Amphetamine Induced Adult Respiratory Distress Syndrome

Study Overview
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Brief Summary
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Methamphetamine and amphetamine has various cardiovascular and central nervous system effects. Long-term use is associated with many adverse health effects including cardiomyopathy, hemorrhagic, and ischemic stroke. Death is usually caused by cardiovascular collapse and while amphetamine abuse has been considered as a potential cause of acute respiratory distress syndrome, the reports are usually anecdotal. This investigation considers reviewing individuals with few to zero medical conditions who develop acute respiratory distress syndrome and are methamphetamine positive

Detailed Description
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Methamphetamine and amphetamine has various cardiovascular and central nervous system effects. Initially prescribed in the 1930s for respiratory ailments such as asthma, current clinical indications of amphetamine range from treatment of attention deficit hyperactivity disorder to narcolepsy. The mechanism of action is primarily potentiation of release of monoamine neurotransmitters, mainly dopamine and norepinephrine, from presynaptic nerve endings into the synaptic space, in addition to attenuation of monoamine metabolism by inhibiting monoamine oxidase. This in turn leads to an increase in sympathetic tone by alpha and beta adrenergic receptor activation, resulting in elevations in heart rate, respiratory rate, and vascular tone. Long-term use is associated with many adverse health effects including cardiomyopathy, hemorrhagic and ischemic stroke. Other long-term associations include increased violent behavior, documented increased motor vehicle accidents, and clandestine manufacturing of the drug. Methamphetamine has also been associated with deleterious effects on society as a whole; it is credited as a cause of increase in rates of crime, abuse, and unemployment, and associated with great economic burden. A significant portion of healthcare resources consumed are rooted in the emergency department, particularly in trauma. Studies previously performed have demonstrated that methamphetamine use among patients that present to trauma centers has been continually increasing. Death is usually caused by cardiovascular collapse and while amphetamine abuse has been considered as a potential cause of acute respiratory distress syndrome, the reports are usually anecdotal. This investigation considers reviewing individuals with few to zero medical conditions who develop acute respiratory distress syndrome and are methamphetamine positive

Official Title
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High Incidence of Adult Respiratory Distress Syndrome Associated With Amphetamine Use in the Burn Population

Conditions
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Burns, Acute Lung Injury, Acute Respiratory Distress Syndrome, Methamphetamine Abuse

Intervention / Treatment
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* Other: Difference in development of Acute Lung Injury in Amphetamine positive and negative patients


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Total body surface area burns between 20% and 60% admitted to the burn unit Exclusion Criteria: Under 18 years of age Burns outside of the inclusion ratio

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Positive for Amphetamine<br>Patients admitted to the burn unit that are positive for amphetamine | Other: Difference in development of Acute Lung Injury in Amphetamine positive and negative patients<br>* No Intervention<br>|
| Negative for Amphetamine<br>Patients admitted to the burn unit that are negative for amphetamine | Other: Difference in development of Acute Lung Injury in Amphetamine positive and negative patients<br>* No Intervention<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Inhalation Injury | Documentation on admission of inhalation injury as defined by burned nasal hairs, burned facial skin, and carbonaceous sputum after admission to the hospital within the first 24 hours. | 24 hours | 
| Total Burn Surface Area | The total burn surface area of the patient on arrival to the hospital assessed within the first 24 hours. With respect to the total burn surface area recorded only 2nd degree burns will be considered as defined as burns that affect the epidermis and dermis. | 24 hours | 
| Length of hospital stay | The total length of hospitalization of individuals with burns and acute respiratory distress syndrome with a max of 180 days from admission. | 180 days | 
| Stroke Volume | Measurement of cardiovascular parameter (stroke volume) of patients with acute respiratory distress syndrome and total burn surface area between 20%-60% in the first 5 days of admission to the hospital. | Collected in the first 5 days after admission | 
| Cardiac Output | Measurement of cardiovascular parameter (cardiac output) of patients with acute respiratory distress syndrome and total burn surface area between 20%-60% in the first 5 days of admission to the hospital. | Collected in the first 5 days after admission | 
| Central Venous Pressure | Measurement of cardiovascular parameter (central venous pressure) of patients with acute respiratory distress syndrome and total burn surface area between 20%-60% in the first 5 days of admission to the hospital. | Collected in the first 5 days after admission |