Inhalation injury is a major cause of morbidity and mortality in burned patients. We performed this study to know the severity of lower airway injury due to inhalation and the influence of these airway injury on early mortality in severely burned patients.
From Jan, 2004 to Jul, 2004, major burn patients with inhalation injury were enrolled prospectively. Bronchoscopic biopsy was done either at carina or at right (or left) 2nd carina. The pathologic grades of biopsy was classified as follows: 0 = normal or minimal epithelial injury; 1 = loss of cilia or moderate epithelial injury; 2 = severe epithelial injury or basement membrane alteration; 3 = extensive ulceration. We analyzed APACHE II scores, P/F ratio, 30-day ICU mortality and their correlation with pathologic grades.
68 patients (M=49, F=19) were enrolled. In survivors (40 cases) and non-survivors (28 cases), there were no statistically significant difference was seen among the patient’s age, sex, initial COHb, APACHE II scores and PaO2/FiO2 ratio. But the percent of total body surface area (%TBSA) burn and APACHE II scores were higher in non-survivors than in survivors (p<0.05, p<0.05). In total patients, there were no significant difference between the %TBSA and the pathologic grades of airway (p=0.056) but significant increased in trends of pathologic grade as increasing the %TBSA (p=0.008). There were not correlation between pathologic grade of airway and APACHE II scores, PaO2/FiO2 ratio in survivors and non-survivors. In survivors, significant negative correlation was seen between the %TBSA and the pathologic grade of airway (r=-0.442, p=0.004) but, not in non-survivors (r=-0.226, p=0.25). Also, there were no significant difference in 30-day ICU mortality according to each pathologic grade (p=0.708).
Increasing burn size concomitant with inhalation showed increase in trends of severity of airway injury, but further study may be needed whether the extents of lower airway injury due to inhalation affect on early mortality in severely burned patients.
The extents of initial airway injury due to inhalation may not be sustained.
Cheol Kim, None.