Diagnostic accuracy and reliability of fiberoptic bronchoscopy in lung injury due to inhalation burns

Background: Lung injury resulting from inhalation of smoke or chemical combustion products is a significant cause of morbidity and mortality. It is important to make an early diagnosis, accurately determine the severity of the injury, and intervene early. The aim of this study is to evaluate the accuracy and reliability of bronchoscopy in the diagnosis and mortality of patients admitted to the burn intensive care unit (ICU) with a preliminary diagnosis of inhalation burn. Methods: This retrospective study was conducted on 48 patients admitted to our burn ICU between 2017 and 2022 with a preliminary diagnosis of inhalation injury. Demographic data, comorbidities, initial physical examination findings TBSA (total body surface area), inhalation injury grades, Baux score, ABSI (A Body Shape Index), type of admission to the ICU (extubated/intubated), additional trauma, difficult airway, facial burn, accompanying carbon monoxide or cyanide poisoning its existence was recorded. Initial blood gas, lactate, carboxy hemoglobin values, the ratio of partial pressure of oxygen in arterial blood to the fraction of inspiratory oxygen concentration (P/F) ratio, chest radiography and fiberoptic bronchoscopy (FOB) findings (based on abbreviated injury score (ASI) criteria, ASI G0: no injury; G1: mild; G2: moderate; G3: severe; and G4: massive injury), duration of mechanical ventilation (MV), hospital and ICU stay, complications of inhalation injury, supportive treatments (Extracorporeal membrane oxygenation (ECMO), and Renal Replacement Therapy (RRT)) and correlations with mortality were also evaluated. Results: It was observed that the most deaths were in G2, the highest ABSI scores and the longest MV, ICU and hospital stays were in G3. In addition, it was determined that the cases that non-survivors were older (p = 0.005), had more burn surfaces (p = 0.026), and bicarbonate and P/F ratios were higher. Conclusions: It was concluded that FOB is an accurate and safe tool in the diagnosis and early treatment of inhalation burns, and that its routine use, even repeated at intervals, can reduce mortality.

Bronchoscopy; Airway burns; Diagnostic

[1] Żwierełło W, Piorun K, Skórka-Majewicz M, Maruszewska A, Antoniewski J, Gutowska I. Burns: classification, pathophysiology, and treatment: a review. International Journal of Molecular Sciences. 2023; 24: 3749.

[2] Alshammari SM, Almarzouq S, Alghamdi AA, Shash H. Mortality and survival analysis of burn patients admitted in a critical care burn unit, Saudi Arabia. Saudi Journal of Medicine & Medical Sciences. 2022; 10: 216–220.

[3] Tasleem S, Siddiqui AI, Zuberi MAW, Tariq H, Abdullah M, Hameed A, et al. Mortality patterns and risk factors in burn patients: a cross-sectional study from Pakistan. Burns Open. 2024; 8: 13–18.

[4] Rice PL, Orgill DP. Assessment and classification of burn injury. 2021. Available at: https://www.uptodate.com/contents/assessment-and-classification-of-burn-injury/print?sectionName=CLASSIFICATIONBYDEPTH&search=burn&topicRef=349&anchor=H10&source=see_link (Accessed: 23 March 2021).

[5] Megahed MA, Elhelbawy RH, Agha MA, Abdelatty NB, El‑Koa AA, El‑Kalashy MM. First-day computed tomography: does it has a role in the assessment of patients with inhalation lung injury? The Egyptian Journal of Bronchology. 2023; 17: 18.

[6] Bagley BA, Senthil-Kumar P, Pavlik LE, Nabi FM, Lee ME, Hartman BC, et al. Care of the critically injured burn patient. Annals of the American Thoracic Society. 2022; 19: 880–889.

[7] Endorf FW, Gamelli RL. Inhalation injury, pulmonary perturbations, and fluid resuscitation. Journal of Burn Care & Research. 2007; 28: 80–83.

[8] Virdis E, Scala E, Paliogiannis P, Zinellu A, Fara G, Pirina P, et al. Role of bronchoscopy in inhalation injury: a case report and literature review. Minerva Respiratory Medicine. 2024; 63: 155-–162.

[9] Woodson LC. Diagnosis and grading of inhalation injury. Journal of Burn Care & Research. 2009; 30: 143–145.

[10] Bai C, Huang H, Yao X, Zhu S, Li B, Hang J, et al. Application of flexible bronchoscopy in inhalation lung injury. Diagnostic Pathology. 2013; 8: 174.

[11] Amin M, Shaarawy H, El-Rab EG. Role of fiberoptic bronchoscopy in management of smoke inhalation lung injury. Egyptian Journal of Chest Diseases and Tuberculosis. 2015; 64: 733–737.

[12] Davis CS, Janus SE, Mosier MJ, Carter SR, Gibbs JT, Ramirez L, et al. Inhalation injury severity and systemic immune perturbations in burned adults. Annals of Surgery. 2013; 257: 1137–1146.

[13] Mosier MJ, Pham TN, Park DR, Simmons J, Klein MB, Gibran NS. Predictive value of bronchoscopy in assessing the severity of inhalation injury. Journal of Burn Care & Research. 2012; 33: 65–73.

[14] Albright JM, Davis CS, Bird MD, Ramirez L, Kim H, Burnham E, et al. The acute pulmonary inflammatory response to the graded severity of smoke inhalation injury. Critical Care Medicine. 2012; 40: 1113–1121.

[15] Spano S, Hanna S, Li Z, Wood D, Cartotto R. Does bronchoscopic evaluation of inhalation injury severity predict outcome? Journal of Burn Care & Research. 2016; 37: 1–11.

[16] Gad SS, Keshk TF, Khames AA, Elkashty MS, Lasheen AEF. Diagnostic value of bronchoscopy in assessing the severity of inhalational lung injury. Menoufia Medical Journal. 2018; 31: 158–162.

[17] Chou SH, Lin SD, Chuang HY, Cheng YJ, Kao EL, Huang MF. Fiber-optic bronchoscopic classification of inhalation injury: prediction of acute lung injury. Surgical Endoscopy. 2004; 18: 1377–1379.

[18] Ji Q, Tang J, Li S, Chen J. Survival and analysis of prognostic factors for severe burn patients with inhalation injury: based on the respiratory SOFA score. BMC Emergency Medicine. 2023; 23: 1.

[19] Charles WN, Collins D, Mandalia S, Matwala K, Dutt A, Tatlock J, et al. Impact of inhalation injury on outcomes in critically ill burns patients: 12-year experience at a regional burns centre. Burns. 2022; 48: 1386–1395.

[20] You K, Yang HT, Kym D, Yoon J, HaejunYim, Cho YS, et al. Inhalation injury in burn patients: establishing the link between diagnosis and prognosis. Burns. 2014; 40: 1470–1475.