosis. Its treatment is complex and often involves invasive mechanical ventilation (IMV). The primary purpose of this study will be to assess the evidence regarding the frequency and mortality of II in burn patients. The secondary purposes will be to assess the evidence regarding the association between IIs and respiratory complications (pneumonia, airway obstruction, acute respiratory failure, acute respiratory distress syndrome), need for IMV and complications in other organ systems, and highlight factors associated with IIs in burn patients and prognostic factors associated with acute respiratory failure, need for IMV and mortality of II in burn patients.<\/jats:p><\/jats:sec><jats:sec id=\"sec002\"><jats:title>Methods<\/jats:title><jats:p>This is a systematic literature review and meta-analysis, according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA). PubMed\/MEDLINE, Embase, LILACS\/VHL, Scopus, Web of Science, and CINAHL databases will be consulted without language restrictions and publication date. Studies presenting incomplete data and patients under 19 years of age will be excluded. Data will be synthesized through continuous (mean and standard deviation) and dichotomous (relative risk) variables and the total number of participants. The means, sample sizes, standard deviations from the mean, and relative risks will be entered into the Review Manager web analysis software (The Cochrane Collaboration).<\/jats:p><\/jats:sec><jats:sec id=\"sec003\"><jats:title>Discussion<\/jats:title><jats:p>Despite the extensive experience managing IIs in burn patients, they still represent an important cause of morbidity and mortality. Diagnosis and accurate measurement of its damage are complex, and therapies are essentially based on supportive measures. Considering the challenge, their impact, and their potential severity, IIs represent a promising area for research, needing further studies to understand and contribute to its better evolution.<\/jats:p><jats:p>The protocol of this review is registered on the International prospective register of systematic reviews platform of the Center for Revisions and Disclosure of the University of York, United Kingdom (<jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.crd.york.ac.uk\/prospero\" xlink:type=\"simple\">https:\/\/www.crd.york.ac.uk\/prospero<\/jats:ext-link>), under number RD42022343944.<\/jats:p><\/jats:sec>","DOI":"10.1371\/journal.pone.0295318","type":"journal-article","created":{"date-parts":[[2024,4,23]],"date-time":"2024-04-23T17:23:32Z","timestamp":1713893012000},"page":"e0295318","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":4,"title":["Frequency, complications, and mortality of inhalation injury in burn patients: A systematic review and meta-analysis protocol"],"prefix":"10.1371","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2304-2046","authenticated-orcid":true,"given":"Juliana Elvira","family":"Herdy Guerra Avila","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7743-4892","authenticated-orcid":true,"given":"Levy","family":"Aniceto Santana","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Denise","family":"Rabelo Suzuki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7804-7517","authenticated-orcid":true,"given":"Vin\u00edcius Zacarias","family":"Maldaner da Silva","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcio Lu\u00eds","family":"Duarte","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aline","family":"Mizusaki Imoto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F\u00e1bio","family":"Ferreira Amorim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2024,4,23]]},"reference":[{"key":"pone.0295318.ref001","first-page":"899","volume-title":"Medicina intensiva: abordagem pr\u00e1tica","author":"EV Campos","year":"2017","edition":"3"},{"key":"pone.0295318.ref002","first-page":"1","volume-title":"Brazilian Medical Association, Brazilian Federal Council of Medicine. Projetos diretrizes","author":"NS Piccolo","year":"2008"},{"issue":"2","key":"pone.0295318.ref003","first-page":"112","article-title":"Pediatric burns: factors associated with physical sequelae in burned children admitted to the Hospital Infantil Joana de Gusm\u00e3o","volume":"12","author":"CN Yoda","year":"2013","journal-title":"Rev Bras Queimaduras"},{"issue":"3","key":"pone.0295318.ref004","first-page":"153","article-title":"Clinical-epidemiological comparison between burnt patients submitted to clinical and surgical treatment in a Bras\u00edlia reference service, from 2010 to 2019","volume":"18","author":"AL Gon\u00e7alves","year":"2019","journal-title":"Rev Bras Queimaduras"},{"key":"pone.0295318.ref005","unstructured":"World Health Organization. Burns. WHO: Washington, 2023 [cited 2022 Oct 01]. www.who.int\/mediacentre\/factsheets\/fs365\/en\/."},{"key":"pone.0295318.ref006","unstructured":"Minist\u00e9rio da Sa\u00fade. Brasil. \u00d3bitos por queimaduras no Brasil: an\u00e1lise inicial dos dados do Sistema de Informa\u00e7\u00f5es sobre Mortalidade, 2015 a 2020 [Burn deaths in Brazil: initial analysis of data from the Mortality Information System, 2015 to 2020]. In: Brazilian Ministry of Health. Boletim Epidemiol\u00f3gico Volume 47 [Epidemiological Bulletin Volume 47]. Brazilian Ministry of Health: Bras\u00edlia, 2022 [cited 2022 Oct 01]. https:\/\/www.gov.br\/saude\/pt-br\/centrais-de-conteudo\/publicacoes\/boletins\/epidemiologicos\/edicoes\/2022\/boletim-epidemiologico-vol-53-no47. p. 40\u201348."},{"issue":"2","key":"pone.0295318.ref007","doi-asserted-by":"crossref","first-page":"258","DOI":"10.1097\/BCR.0000000000000064","article-title":"National trends in burn and inhalation injury in burn patients: results of analysis of the nationwide inpatient sample database","volume":"36","author":"A Veeravagu","year":"2015","journal-title":"J Burn Care Res"},{"issue":"2","key":"pone.0295318.ref008","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1177\/0310057X20913282","article-title":"There is no fire without smoke! Pathophysiology and treatment of inhalational injury in burns: A narrative review","volume":"48","author":"AD Holley","year":"2020","journal-title":"Anaesth Intensive Care"},{"issue":"3","key":"pone.0295318.ref009","first-page":"e1","article-title":"Points & Pearls: Emergency department management of smoke inhalation injury in adults","volume":"20","author":"J Nusbaum","year":"2018","journal-title":"Emerg Med Pract"},{"issue":"1","key":"pone.0295318.ref010","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1097\/BCR.0B013E31802C889F","article-title":"Inhalation injury, pulmonary perturbations, and fluid resuscitation","volume":"28","author":"FW Endorf","year":"2007","journal-title":"J Burn Care Res"},{"issue":"4","key":"pone.0295318.ref011","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1515\/jccm-2017-0024","article-title":"Repeated Bronchoscopy\u2014Treatment of Severe Respiratory Failure in a Fire Victim","volume":"3","author":"OR Petris","year":"2017","journal-title":"J Crit Care Med (Targu Mures)"},{"key":"pone.0295318.ref012","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1186\/1757-7241-21-31","article-title":"Inhalation injury: epidemiology, pathology, treatment strategies","volume":"21","author":"DJ Dries","year":"2013","journal-title":"Scand J Trauma Resusc Emerg Med"},{"key":"pone.0295318.ref013","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1186\/s13054-015-1077-4","article-title":"Diagnosis and management of inhalation injury: an updated review","volume":"19","author":"PF Walker","year":"2015","journal-title":"Crit Care"},{"issue":"3","key":"pone.0295318.ref014","doi-asserted-by":"crossref","first-page":"513","DOI":"10.1016\/j.cps.2017.02.011","article-title":"Management of Pulmonary Failure after Burn Injury: From VDR to ECMO","volume":"44","author":"A Nayyar","year":"2017","journal-title":"Clin Plast Surg"},{"issue":"6","key":"pone.0295318.ref015","doi-asserted-by":"crossref","first-page":"362","DOI":"10.1056\/NEJM199802053380604","article-title":"Objective estimates of the probability of death from burn injuries","volume":"338","author":"CM Ryan","year":"1998","journal-title":"N Engl J Med"},{"issue":"1","key":"pone.0295318.ref016","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1097\/00000658-198701000-00015","article-title":"The influence of inhalation injury and pneumonia on burn mortality","volume":"205","author":"KZ Shirani","year":"1987","journal-title":"Ann Surg"},{"issue":"5","key":"pone.0295318.ref017","doi-asserted-by":"crossref","first-page":"464","DOI":"10.1056\/NEJMra1601128","article-title":"Fire-Related Inhalation Injury","volume":"375","author":"RL Sheridan","year":"2016","journal-title":"N Engl J Med"},{"issue":"4","key":"pone.0295318.ref018","doi-asserted-by":"crossref","first-page":"555","DOI":"10.1016\/j.cps.2009.05.013","article-title":"Airway management and smoke inhalation injury in the burn patient","volume":"36","author":"LC Cancio","year":"2009","journal-title":"Clin Plast Surg"},{"key":"pone.0295318.ref019","doi-asserted-by":"crossref","first-page":"1753466619847901","DOI":"10.1177\/1753466619847901","article-title":"Preclinical and clinical studies of smoke-inhalation-induced acute lung injury: update on both pathogenesis and innovative therapy","volume":"13","author":"B Guo","year":"2019","journal-title":"Ther Adv Respir Dis"},{"issue":"3","key":"pone.0295318.ref020","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1016\/j.cps.2017.02.009","article-title":"Inhalation Injury: Pathophysiology, Diagnosis, and Treatment","volume":"44","author":"SW Jones","year":"2017","journal-title":"Clin Plast Surg"},{"issue":"6","key":"pone.0295318.ref021","doi-asserted-by":"crossref","first-page":"774","DOI":"10.1097\/ACO.0000000000000929","article-title":"Advances in airway management and mechanical ventilation in inhalation injury","volume":"33","author":"RK Gigengack","year":"2020","journal-title":"Curr Opin Anaesthesiol"},{"issue":"5","key":"pone.0295318.ref022","doi-asserted-by":"crossref","first-page":"1040","DOI":"10.1016\/j.burns.2017.11.013","article-title":"The diagnosis and management of inhalation injury: An evidence based approach","volume":"44","author":"CJ Deutsch","year":"2018","journal-title":"Burns"},{"key":"pone.0295318.ref023","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: an updated guideline for reporting systematic reviews","volume":"372","author":"MJ Page","year":"2021","journal-title":"BMJ"},{"key":"pone.0295318.ref024","first-page":"184","volume-title":"Total Burn Care","author":"CL Woodson","year":"2017","edition":"5"},{"issue":"23","key":"pone.0295318.ref025","first-page":"2526","article-title":"Acute respiratory distress syndrome: the Berlin Definition","volume":"307","author":"ARDS Definition Task Force","year":"2012","journal-title":"JAMA"},{"key":"pone.0295318.ref026","unstructured":"Wells GA, Shea B, O\u2019Connell Da, Peterson J, Welch V, Losos M, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomized studies in meta-analyses [Internet]. Oxford: The Ottawa Hospital Research Institute; 2000. [cited 2022 Oct 01]. http:\/\/www.ohri.ca\/programs\/clinical_epidemiology\/oxford.as."},{"issue":"10 Suppl1","key":"pone.0295318.ref027","first-page":"29","article-title":"A revised tool for assessing risk of bias in randomized trials","author":"JPT Higgins","year":"2016","journal-title":"Cochrane Methods 2016. Cochrane Database Syst Rev"},{"key":"pone.0295318.ref028","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1016\/j.jclinepi.2017.05.006","article-title":"The GRADE Working Group clarifies the construct of certainty of evidence","volume":"87","author":"M Hultcrantz","year":"2017","journal-title":"J Clin Epidemiol"},{"issue":"6","key":"pone.0295318.ref029","first-page":"967","article-title":"The utility of bronchoscopy after inhalation injury complicated by pneumonia in burn patients: results from the National Burn Repository","volume":"30","author":"JA Carr","year":"2009","journal-title":"J Burn Care Res"},{"issue":"2","key":"pone.0295318.ref030","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1016\/j.burns.2008.05.021","article-title":"Management of burns of over 80% of total body surface area: a comparative study","volume":"35","author":"F Guo","year":"2009","journal-title":"Burns"},{"key":"pone.0295318.ref031","first-page":"174","volume-title":"Total Burn Care","author":"DL Traber","year":"2017","edition":"5"},{"issue":"3","key":"pone.0295318.ref032","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1586\/ers.09.21","article-title":"Pathophysiology, management and treatment of smoke inhalation injury","volume":"3","author":"S Rehberg","year":"2009","journal-title":"Expert Rev Respir Med"},{"key":"pone.0295318.ref033","first-page":"381","volume-title":"Total Burn Care","author":"LJ Porro","year":"2017","edition":"5"},{"issue":"3 Suppl 2","key":"pone.0295318.ref034","doi-asserted-by":"crossref","first-page":"S98","DOI":"10.1097\/SAP.0000000000001377","article-title":"Inhalation Injury in the Burned Patient","volume":"80","author":"G Foncerrada","year":"2018","journal-title":"Ann Plast Surg"},{"issue":"6","key":"pone.0295318.ref035","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1177\/0885066617714770","article-title":"High-Frequency Ventilation Modalities as Salvage Therapy for Smoke Inhalation-Associated Acute Lung Injury: A Systematic Review","volume":"33","author":"AC Miller","year":"2018","journal-title":"J Intensive Care Med"},{"issue":"1","key":"pone.0295318.ref036","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1093\/jbcr\/irab085","article-title":"Respiratory Characteristics in Patients With Major Burn Injury and Smoke Inhalation","volume":"43","author":"YH Won","year":"2022","journal-title":"J Burn Care Res"},{"issue":"1","key":"pone.0295318.ref037","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1097\/00005373-199601000-00016","article-title":"Pulmonary complications in inhalation injuries with associated cutaneous burn","volume":"40","author":"GE Darling","year":"1996","journal-title":"J Trauma"},{"issue":"5","key":"pone.0295318.ref038","doi-asserted-by":"crossref","first-page":"1365","DOI":"10.1378\/chest.107.5.1365","article-title":"Using bronchoscopy and biopsy to diagnose early inhalation injury. Macroscopic and histologic findings","volume":"107","author":"MJ Masan\u00e8s","year":"1995","journal-title":"Chest"},{"issue":"8","key":"pone.0295318.ref039","doi-asserted-by":"crossref","first-page":"1481","DOI":"10.1016\/j.burns.2014.06.016","article-title":"The impact of inhalation injury in patients with small and moderate burns","volume":"40","author":"MC Chen","year":"2014","journal-title":"Burns"},{"key":"pone.0295318.ref040","doi-asserted-by":"crossref","first-page":"tkaa015","DOI":"10.1093\/burnst\/tkaa015","article-title":"Nebulized heparin for inhalation injury in burn patients: a systematic review and meta-analysis","volume":"8","author":"X Lan","year":"2020","journal-title":"Burns Trauma"},{"issue":"1","key":"pone.0295318.ref041","doi-asserted-by":"crossref","first-page":"182.e1","DOI":"10.1016\/j.jcrc.2013.06.017","article-title":"Heparin\/N-acetylcysteine: an adjuvant in the management of burn inhalation injury: a study of different doses","volume":"29","author":"NM Elsharnouby","year":"2014","journal-title":"J Crit Care"},{"issue":"3","key":"pone.0295318.ref042","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1097\/00004630-199805000-00004","article-title":"Reduction in mortality in pediatric patients with inhalation injury with aerosolized heparin\/N-acetylcystine [correction of acetylcystine] therapy","volume":"19","author":"MH Desai","year":"1998","journal-title":"J Burn Care Rehabil"},{"issue":"1","key":"pone.0295318.ref043","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1186\/s12967-020-02300-4","article-title":"Emerging therapies for smoke inhalation injury: a review","volume":"18","author":"A Mercel","year":"2020","journal-title":"J Transl Med"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0295318","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,11,16]],"date-time":"2024-11-16T22:18:11Z","timestamp":1731795491000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0295318"}},"subtitle":[],"editor":[{"given":"Mohamed","family":"Boussarsar","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2024,4,23]]},"references-count":43,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2024,4,23]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0295318","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,4,23]]}}}