Bronchoalveolar lavage analysis in victims of severe facial burns.
OBJECTIVE
To analyze bronchoalveolar lavage (BAL) specimens of burn victims who inhaled smoke, in order to identify alterations associated with mortality or survival.


METHODS
Eighteen victims of facial burns were submitted to BAL up to 24 h after the event. We investigated cell and protein content, including TNF-alpha, HLA-DR, CD14, CD68 and iNOS.


RESULTS
Of the 18 patients submitted to bronchoscopy, 8 (44.4%) died during the follow-up period. The mean age of patients who died was significantly higher (44.7 vs. 31.5 years). On average, the patients who died had burns covering 60.1% of the total body surface area, compared with 26.1% in the survivors (p < 0.0001). Of the 18 patients submitted to bronchoscopy, 11 (61.1%) showed endoscopic signs of smoke inhalation injury, and 4 (36.4%) of those 11 died. Of the 7 patients with no signs of smoke inhalation injury, 4 (57.1%) died. The mean number of ciliated epithelial cells in the BAL fluid was significantly higher in the patients who died than in the survivors (6.6% vs. 1.4%; p = 0.03). There were no significant differences between the groups in terms of any of the other parameters evaluated.


CONCLUSIONS
The total body surface area burned was a predictive factor for mortality. Increased numbers of ciliated epithelial cells in the BAL fluid, denoting bronchial epithelial desquamation, were associated with higher mortality in patients with facial burns.
Rabello
Eucir
E
School of Medicine, Clementino Fraga Filho University Hospital, Universidade Federal do Rio de Janeiro - UFRJ, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
Batista
Vera Flores
VF
Lago
Patrícia Martins
PM
Alvares
Renata de Azevedo Gameiro
Rde A
Martinusso
Cesônia de Assis
Cde A
Lapa e Silva
José Roberto
JR
D000328:Adult; D015415:Biomarkers / Q000032:analysis; D001938:Brazil / Q000453:epidemiology; D001992:Bronchoalveolar Lavage Fluid / Q000166:cytology*; D001999:Bronchoscopy; D002056:Burns / Q000401:mortality* / Q000473:pathology; D005151:Facial Injuries / Q000401:mortality* / Q000473:pathology; D005260:Female; D006684:HLA-DR Antigens / Q000032:analysis; D006801:Humans; D018950:Lipopolysaccharide Receptors / Q000032:analysis; D008297:Male; D010865:Pilot Projects; D011379:Prognosis; D011446:Prospective Studies; D012720:Severity of Illness Index; D015208:Smoke Inhalation Injury / Q000401:mortality* / Q000473:pathology; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis
D015415:Biomarkers; D006684:HLA-DR Antigens; D018950:Lipopolysaccharide Receptors; D014409:Tumor Necrosis Factor-alpha