title: Bronchoscopy-derived correlates of lung injury following inhalational injuries: a prospective observational study.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
authors.forename: Samuel W
authors.initials: SW
authors.lastname: Jones
authors.forename: Haibo
authors.initials: H
authors.lastname: Zhou
authors.forename: Shiara M
authors.initials: SM
authors.lastname: Ortiz-Pujols
authors.forename: Robert
authors.initials: R
authors.lastname: Maile
authors.forename: Margaret
authors.initials: M
authors.lastname: Herbst
authors.forename: Benny L
authors.initials: BL
authors.lastname: Joyner
authors.forename: Hongtao
authors.initials: H
authors.lastname: Zhang
authors.forename: Matthew
authors.initials: M
authors.lastname: Kesic
authors.forename: Ilona
authors.initials: I
authors.lastname: Jaspers
authors.forename: Kathleen A
authors.initials: KA
authors.lastname: Short
authors.forename: Anthony A
authors.initials: AA
authors.lastname: Meyer
authors.forename: David B
authors.initials: DB
authors.lastname: Peden
authors.forename: Bruce A
authors.initials: BA
authors.lastname: Cairns
authors.forename: Terry L
authors.initials: TL
authors.lastname: Noah
mesh_terms: D015415:Biomarkers / Q000032:analysis*; D001992:Bronchoalveolar Lavage Fluid / Q000737:chemistry* / Q000166:cytology / Q000382:microbiology; D001999:Bronchoscopy / Q000379:methods*; D016207:Cytokines / Q000032:analysis; D004797:Enzyme-Linked Immunosorbent Assay; D006090:Gram-Negative Bacteria / Q000302:isolation & purification; D006801:Humans; D007249:Inflammation / Q000473:pathology*; D009657:North Carolina; D011446:Prospective Studies; D015208:Smoke Inhalation Injury / Q000382:microbiology / Q000473:pathology*
chemical_list: D015415:Biomarkers; D016207:Cytokines