Bronchoscopy-derived correlates of lung injury following inhalational injuries: a prospective observational study

• Published in: PloS one Vol. 8; no. 5; p. e64250
• Main Authors: Jones, Samuel W, Zhou, Haibo, Ortiz-Pujols, Shiara M, Maile, Robert, Herbst, Margaret, Joyner, Jr, Benny L, Zhang, Hongtao, Kesic, Matthew, Jaspers, Ilona, Short, Kathleen A, Meyer, Anthony A, Peden, David B, Cairns, Bruce A, Noah, Terry L
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 17-05-2013; Public Library of Science (PLoS)
• Subjects: Airway management; Analysis; Asthma; Bacteria; Biology; Biomarkers - analysis; Bronchoalveolar Lavage Fluid - chemistry; Bronchoalveolar Lavage Fluid - cytology; Bronchoalveolar Lavage Fluid - microbiology; Bronchoscopy; Bronchoscopy - methods; Burns; Burns (injuries); Cell injury; Clinical outcomes; Cystic fibrosis; Cytokines - analysis; Edema; Environmental health; Enzyme-Linked Immunosorbent Assay; Gram-negative bacteria; Gram-Negative Bacteria - isolation & purification; Health aspects; Humans; Infection; Infections; Inflammation; Inflammation - pathology; Inhalation; Injuries; Injury analysis; Interleukin 10; Interleukin 12; Lung diseases; Lungs; Markers; Mechanical ventilation; Medical research; Medicine; Morbidity; Mortality; Multivariate analysis; North Carolina; Observational studies; Patients; Pediatrics; Prospective Studies; Respiration; Respiratory distress syndrome; Respiratory tract; Rodents; Secretions; Sepsis; Smoke Inhalation Injury - microbiology; Smoke Inhalation Injury - pathology; Soot; Surface area; Surgery; Toxins; Ventilation; Ventilators; North Carolina; United States > US
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0064250

Acute lung injury (ALI) is a major factor determining morbidity following burns and inhalational injury. In experimental models, factors potentially contributing to ALI risk include inhalation of toxins directly causing cell damage; inflammation; and infection. However, few studies have been done in humans.
We carried out a prospective observational study of patients admitted to the NC Jaycees Burn Center who were intubated and on mechanical ventilation for burns and suspected inhalational injury. Subjects were enrolled over an 8-month period and followed till discharge or death. Serial bronchial washings from clinically-indicated bronchoscopies were collected and analyzed for markers of cell injury and inflammation. These markers were compared with clinical markers of ALI.
Forty-three consecutive patients were studied, with a spectrum of burn and inhalation injury severity. Visible soot at initial bronchoscopy and gram negative bacteria in the lower respiratory tract were associated with ALI in univariate analyses. Subsequent multivariate analysis also controlled for % body surface area burns, infection, and inhalation severity. Elevated IL-10 and reduced IL-12p70 in bronchial washings were statistically significantly associated with ALI.
Independently of several factors including initial inhalational injury severity, infection, and extent of surface burns, high early levels of IL-10 and low levels of IL-12p70 in the central airways are associated with ALI in patients intubated after acute burn/inhalation injury. Lower airway secretions can be collected serially in critically ill burn/inhalation injury patients and may yield important clues to specific pathophysiologic pathways.