Chest
Volume 107, Issue 5, May 1995, Pages 1365-1369
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Clinical Investigations: Inhalaiton
Using Bronchoscopy and Biopsy to Diagnose Early Inhalation Injury: Macroscopic and Histologic Findings

https://doi.org/10.1378/chest.107.5.1365Get rights and content

Objective

To learn the value of bronchoscopy and biopsy in the early diagnosis of inhalation injury ARDS.

Setting

Burn Center, CHU Saint-Antoine, Paris, France.

Design

130 consecutively admitted burn patients were bronchoscoped on admission.

Measurements

The appearance of the bronchial tree was recorded, and biopsies were taken from spurs of the proximal and distal branches of the right bronchi.

Results

Either bronchoscopy or biopsy was positive in 46 cases. Twenty three of 44 patients with chemical inhalation injury developed ARDS (52%). Of 83 negative cases only 6 developed ARDS (7%).

Conclusion

Bronchoscopy with biopsy is useful in predicting the development of ARDS in burn patients.

Section snippets

Study Population

This prospective study conducted between January 1987 and November 1989 involved a total of 130 patients. All patients free of coagulation disturbances admitted on or before day 3 were included, whatever the type of skin burn injury (Table 1).

Bronchoscopy

Only bronchoscopy procedures for diagnostic purposes were taken into account. All patients admitted to the ICU of the burn center underwent fiberoptic bronchoscopy as soon as possible (mean ± SD, 25 ±17.4 h after injury). The procedure was carried out

Results

No complications of bronchoscopy arose. There was no histologic difference between the proximal and distal biopsies (Tables 3 and 4).

The routine use of bronchoscopy enabled 46 cases of inhalation injury to be diagnosed among the 130 patients (35%). Forty-four of these 46 cases involved chemical inhalation injury. If classical diagnostic criteria had been applied to these 44 patients before carrying out bronchoscopy, some asymptomatic cases would have gone undiagnosed because 19 (43%) patients

Discussion

The macroscopic and histologic aspect of the bronchial mucosa was strictly normal in 83 cases despite a previous report that hypovolemic shock modifies the aspect of the bronchial mucosa.15 According to this author, the appearance of the mucosa remains normal making it impossible to diagnose inhalation injury until hemodynamic equilibrium is restored. Our findings show that inhalation injury can be diagnosed within a few hours of the accident and that the macroscopic and histologic aspect of

References (21)

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