Cardiopulmonary Hemodynamic Alterations During Early Resuscitation in Burn Patients with Inhalation Injury: Do They Impact Prognosis?

Inhalation injury remains a major contributor to morbidity and mortality in critically ill burn patients, although its hemodynamic impact during early resuscitation is incompletely understood. Patients with inhalation injury could exhibit distinct hemodynamic alterations compared with those without inhalation injury, potentially contributing to worse outcomes. We conducted a prospective, single-center observational study over four years including adult patients with major burns. Hemodynamic variables, fluid administration, and analytical biomarkers during initial resuscitation were analyzed according to inhalation injury. A total of 180 patients were included: 96 with ≥20% TBSA burned without inhalation injury and 84 with inhalation injury irrespective of TBSA, with similar severity scores. Patients with inhalation injury were older and had lower %TBSA burned. They exhibited reduced initial cardiac index (CI), higher lactate, increased stroke volume variation, greater late extravascular lung water index, and elevated NT-proBNP. Mechanical ventilation was more frequent (88% vs. 59%), with a non-significant trend toward higher mortality (28% vs. 18%, P = .10). Fluid requirements were comparable between groups. In a predefined 25%-75% TBSA subgroup, hemodynamic patterns were consistent with the overall cohort. Among patients with inhalation injury, non-survivors showed lower initial CI and higher lactate, troponin, extravascular lung water, and NT-proBNP, despite similar intrathoracic blood volume. These findings demonstrated that inhalation injury was associated with early reductions in CI, lower preload, and a delayed increase in extravascular lung water without higher fluid requirements; mortality correlated with greater cardiac dysfunction and elevated myocardial injury biomarkers during resuscitation.