19 Nebulized Tobramycin is Associated with Decreased Pneumonia After Inhalation Injury

Abstract Introduction Management of inhalation injury is largely supportive and consists primarily of mechanical ventilation, bronchodilators, muscarinic receptor antagonists, and inhaled mucolytics and anticoagulants. Patients with inhalation injury are at high risk for pneumonia. Nebulized tobramycin is well supported in the use of chronic lung infections in patients with cystic fibrosis (CF). We hypothesize that after inhalation injury patients empirically treated with nebulized tobramycin (NT) have decreased incidence of pneumonia. Methods A protocol for a standardized 7-day course of nebulized treatments with bronchodilators, inhaled mucolytics combined with inhaled anticoagulants and Nebulized tobramycin was developed. Starting in May 2013, all patients that had a clinical diagnosis of inhalation documented by the attending physician were started on the 7-day treatment course. Patients with inhalation injury from 2009–2019 were retrospectively reviewed for treatment of inhalation injury. Univariate analysis and multiple logistic regression were performed using Stata. Results Of 90 patients with inhalation injury, median age was 52 (IQR:31–60) with 27% (n=23) women and median TBSA of 10%(IQR:0.7–35%). The median length of stay was 21 days (IQR:6–47). Median ventilator days were lower in patients treated with NT (8.5, IQR:4–21) compared to patients that did not receive NT (10, IQR:3–23) but was not significant (p=0.85). However, of those that received NT, the presence of pneumonia was significantly lower compared to patients not treated with NT (p=0.032). (Table 1) Patients who were not treated with NT developed pneumonia earlier (day 5, IQR:3–7) than patients treated with NT (day 10, IQR 6–16, p=0.02) After adjusting for grade of inhalation injury, patients who did not receive NT were 2.7 times as likely to get pneumonia compared to patients who received NT (p=0.037). Conclusions NT is a prophylactic strategy for pneumonia in patients with CF, well documented to be safe. It allows for concentrated antibacterial coverage localized to the area of infection without significant systemic absorption. After seeing ~60% incidence of pneumonia in inhalation patients, we developed a strategy that avoided systemic prophylactic treatment. Initial data shows empiric administration of NT in patients with inhalation injury may abrogate the development pneumonia. Additional research and clinical trials are needed to better understand the role of inhaled tobramycin in the management of inhalation injury.