Burn injury due to smoking in bed: clinical features and treatment

Intention. To compare results of treatment among patients with burn injury associated with alcohol and smoking in bed vs general burn injuries.

Methodology: The main study group included 60 patients with burns > 10 % TBSA, resulting from the ignition of the bed from an unfinished cigarette. The control group consisted of case histories of 330 patients with burns of similar area not associated with smoking in bed. Statistical data processing was performed using Microsoft Office Excel 2007 and IBM SPSS 20.0 using descriptive and non-parametric statistics.

Results: Multifactorial injuries due smoking in bed combine deep burns, inhalation injury and poisoning with combustion products (so-called sofa injury) and are much more common in men (p = 0.002). Alcohol intoxication significantly increases the risk of such injuries (p = 0.001). “Sofa injuries” need longer (p = 0.001) and more expensive (p = 0.05) treatment than other burn categories. Early excision is preferable with one-stage skin graft. If the radical excision fails, then a vacuum dressing should be considered for temporary wound closure. Mortality in this group reaches 53 % and significantly exceeds that from any other type of thermal injury (p = 0.002).

Conclusion: The so-called “sofa injury” is most common in middle-aged patients. Associated burn disease includes extensive deep burns of the trunk and upper extremities, usually with alcohol intoxication, inhalation injury and carbon monoxide poisoning. Most victims develop burn sepsis and multiple organ failure. Stratified excision is ineffective in most these patients. When excised to the fascia level, radical necrotomy can be achieved only in 60 % of cases. Taking these features into account helps to organize treatment correctly, optimize systemic therapy and create personalized surgical tactics, which should improve the results of treatment in patients with “sofa injury”. However, further clinical trials are necessary to confirm this theory.

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