Marek Kawecki, Piotr Wróblewski, Stanisław Sakiel, Stefan Gaweł, Justyna Glik, Mariusz Nowak, Andriessen A
Burn Centre, Siemianowice, Slaskie, Poland.
Burns. 2007 Aug;33(5):554-60. doi: 10.1016/j.burns.2006.08.030. Epub 2007 Mar 21.
Fibreoptic bronchoscopy has been recently introduced to our practice, its value in the diagnosis and management of respiratory tract burns has been well established. The aim of the prospective study was to ascertain whether, in our routine clinical practice, a correlation could be shown between clinical and bronchoscopic diagnosis. The outcome of the study could support a rationale for introduction of this tool in other centers in Poland. In the period between 1 October 2001 and 30 June 2004, of the 1247 burn patients, that were hospitalized in our centre and admitted directly after burn, N=292 patients (59 women and 233 men) were included in the study. For clinical diagnosis, a clinical pathway was used, which includes a questionnaire probing for signs and symptoms of inhalation trauma. When on initial assessment there was a suspicion of inhalation trauma (>3/11 points), a prompt fibreoptic bronchoscopy was performed. Diagnoses of an inhalation burn was confirmed in 261/292 patients, of whom upon initial assessment an inhalation trauma was suspected. Clinical assessment showed that 62/261 scored 5/11, 57/261 scored 6/11, 122/261 had a score of 7/11 and 20/261 scored >7/11. In this group an upper respiratory tract burn was diagnosed in 111/261 cases, damage of the main respiratory tract in 130/261 cases, and an inhalation trauma of the lower respiratory tract was confirmed in 20/261 cases. Based on our findings we concluded that fibreoptic bronchoscopy was shown to be a useful method in our routine clinical practice to confirm diagnosis and treatment of inhalation burns. The high agreement between the clinical suspicion of inhalation injury and the incidence confirmed by bronchoscopy and biopsies, suggest that the clinical indicators we use are reliable. We noted that performing fibreoptic bronchoscopy in patients with acute breathing insufficiency, who are intubated and require high concentrations of oxygen, is not recommended.
纤维支气管镜检查最近已应用于我们的临床实践，其在呼吸道烧伤诊断和治疗中的价值已得到充分证实。这项前瞻性研究的目的是确定在我们的常规临床实践中，临床诊断与支气管镜诊断之间是否存在相关性。该研究结果可为波兰其他中心引入这一工具提供理论依据。在2001年10月1日至2004年6月30日期间，在我们中心住院且烧伤后直接入院的1247例烧伤患者中，N = 292例患者（59名女性和233名男性）被纳入研究。对于临床诊断，采用了临床路径，其中包括一份询问吸入性创伤体征和症状的问卷。当初步评估怀疑有吸入性创伤（>3/11分）时，立即进行纤维支气管镜检查。292例患者中有261例确诊为吸入性烧伤，其中初步评估时怀疑有吸入性创伤。临床评估显示，261例中有62例得分为5/11，57例得分为6/11，122例得分为7/11，20例得分>7/11。在该组中，261例中有111例诊断为上呼吸道烧伤，130例诊断为主呼吸道损伤，20例确诊为下呼吸道吸入性创伤。根据我们的研究结果，我们得出结论，在我们的常规临床实践中，纤维支气管镜检查被证明是一种用于确诊和治疗吸入性烧伤的有用方法。吸入性损伤的临床怀疑与支气管镜检查和活检确诊的发病率之间的高度一致性表明我们使用的临床指标是可靠的。我们注意到，不建议对急性呼吸功能不全、已插管且需要高浓度氧气的患者进行纤维支气管镜检查。
