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Toxic epidermal necrolysis (TEN) is a rare condition affecting an estimated 1 to 2 cases per million per year, with reported mortality between 30% and 50% typically because of multiorgan failure or sepsis. Acute pulmonary complications from this disorder include bronchial mucosal sloughing, pulmonary edema, and infectious pneumonitis. Pulmonary complications in TEN occurred in 46% of patients in one series. Use of extracorporeal life support (ECLS) in adults with acute respiratory distress syndrome (ARDS) has increased markedly during the past few years after successful treatment in adults with swine flu (H1N1) and publication of the CESAR (conventional ventilation or ECMO for severe adult respiratory failure) trial, which demonstrated a lower mortality and disability at 6 months for patients referred to an ECLS center. The suggested ideal candidate for ECLS would be one with an acute, reversible, survivable illness if not for associated ARDS, no significant comorbidities, no contraindication to systemic anticoagulation, less than 8 days on mechanical ventilation, and younger than 65 years of age., Published in the Journal of Burn Care & Research, v35 n6 pE428-E430, November/December 2014.

BACKGROUND: Acute respiratory distress syndrome (ARDS) prevalence and related outcomes in burned military casualties from Iraq and Afghanistan have not been described previously. The objective of this article was to report ARDS prevalence and its associated in-hospital mortality in military burn patients. METHODS: Demographic and physiologic data were collected retrospectively on mechanically ventilated military casualties admitted to our burn intensive care unit from January 2003 to December 2011. Patients with ARDS were identified in accordance with the new Berlin definition of ARDS. Subjects were categorized as having mild, moderate, or severe ARDS. Multivariate logistic regression identified independent risk factors for developing moderate-to-severe ARDS. The main outcome measure was the prevalence of ARDS in a cohort of patients burned as a result of recent combat operations. RESULTS: A total of 876 burned military casualties presented during the study period, ofwhom291 (33.2%) required mechanical ventilation. Prevalence of ARDS in this cohort was 32.6%, with a crude overall mortality of 16.5%. Mortality increased significantly with ARDS severity: mild (11.1%), moderate (36.1%), and severe (43.8%) compared with no ARDS (8.7%) ( p 0.001). Predictors for the development of moderate or severe ARDS were inhalation injury (odds ratio [OR], 1.90; 95% confidence interval [CI], 1.01-3.54; p = 0.046), Injury Severity Score (ISS) (OR, 1.04; 95%CI, 1.01-1.07; p = 0.0021), pneumonia (OR, 198; 95%CI, 1.07-3.66; p = 0.03), and transfusion of fresh frozen plasma (OR, 1.32; 95% CI, 1.01-1.72; p = 0.04). Size of burn was associated with moderate or severe ARDS by univariate analysis but was not an independent predictor of ARDS by multivariate logistic regression (p 0.05). Age, size of burn, and moderate or severe ARDS were independent predictors of mortality., Published in the Journal of Trauma and Acute Care Surgery, v76 n3 p821-827, 2014. Prepared in collaboration with the San Antonio Military Medical Center, Fort Sam Houston, TX, and the Uniformed Services University of the Health Sciences, Bethesda, MD.