Bronchial wheezing predicts inflammation and respiratory failure in fire smoke victims

• Published in: Acta anaesthesiologica Scandinavica Vol. 61; no. 9; pp. 1142 - 1154
• Main Authors: Nakstad, E. R., Aass, H. C. D., Opdahl, H., Witsø, A., Borchsenius, F., Heyerdahl, F., Skjønsberg, O. H.
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01-10-2017
• Subjects: Adult; Aged; Aged, 80 and over; Alveoli; Biochemical markers; Blood; Blood Gas Analysis; Bronchial Diseases - physiopathology; Bronchoalveolar Lavage Fluid; Bronchus; Carbon Monoxide Poisoning - diagnosis; Carbon Monoxide Poisoning - physiopathology; Cerebrospinal fluid; Critical Care; Cytokines; Cytokines - blood; Dyspnea; Dyspnea - etiology; Dyspnea - physiopathology; Female; Fires; Gas exchange; Granulocyte colony-stimulating factor; Humans; Inflammation; Inhalation; Interleukin 1; Interleukin 6; Interleukin 8; Male; Middle Aged; Monocyte chemoattractant protein 1; Patients; Pneumonia - diagnosis; Pneumonia - etiology; Pneumonia - physiopathology; Predictive Value of Tests; Prospective Studies; Respiration; Respiratory failure; Respiratory function; Respiratory Function Tests; Respiratory Insufficiency - diagnosis; Respiratory Insufficiency - etiology; Respiratory Insufficiency - physiopathology; Respiratory Sounds - physiopathology; Smoke; Smoke inhalation; Smoke Inhalation Injury - complications; Smoke Inhalation Injury - physiopathology; Wheezing; Young Adult
• ISSN: 0001-5172; 1399-6576
• DOI: 10.1111/aas.12962

Background
Acute fire smoke inhalation injury involves inflammatory mediators whose roles are poorly understood. We carried out a prospective observational study of fire smoke victims to identify clinical and biochemical markers that may predict pulmonary dysfunction and investigated possible correlations between dysfunction and cytokines in bronchoalveolar lavage (BAL) fluid and blood.
Methods
Forty patients with respiratory and/or neurological symptoms following acute fire smoke inhalation had pulmonary function tests and blood gas analyses performed on admission, at discharge, and after 3 months. Cytokines were measured using BioPlex/XMap technology.
Results
On admission, 30 (75%) patients had dyspnea. Patients presenting with bronchial wheezing (n = 14) had significantly lower PEF (201 l/min, 82–360) than non‐wheezing patients (406 l/min, 100–683) (n = 16, P = 0.03). Bronchial wheezing predicted need for ICU treatment with OR = 93.3 at 95% CI (P < 0.001) and was associated with gas exchange impairment, with mean paO2/FiO2 ratio 34.4 (11.8–49.8) kPa on admission and 21.3 (8.3–44.5) kPa 48 h later. Blood HbCO also predicted ICU treatment, with OR = 1.58 at 95% CI (P < 0.001). Serum CRP, IL‐6, IL‐8, and MCP‐1 were significantly higher in wheezing patients after 12–24 h compared with non‐wheezing patients and study controls. Cytokine levels were still elevated after 3 months. BAL fluid had significantly higher levels of IL‐8, MCP‐1, IL‐1β, and G‐CSF compared with healthy controls.
Conclusion
In victims of fire smoke inhalation, pulmonary wheezing predicts inflammation, pulmonary dysfunction, respiratory failure, and need for intensive care.