title: The acute pulmonary inflammatory response to the graded severity of smoke inhalation injury.
abstract: OBJECTIVE
  To determine whether the graded severity of smoke inhalation is reflected by the acute pulmonary inflammatory response to injury.
  
  
  METHODS
  In a prospective observational study, we assessed the bronchoalveolar lavage fluid for both leukocyte differential and concentration of 28 cytokines, chemokines, and growth factors. Results were then compared to the graded severity of inhalation injury as determined by Abbreviated Injury Score criteria (0, none; 1, mild; 2, moderate; 3, severe; 4, massive).
  
  
  METHODS
  All patients were enrolled at a single tertiary burn center.
  
  
  METHODS
  The bronchoalveolar lavage fluid was obtained from 60 patients within 14 hrs of burn injury who underwent bronchoscopy for suspected smoke inhalation.
  
  
  METHODS
  None.
  
  
  RESULTS
  Those who presented with worse grades of inhalation injury had higher plasma levels of carboxyhemoglobin and enhanced airway neutrophilia. Patients with the most severe inhalation injuries also had a greater requirement for tracheostomy, longer time on the ventilator, and a prolonged stay in the intensive care unit. Of the 28 inflammatory mediators assessed in the bronchoalveolar lavage fluid, 21 were at their highest in those with the worst inhalation injury scores (grades 3 and 4), the greatest of which was interleukin-8 (92,940 pg/mL, grade 4). When compared in terms of low inhalation injury (grades 1-2) vs. high inhalation injury (grades 3-4), we found significant differences between groups for interleukin-4, interleukin-6, interleukin-9, interleukin-15, interferon-γ, granulocyte-macrophage colony-stimulating factor, and monocyte chemotactic protein-1 (p < .05 for all).
  
  
  CONCLUSIONS
  These data reveal that the degree of inhalation injury has basic and profound effects on burn patient morbidity, evokes complex changes of multiple alveolar inflammatory proteins, and is a determinant of the pulmonary inflammatory response to smoke inhalation. Accordingly, future investigations should consider inhalation injury to be a graded phenomenon.
authors: Burn and Shock Trauma Institute, Department of Surgery, Loyola University Chicago, Stritch School of Medicine, Maywood, IL, USA.
authors: Joslyn M
authors: JM
authors: Albright
authors: Christopher S
authors: CS
authors: Davis
authors: Melanie D
authors: MD
authors: Bird
authors: Luis
authors: L
authors: Ramirez
authors: Hajwa
authors: H
authors: Kim
authors: Ellen L
authors: EL
authors: Burnham
authors: Richard L
authors: RL
authors: Gamelli
authors: Elizabeth J
authors: EJ
authors: Kovacs
mesh_terms: D000328:Adult; D000368:Aged; D001992:Bronchoalveolar Lavage Fluid / Q000166:cytology / Q000276:immunology; D018925:Chemokines / Q000032:analysis; D016207:Cytokines / Q000032:analysis; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000175:diagnosis* / Q000276:immunology / Q000473:pathology; D012720:Severity of Illness Index; D015208:Smoke Inhalation Injury / Q000175:diagnosis* / Q000276:immunology / Q000473:pathology; D016896:Treatment Outcome
chemical_list: D018925:Chemokines; D016207:Cytokines