Chest
Clinical Investigations: InhalaitonUsing Bronchoscopy and Biopsy to Diagnose Early Inhalation Injury: Macroscopic and Histologic Findings
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
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Cited by (68)
Upper Airway Burn Injury
2020, Operative Techniques in Otolaryngology - Head and Neck SurgeryManagement of severe thermal burns in the acute phase in adults and children
2020, Anaesthesia Critical Care and Pain MedicinePathophysiology, research challenges, and clinical management of smoke inhalation injury
2016, The LancetCitation Excerpt :Consequently, some commonly used diagnostic criteria100–105 have been of uncertain reliability that has compromised their use. Even those studies63,65,66,71,100–112 that have proposed specific criteria for diagnosis and grading of inhalation injury have not been universally accepted. The lack of diagnostic consensus supports the conduct of a large prospective multicentre randomised controlled trial to develop universal guidelines to diagnose and grade the severity of smoke inhalation injury.
Inhalation injury in burn patients: Establishing the link between diagnosis and prognosis
2014, BurnsCitation Excerpt :The mortality and incidence rate in burn patients with inhalation injury of this study were not largely different from above reports. Inhalation injury is usually diagnosed on the basis of a combination of the patient's history (burns sustained in a closed space, unconsciousness at the scene, delayed extrication), physical findings (singed facial hair, carbonaceous deposits in the oropharynx or sputum, facial burn), and other diagnostic modalities (e.g., measurement of carbon monoxide levels, bronchoscopy, serial chest radiography, computed tomography) [15–17]. The best method of diagnosing inhalation injury is on the basis of clinical manifestations and bronchoscopic findings [6].