Application of flexible bronchoscopy in inhalation lung injury

Abstract

Background: As acute inhalational injury is an uncommon presentation to most institutions, a standard approach to its assessment and management, especially using flexible bronchoscopy, has not received significant attention.

Methods: The objective of this study is to evaluate the value of using flexible bronchoscopy as part of the evaluation and management of patients with inhalational lung injury. Twenty-three cases of inhalational lung injury were treated in our three hospitals after a fire in a residential building. The twenty cases that underwent bronchoscopy as part of their management are included in this analysis. After admission, the first bronchoscopy was conducted within 18-72 hours post inhalational injury. G2-level patients were reexamined 24 hours after the first bronchoscopy, while G1-level patients were reexamined 72 hours later. Subsequently, all patients were re-examined every 2-3 days until recovered or until only tunica mucosa bronchi congestion was identified by bronchoscopy.

Results: Twenty patients had airway injury diagnosed by bronchoscopy including burns to the larynx and glottis or large airways. Bronchoscopic classification of the inhalation injury was performed, identifying 12 cases of grade G1 changes and 8 cases of grade G2. The airway injury in the 12 cases of grade G1 patients demonstrated recovery in 2-8 days, in the airway injury of the 8 cases of grade G2 patients had a prolonged recovery with airway injury improving in 6-21 days averaged. The difference in recovery time between the two groups was significant (P <0.05).

Conclusions: The use of flexible bronchoscopy has great value in the diagnosis of inhalational injury without any complications. Its use should be incorporated into clinical practice.

Virtual slides: The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1476676925108926.

Figure 1

Bronchoscopic findings in patient A, 18 hours post inhalation injury. The trachea was classified as grade G1, with mild edema and congestion of the bronchus (A), without carbon soot being identified (B).

Figure 2

Bronchoscopic findings of Patient B, eighteen hours after inhalation injury. The trachea was classified as grade G2 with severe edema and congestion of the bronchus (A). Carbon soot deposition and the formation of pseudomembrane was also demonstrated (B).

Figure 3

Bronchoscopic findings of Patient C; A) eighteen hours after inhalation injury. B) The trachea was classified as grade G2 with severe edema and congestion of the bronchus in addition to carbon soot deposition.

Figure 4

Bronchoscopic findings in patient C, 11 days post-inhalation injury. In both the trachea (A) and bronchus (B) carbon soot and inflammation had resolved with only mild edema and congestion remaining.