Retrospective study of fiberoptic bronchoscopy airway lavage in the treatment of extremely severe burn patients with severe inhalation injury

Abstract

Objective: To explore the clinical effects of fiberoptic bronchoscopy airway lavage (FBAL) in the treatment of extremely severe burn patients with severe inhalation injury. Methods: From January 2015 to January 2019, 47 extremely severe burn patients with severe inhalation injury who were hospitalized in Tongren Hospital of Wuhan University & Wuhan Third Hospital, meeting the inclusion criteria, were recruited in this retrospective cohort study. According to whether or not they were treated with FBAL, the patients were divided into fiberoptic bronchoscopy group (23 cases, 19 males and 4 females) and routine group (24 cases, 20 males and 4 females), with the age of (44±11) and (49±9) years, and the admission time of 4 (3, 4) h and 4 (3, 5) h respectively. The patients in routine group were given routine comprehensive treatment, and the patients in fiberoptic bronchoscopy group were treated with FBAL on the basis of routine comprehensive treatment. The pH value, arterial partial pressure of oxygen (PaO(2)), arterial partial pressure of carbon dioxide (PaCO(2)), arterial oxygen saturation (SaO(2)), oxygenation index, white blood cell count (WBC), neutrophils, blood lactic acid, and procalcitonin (PCT) at admission and on post injury day (PID) 3, 5, 7, and 10, the time of mechanical ventilation, the day of intensive care unit (ICU) stay, the incidence of complications and death within PID 28 were compared between the two study groups. The occurrences of bronchospasm and asphyxia of patients in fiberoptic bronchoscopy group were monitored. Data were statistically analyzed with independent sample t test, Mann-Whitney U test, Bonferroni correction, chi-square test, and Fisher's exact probability test. Results: (1) At admission, the values of pH, PaO(2), PaCO(2), SaO(2), and oxygenation index of patients in the two groups were similar (Z=-0.118, -0.320, -0.362, -2.416, -0.234, P>0.05). On PID 3, 5, 7, and 10, the values of pH, PaO(2), SaO(2), and oxygenation index of patients in fiberoptic bronchoscopy group were significantly higher than those of routine group (Z(3 d)=-4.711, -4.161, -5.525, -2.661; Z(5 d)=-3.489, -4.678, -5.875, -3.599; Z(7 d)=-5.104, -4.619, -5.876, -4.844; Z(10 d)=-4.026, -5.698, -5.877, -4.716; P<0.05 or P<0.01). The PaCO(2) values of patients in fiberoptic bronchoscopy group were significantly lower than those of routine group (Z=-2.895, -3.162, -3.407, -2.831, P<0.05 or P<0.01). (2) At admission and on PID 3, 5, and 7, the values of WBC, blood lactic acid, and PCT of patients in the two groups were similar (Z=-0.830, -0.915, -0.458, -0.648, -1.714, -1.479; -0.330, -0.128, -1.766, -0.494, -1.396, -1.522, P>0.05). On PID 10, the values of WBC, blood lactic acid, and PCT of patients in fiberoptic bronchoscopy group were significantly lower than those of routine group (Z=-3.502, -2.630, -2.662, P<0.05 or P<0.01). At admission, the value of neutrophils of patients in fiberoptic bronchoscopy group was 0.887 (0.862, 0.912), which was similar to 0.887 (0.856, 0.897) in routine group (Z=-0.404, P>0.05). On PID 3, 5, 7, and 10, the values of neutrophils of patients in fiberoptic bronchoscopy group were respectively 0.848 (0.802, 0.867), 0.831 (0.815, 0.849), 0.798 (0.771, 0.849), 0.796 (0.751, 0.869), which were significantly lower than those of routine group [0.882 (0.820, 0.906), 0.871 (0.835, 0.903), 0.845 (0.819, 0.905), 0.881 (0.819, 0.916), Z=-2.756, -2.810, -2.618, -3.033, P<0.05]. (3) The time of mechanical ventilation and the days of ICU stay of patients were shorter in fiberoptic bronchoscopy group than those in routine group (Z=-2.199, t=2.368, P<0.05). Within PID 28, the number of patients with complications was significantly less in fiberoptic bronchoscopy group than in routine group (χ(2)=5.436, P<0.05), while the incidence of death within PID 28 in fiberoptic bronchoscopy group was similar to that of routine group (P>0.05). The airway lavage procedures of patients in fiberoptic bronchoscopy group went well with no bronchospasm or asphyxia occurred. Conclusions: FBAL is effective in treating extremely severe burn patients combined with severe inhalation injury. It can improve the oxygenation status of the lung, reduce the systemic inflammatory reaction of patients, shorten the time of mechanical ventilation and ICU stay, and reduce the incidence of complications.