Diagnostic value of bronchoscopy in assessing the severity of inhalational lung injury

Abstract

Objectives The aim of this study was to assess the value of using flexible bronchoscopy in the evaluation and management of patients with suspected inhalational lung injury admitted in the Burn Unit, Menoufia University Hospitals, within the first 24–72 h of admission. Background Inhalation injury is a major cause of morbidity and mortality in burn patients. It is one of the three most significant predictors of death after thermal injury. The incidence of respiratory failure is significant after inhalational injuries. Patients and methods This study was carried out on 30 patients who were admitted with inhalation injury in the Burn Unit, Department of Plastic Surgery. All patients were subjected to history taking, complete medical examination, and thorough laboratory and radiological investigations. Results At the time of bronchoscopy, 12 (40%) patients were graded as G1 airway findings, 11 (36.7%) cases were graded as G2 airway findings, four (13.3%) patients were graded as G0, and three (10%) patients were graded as G3. About 26 patients had undergone bronchoalveolar lavage to remove secretions, sloughs, and carbonaceous materials until the airways became clear. On admission, 21 patients showed no pathology in their radiograph (70%), whereas nine patients showed increased bronchovascular markings and pneumonic patches. It was found that 63.6% of patients aged greater than or equal to 45 years died and 78.9% of patients aged less than 45 years survived. This shows that the mortality rate from inhalational injury increases with increasing age. Conclusion Bronchoscopy is considered the 'gold standard' for early evaluation of upper airway injury and prediction of acute lung injury.