Department of Hand, Plastic and Reconstructive Surgery, Microsurgery - Burn Center BG Trauma Center Ludwigshafen, Rhine, Hand and Plastic Surgery, University Heidelberg, Ludwig-Guttmann-Str. 13, D-67071 Ludwigshafen, Germany.
Institute of Medical Biometry and Informatics, University Heidelberg, Im Neuenheimer Feld 130.3, D-69120 Heidelberg, Germany.
Burns. 2019 Sep;45(6):1275-1282. doi: 10.1016/j.burns.2019.07.011. Epub 2019 Aug 3.
Inhalation injury is a common complication of thermal trauma. Fiberoptic bronchoscopy (FOB) is regarded as current standard practice in diagnosing and grading inhalation injury. Nonetheless, its predictive value in terms of therapeutic decision-making and clinical outcome is controversial.
Adult burn patients with inhalation injury (InI) were selected from the National Burn Repository of the American Burn Association. Subjects were propensity score pair-matched based on injury severity and grouped based on whether or not FOB had been performed (FOB, CTR, respectively). Mortality, incidence of pneumonia, length of hospitalization, length of ICU stay and dependency on mechanical ventilation were compared between the two groups.
3014 patients were matched in two groups with a mean TBSA of 22.4%. There was no significant difference in carboxyhemoglobin fraction at admission. Patients, who underwent FOB on admission had a significantly increased incidence of pneumonia (p < 0.001), mortality (p < 0.05), length of hospitalization (p = 0.002), ICU stay (p < 0.001) and duration of mechanical ventilation (p = 0.006). In a subgroup analysis of patients with TBSA of at least 20%, incidence of pneumonia was significantly higher in the FOB group (p < 0.001) and longer mechanical ventilation was required (p = 0.036).
Diagnosis and grading of InI through FOB is the current standard, although its predictive value regarding key outcome parameters and therapeutic decision-making, remains unclear. The potential procedural risk of FOB itself should be considered. This study demonstrates correlations of FOB with major clinical outcomes in both a general collective of burned adults as well as severely burned adults. Although these findings must be interpreted with caution, they may induce further research into potential harm of FOB and critical review of routine diagnostic FOB in suspected inhalation injury in thermally injured patients.
吸入性损伤是热创伤的常见并发症。纤维支气管镜（FOB）被认为是目前诊断和分级吸入性损伤的标准方法。然而，其在治疗决策和临床结果方面的预测价值仍存在争议。
从美国烧伤协会的国家烧伤资料库中选择有吸入性损伤（InI）的成年烧伤患者。根据损伤严重程度进行倾向评分匹配，并根据是否进行 FOB 分组（FOB 组、对照组）。比较两组患者的死亡率、肺炎发生率、住院时间、ICU 入住时间和对机械通气的依赖程度。
两组患者共匹配 3014 例，平均 TBSA 为 22.4%。入院时碳氧血红蛋白分数无显著差异。入院时行 FOB 的患者肺炎发生率（p<0.001）、死亡率（p<0.05）、住院时间（p=0.002）、ICU 入住时间（p<0.001）和机械通气时间（p=0.006）显著增加。在 TBSA 至少为 20%的患者亚组分析中，FOB 组肺炎发生率显著更高（p<0.001），且需要更长时间的机械通气（p=0.036）。
通过 FOB 诊断和分级 InI 是目前的标准方法，尽管其对关键结局参数和治疗决策的预测价值仍不清楚。应考虑 FOB 本身的潜在程序风险。本研究表明，FOB 与烧伤成年患者和严重烧伤成年患者的主要临床结局相关。尽管这些发现需要谨慎解释，但它们可能会引发进一步研究 FOB 的潜在危害，并对疑似热损伤患者吸入性损伤的常规诊断性 FOB 进行批判性审查。
