Abstract
Smoke inhalation injury causes acute airway injury that may result in airway compromise with significant morbidity and mortality. We investigate the ability of high resolution endobronchial optical coherence tomography (OCT) to obtain real-time images for quantitatively assessing regional differences between upper tracheal versus lower tracheal and bronchial airway injury responses to smoke inhalation in vivo using a prototype spectral domain (SLD)-OCT system we constructed, and flexible fiber optic probes. 33 New Zealand White rabbits are intubated and mechanically ventilated. The treatment groups are exposed to inhaled smoke. The OCT probe is introduced through the endotracheal tube and maintained in place for 5 to 6 h. Images of airway mucosa and submucosa are obtained at baseline and at specified intervals postexposure. Starting within less than 15 min after smoke inhalation, there is significant airway thickening in the smoke-exposed animals. This is maintained over 5 h of imaging studies. The lower tracheal airway changes, correlating closely with carboxyhemoglobin levels, are much greater than upper tracheal changes. Significant differences are seen in lower trachea and bronchi after acute smoke inhalation compared to upper trachea as measured in vivo by minimally invasive OCT. OCT is capable of quantitatively detecting regional changes in airway swelling following inhalation injury.
Highlights
Smoke inhalation injury is a major cause of morbidity and mortality among victims of fires
30 animals total were exposed to inhaled room-temperature smoke for this study. 14 animals were in the lower trachea/bronchi exposure group, 16 in the upper tracheal exposure group, and 3 controls
Despite the marked changes in the subepithelial layers seen on optical coherence tomography (OCT), only epithelial cell layer changes were seen on histologic examination (Fig. 1)
Summary
Smoke inhalation injury is a major cause of morbidity and mortality among victims of fires. Pathophysiologic changes include hyperemia, edema, sloughing, and necrosis, which can cause airway compromise and acute lung injury.[1,2,3,4,5,6,7,8,9] Currently, there are no highly reliable diagnostic techniques in the clinical setting to predict or assess the degree of airway compromise following smoke inhalation. The purpose of this study was to demonstrate the potential role of OCT in quantitatively detecting early smoke inhalation injury and assessing differences in response of more proximal versus distal large airways to smoke inhalation injury
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