Murphy Tyler J, Krebs Elizabeth D, Riffert Derek A, Mubang Ronnie, Nordness Mina F, Guidry Christopher, Gondek Stephen, Beyene Robel T
Department of Surgery, Vanderbilt University Medical Center, Nashville, TN 37212, USA.
Vanderbilt University School of Medicine, Nashville, TN 37232, USA.
J Burn Care Res. 2025 Jan 24;46(1):61-66. doi: 10.1093/jbcr/irae198.
The standard modality for diagnosis of smoke inhalational injury in burn patients is bronchoscopy with or without bronchoalveolar lavage (BAL). However, the risks associated with these procedures are poorly described in established literature. We sought to investigate the association between diagnostic BAL at admission and the development of pneumonia in burn patients. This retrospective analysis of intubated burn patients studied those who underwent bronchoscopy on admission, comparing patients who received BAL to those who did not. Demographics and baseline characteristics were analyzed using chi-squared or Student's t-test. Unadjusted and multivariable logistic regression studies assessed the effect of admission BAL on the development of pneumonia. Out of the 196 patients who underwent bronchoscopy, 98 met our criteria for analysis. The BAL group was more likely to be male and have a higher grade of abbreviated injury score. Patients who received BAL were more likely to develop pneumonia during the admission in both unadjusted and multivariable logistic regression models. These patients also had a longer hospital length of stay, greater number of ventilator days, and were more likely to undergo second bronchoscopy. These findings associate admission BAL with increased risk of pneumonia during the index hospitalization, suggesting a judicious use of BAL during admission bronchoscopy in burn patients.
烧伤患者烟雾吸入性损伤的标准诊断方式是进行支气管镜检查，可伴有或不伴有支气管肺泡灌洗（BAL）。然而，现有文献中对这些操作相关风险的描述并不充分。我们试图研究入院时诊断性BAL与烧伤患者发生肺炎之间的关联。这项对插管烧伤患者的回顾性分析研究了入院时接受支气管镜检查的患者，将接受BAL的患者与未接受BAL的患者进行比较。使用卡方检验或学生t检验分析人口统计学和基线特征。未调整和多变量逻辑回归研究评估了入院时BAL对肺炎发生的影响。在196例接受支气管镜检查的患者中，98例符合我们的分析标准。BAL组男性比例更高，简略损伤评分等级更高。在未调整和多变量逻辑回归模型中，接受BAL的患者在入院期间更易发生肺炎。这些患者的住院时间也更长，机械通气天数更多，且更有可能接受第二次支气管镜检查。这些发现表明入院时BAL与指数住院期间肺炎风险增加相关，提示在烧伤患者入院支气管镜检查时应谨慎使用BAL。
