Fiber-optic bronchoscopic classification of inhalation injury: prediction of acute lung injury.
BACKGROUND
Fiber-optic bronchoscopy is widely used for the early diagnosis of inhalation injury. However, there is no current bronchoscopic classification of inhalation injury for the prediction of acute lung injury (ALI). Our goal was to devise such a classification.


METHODS
Between February 1993 and January 2002, 167 patients with highly suspicious inhalation injuries were collected. All patients received fiber-optic bronchoscopy within 24 h after their accident. In total, 108 patients were diagnosed as positive under direct inspection. The patients were divided into three groups (G(1), G(2), and G(3)) according to the depth of mucosal damage. Six patients were found to be positive by biopsy and were assigned to group Gb. Of these 114 positive cases, 27 developed ALI. Meanwhile, 53 patients were diagnosed as negative; these patients were assigned to group G(0).


RESULTS
After analysis, the following results were noted: G(0) (n = 53), two ALI (3.8%); G(1) (n = 49), two ALI (4%); G(2) (n = 46), 15 ALI (33%); G(3)(n = 13),10 ALI (77%); Gb (n = 6), no ALI. We discovered that the deeper the mucosal injuries, the higher the rate of ALI. There were no deaths related to the procedure.


CONCLUSIONS
Fiber-optic bronchoscopy is a safe and effective method for the early diagnosis of inhalation injuries. Also, it is a good predictor of ALL. We hope that in the near future, this classification will serve as a treatment guideline for the early prevention of ALI. The more severe the damage, the more alert clinicians need to be to improve the patient's chances for survival.
Chou
S H
SH
Division of Chest Surgery, Kaohsiung Medical University, 100 Shih Chuan 1st Road, 80708, Kaohsiung, Taiwan.
Lin
S-D
SD
Chuang
H-Y
HY
Cheng
Y-J
YJ
Kao
E L
EL
Huang
M-F
MF
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001999:Bronchoscopy / Q000379:methods; D002059:Burns, Inhalation / Q000145:classification* / Q000150:complications / Q000175:diagnosis*; D005260:Female; D005336:Fiber Optic Technology; D006801:Humans; D008297:Male; D008875:Middle Aged; D055100:Optical Fibers; D011237:Predictive Value of Tests; D012128:Respiratory Distress Syndrome / Q000145:classification* / Q000175:diagnosis* / Q000209:etiology