title: Bronchoscopy in the blast injury patient.
abstract: OBJECTIVE
  Delayed presentation of secondary airway injury is a significant clinical entity following blast injury.
  
  
  METHODS
  Retrospective review.
  
  
  METHODS
  Combat Support Hospital, Operation Iraqi Freedom.
  
  
  METHODS
  Twenty-three blast injury patients with bronchoscopic evidence of secondary airway injury.
  
  
  METHODS
  Symptom development and time frame, bronchoscopic findings, and requirement for mechanical ventilation.
  
  
  RESULTS
  All of the 23 patients presented within 12 hours of injury. Eleven patients (48%) arrived at the hospital after prior endotracheal intubation. The majority (17 patients [74%]) of patients had no carbonaceous sputum, singed nasal hair, or thoracic trauma that would suggest possible airway injury. Bronchoscopy revealed mucosal erythema and edema in 16 (70%) of the patients, 6 (23%) had additional airway carbonaceous deposits, and 5 (21%) had normal findings on initial bronchoscopy. Eight patients (35%) initially breathing spontaneously and demonstrating no thoracic trauma required intubation within 12 hours of admission owing to impending loss of airway patency. Bronchoscopy revealed significant airway edema (>50% patency loss) in 6 (75%) of these 8 patients, with additional carbonaceous deposits in 3 patients (38%). Patients requiring delayed intubation had a significantly greater respiratory rate on initial examination.
  
  
  CONCLUSIONS
  Manifestation of secondary airway injury may be delayed up to 12 hours following blast injury. We believe that blast injury patients should be observed for at least 18 hours after injury or until edema has resolved and in a setting amenable to emergent airway support and rapid bronchoscopic evaluation at the earliest indication of possible airway compromise.
authors.affiliation: Departments of Surgery and Pulmonary/Critical Medicine, Madigan Army Medical Center, Tacoma, Wash, USA. matthew.eckert@amed.army.mil
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Eckert
authors.forename: Cynthia
authors.initials: C
authors.lastname: Clagett
authors.forename: Matthew
authors.initials: M
authors.lastname: Martin
authors.forename: Kenneth
authors.initials: K
authors.lastname: Azarow
mesh_terms: D001753:Blast Injuries / Q000175:diagnosis*; D001980:Bronchi / Q000293:injuries* / Q000473:pathology; D001999:Bronchoscopy; D005500:Follow-Up Studies; D006801:Humans; D012189:Retrospective Studies; D013898:Thoracic Injuries / Q000175:diagnosis*; D014132:Trachea / Q000293:injuries* / Q000473:pathology; D015599:Trauma Severity Indices