The authors propose to investigate the usefulness of the routine administration of hydroxocobalamin in burns patients who are suspected to have an inhalational component to their injury. Mention is made of the important fact that no previous published literature has specifically assessed the benefit of the routine use of the hydroxocobalamin in inhalational injuries. The authors conduct a very robust retrospective data collection comparing 138 adult patients who received hydroxocobalamin with 135 patients who did not. The study groups were homogenous with a slight male prevalence. The groups’ outcomes were analysed with the primary end-point being mortality and secondary end-points including the proven development of pneumonia. The study’s results confirm that the routine use of hydroxocobalamin in inhalational injuries does not improve mortality but significantly reduces the incidence of pneumonia and time on mechanical ventilation.
This is a very well conducted and useful study that aims to address important issues in the difficult management of inhalational injuries. The results strongly suggest that hydroxocobalamin likely has a beneficial, protective effect following inhalational injury. However, further studies will be needed in terms of prospective randomised controlled trials to more definitely delineate the benefits that this treatment may have. It would also be interesting to know more precisely what the pharmacological properties are of hydroxocobalamin that may be responsible for any respiratory protection.
