纤维支气管镜诊断和治疗吸入性损伤

目的通过纤维支气管镜对吸入性损伤进行系统形态学观察,探讨纤维支气管镜下诊断吸入性损伤的形态学标准,早期诊断的可行性,以及纤维支气管镜在吸入性损伤的局部治疗作用。方法经过１０年来１４４例临床应用纤维支气管镜诊治吸入性损伤体会,观察不同损伤程度的形态表现。结果得出镜下诊断和分类,早期（伤后８ｈ内）经纤维支气管镜诊断吸入性损伤的可行性及意义,借助纤维支气管镜对吸入性损伤局部进行吸引、刷洗、灌注等治疗的临床效果。结论纤维支气管镜在诊断治疗吸入性损伤中有其特殊地位和普及应用的必要性。     

纤维支气管镜诊断和治疗吸入性损伤

目的通过纤维支气管镜对吸入性损伤进行系统形态学观察,探讨纤维支气管镜下诊断吸入性损伤的形态学标准,早期诊断的可行性,以及纤维支气管镜在吸入性损伤的局部治疗作用。方法经过10年来144例临床应用纤维支气管镜诊治吸入性损伤体会,观察不同损伤程度的形态表现。结果得出镜下诊断和分类,早期(伤后8h 内)经纤维支气管镜诊断吸入性损伤的可行性及意义,借助纤维支气管镜对吸入性损伤局部进行吸引、刷洗、灌注等治疗的临床效果。结论纤维支气管镜在诊断治疗吸入性损伤中有其特殊地位和普及应用的必要性。     

内镜激光流量计诊断和定量分析吸入性损伤的有效方法

吸入性损伤的诊断,临床上主要依靠病史,~(133)X_e扫描及气管镜虽可帮助诊断并能大大提高诊断的准确性,但需要特殊的条件,限制了广泛开展。通过纤维支气管镜,对吸入性损伤可进行形态学观察,但对损伤程度仍不能做定量分析。吸入性损伤特征之一是气管、支气管粘膜充血,因而激光流量计可以通过测定气管、支气管组织的血流量变化进行诊断、分析。用双腔Carlen导管分别对羊(7只)左、右肺通气。     

支气管肺泡灌洗治疗重度吸入性损伤16例

重度吸入性损伤是烧伤早期死亡率高和影响预后的一个重要因素 ,及时诊断和治疗是救治成功的关键。 1996年 1月以来 ,我院共收治重度吸入性损伤 16例 ,利用纤维支气管镜进行支气管肺泡灌洗 (ＢＡＬ) ,取得了较好的临床效果 ,报告如下。1.临床资料 :本组 16例 ,其中男性 14例、女     

喉烧伤的监测和诊断

目的　探讨喉烧伤的早期诊治、急性喉梗阻的预防及处理时机和治疗方法选择问题。方法　用纤维喉镜对１８ 例喉烧伤患者进行了连续观察,监测喉的各解剖部位的充血、水肿和水泡的发展和运动功能的变化以及对通气功能的影响。结果　观察表明,依据呼吸道解剖范围而制定的吸入性损伤的严重程度分类并不能反映喉局部烧伤的严重程度。在镜下根据三个易导致喉梗阻的危险部位的变化：声门裂狭窄、会厌肿胀、喉咽腔内襞的水泡,对喉烧伤的严重程度进行了分析,将喉烧伤分为三型,以指导临床治疗。结论　明确吸入性损伤中喉烧伤的诊断,可正确选择治疗方法、确定手术时机,使急性喉梗阻得以缓解,降低吸入性损伤早期死亡率     

喉烧伤的监测和诊断

目的探讨喉烧伤的早期诊治、急性喉梗阻的预防及处理时机和治疗方法选择问题。方法用纤维喉镜对18例喉烧伤患者进行了连续观察,监测喉的各解剖部位的充血、水肿和水泡的发展和运动功能的变化以及对通气功能的影响。结果观察表明,依据呼吸道解剖范围而制定的吸入性损伤的严重程度分类并不能反映喉局部烧伤的严重程度。在镜下根据三个易导致喉梗阻的危险部位的变化:声门裂狭窄、会厌肿胀、喉咽腔内襞的水泡,对喉烧伤的严重程度进行了分析,将喉烧伤分为三型,以指导临床治疗。结论明确吸入性损伤中喉烧伤的诊断,可正确选择治疗方法、确定手术时机,使急性喉梗阻得以缓解,降低吸入性损伤早期死亡率。     

吸入性损伤患者床旁纤维支气管镜检查的护理配合

吸入性损伤在烧伤患者中较为常见,其病情复杂,病死率高。纤维支气管镜（纤支镜）检查为正确诊断及评估吸入性损伤的严重程度提供了重要依据。现将我科75例吸入性损伤患者床旁纤支镜检查护理配合经验报告如下。     

纤维支气管镜在吸入性损伤的应用

吸入性损伤是当前烧伤的主要死亡原因之一。为了进一步观察了解吸入性损伤后患者的呼吸道损伤程度,自1997年2月～2000年11月我科对收治的大面积烧伤合并吸入性损伤的患者应用纤维支气管镜进行检查治疗,报告如下。 1 临床资料 1.1 一般资料:本组8例吸入性损伤,其中男性7例,女1例,平均烧伤面积36.4±15.5％,Ⅲ度烧伤为23.8±11.3％。8例患者中死亡2例,死亡率占25％。其中死于多脏器功能衰竭1例,死于气管内大出血1例。 1.2 临床特点:本组8例均有密闭空间烧伤史,6例火焰     

应用纤维支气管镜活检术诊断早期吸入性损伤

就应用纤维支气管镜活检术诊断早期吸入性损伤的价值进行了研究。无凝血功能障碍的各类烧伤患者130例。在发生烧伤后尽快进行纤维支气管镜检查,其中伤后12h以前检查者为31.5％,12～24h为32.3％,24～48h为29.2％,深部组织活检一律于右侧支气管壁施行。     

气管内黏膜移植治疗早期吸入性损伤的初步观察

吸入性损伤死亡高，是临床治疗的难题。笔从切（削）痂 植皮手术进行创面修复中得到启示。试图采用清创 黏膜移植的方式修复早期气道 创面，并通过动物实验探讨吸入性损伤黏膜移植的可行性，黏膜来源，手术方式及效果，旨在为吸入性损伤的治疗寻找新方法。     

Inhalation injury--an increasing problem

Inhalation injury is a common complication of thermal accidents occurring in one-third of patients burned. The routine use of fiberoptic bronchoscopy on all patients incurring thermal burns provides an accurate and safe means for diagnosis. Although complications for inhalation injury are common, the mortality can be reduced by early diagnosis and attention to careful fluid resuscitation, aggressive pulmonary therapy and the avoidance of prophylatic steroids.     

Smoke inhalation injury: diagnosis and respiratory management

Smoke inhalation is a significant comorbid factor following major thermal injury. Smoke exposure is only a trigger for the sequence of events responsible for the development of inhalation injury. Noxious chemicals generated by incomplete combustion injure the exposed bronchoepithelium and stimulate the release of chemical mediators that cause a progressive inflammatory process. Airway inflammation and pulmonary edema impair gas exchange and increase the susceptibility to pulmonary infection. Earlier diagnosis and treatment of inhalation injury is an important element to improve the clinical course of severe burn patients. The American Burn Association, however, recently concluded that there are insufficient data to support a treatment standard for the diagnosis of inhalation injury. At present, the diagnosis of inhalation injury is supported by the combination of history, physical examination, bronchoscopy, and laboratory findings For accurate diagnosis of inhalation injury, helical CT scanning and examination to detect activated leukocytes in bronchoalveolar lavage fluid may be warranted. In the respiratory management of inhalation injury, repeated removal of pseudomembrane by fiberoptic bronchoscopy and the use of adequate PEEP to avoid airway obstruction are essential. High-frequency percussive ventilation can be a suitable mode of ventilation for inhalation injury.     

Virtual bronchoscopy for diagnosis of inhalation injury in burnt patients

Virtual bronchoscopy using a multislice CT scanner, is a new non-invasive imaging technique and its utility in the diagnosis of inhalation injury in burnt patients has not been reported in literature yet. Initial experience of technique is encouraging and it merits more interest. It overcomes many of the limitations of the presently established procedure of fibreoptic bronchoscopy. Ten burned patients with clinical suspicion of inhalation injury underwent this investigation and in eight of these the diagnosis was confirmed.     

Inhalation injury in burn patients: Establishing the link between diagnosis and prognosis

This study was to re-evaluate inhalation injury as a prognostic factor in burn patients and to determine the factors that should be considered when refining the definition of inhalation injury. A total of 192 burn patients (152 men, 40 women; mean age, 46.1 ± 13.8 years) who were suspected to have an inhalation injury and underwent bronchoscopy between January 2010 and June 2012 were included in this prospective observational study. All patients underwent bronchoscopy within 24 h of sustaining the burn. The bronchoscopic findings were classified as normal, mild, moderate, and severe. Mechanical ventilation was administered, when required. Age, percentage of TBSA burned, ABSI score, requirement of mechanical ventilation and PF ratio, but not inhalation injury, COHb level, and bronchoscopic grades, significantly differed between the survivors and non-survivors (p < 0.05). Mechanical ventilation (adjusted odds ratio [OR]: 9.787) and severe inhalation injury on bronchoscopy (adjusted OR: 45.357) were independent predictors of mortality on multivariate logistic regression analysis. Inhalation injury diagnosed through history does not predict mortality from burns. Other components such as severity of inhalation injury determined using bronchoscopy, and administration of mechanical ventilation might help predict the morbidity and mortality of burn patients with inhalation injury and all of the factors should be considered when the definition of inhalation injury is refined.     

Fiber-optic bronchoscopic classification of inhalation injury: prediction of acute lung injury

Background: Fiber-optic bronchoscopy is widely used for the early diagnosis of inhalation injury. However, there is no current bronchoscopic classification of inhalation injury for the prediction of acute lung injury (ALI). Our goal was to devise such a classification.Methods: Between February 1993 and January 2002, 167 patients with highly suspicious inhalation injuries were collected. All patients received fiber-optic bronchoscopy within 24 h after their accident. In total, 108 patients were diagnosed as positive under direct inspection. The patients were divided into three groups (G₁, G₂, and G₃) according to the depth of mucosal damage. Six patients were found to be positive by biopsy and were assigned to group Gb. Of these 114 positive cases, 27 developed ALI. Meanwhile, 53 patients were diagnosed as negative; these patients were assigned to group G₀.Results: After analysis, the following results were noted: G₀ (n = 53), two ALI (3.8%); G₁ (n = 49), two ALI (4%); G₂ (n = 46), 15 ALI (33%); G₃(n = 13),10 ALI (77%); Gb (n = 6), no ALI. We discovered that the deeper the mucosal injuries, the higher the rate of ALI. There were no deaths related to the procedure.Conclusions: Fiber-optic bronchoscopy is a safe and effective method for the early diagnosis of inhalation injuries. Also, it is a good predictor of ALL.We hope that in the near future, this classification will serve as a treatment guideline for the early prevention of ALI. The more severe the damage, the more alert clinicians need to be to improve the patients chances for survival.     

Assessment of fiberoptic bronchoscopic examination in inhalation injury--analysis of 32 cases

68 times of fiberoptic bronchoscopic serial examinations in 32 patients with inhalation injury were performed at early stage after injury. Bronchoscopic abnormalities including congestion, erythema, edema and necrosis were observed. Patients were divided into three groups according to the degree of damage: mild, moderate and severe. 8 patients with mild inhalation injury, their bronchoscopic abnormalities included slight congestion and edema, these changes extended to the carina with disappearance of the trachea rings, airway lumen was slight narrowed, carina was blunted, these lesions were resolved within one week after injury. The fiberoptic bronchoscopy of patients with moderate injury showed moderate congestion and edema of mucosa of the trachea, disappearance of the trachea rings, the lumen was more narrowed as compared with mild injury. The blunted carina widen to 0.5 cm due to swelling, the mucosa of primary bronchus showed slight congestion and edema. These lesions were resolved 2 weeks after injury. The fiberoptic bronchoscopic abnormalities of 13 patients with severe inhalation injury were extreme congestion and edema of the trachea mucosa with necrosis; hemorrhage and ulceration of the mucosa were seen. The trachea lumen was significantly narrowed, the carina widened to 1 cm, and even the primary bronchus mucosa manifested moderate congestion and edema with necrosis. However, secondary bronchus mucosa was only slightly damaged. All lesions resolved about three weeks after injury. The results of the fiberoptic bronchoscopy correlated with the clinical course, blood gas analysis, as well as the prognosis.     

Fibreoptic bronchoscopy in routine clinical practice in confirming the diagnosis and treatment of inhalation burns

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.     

Pulmonary injury in burned patients

Inhalation injury has emerged as the number one cause of fatality in the burn patient. Fiberoptic bronchoscopy and 133Xe scanning complement traditional clinical signs of inhalation injury and have led to discovery of a higher incidence of these injuries among patients with burns. Patients with inhalation injury typically demonstrate three stages: acute pulmonary insufficiency, pulmonary edema, and bronchopneumonia, all of which carry at least 50 per cent mortality rates. The major early pathophysiologic changes in the lungs of burned patients are related to upper-airway obstruction and lower-airway permeability edema. Treatment consists of intubation for signs of respiratory distress, pulmonary toilet, humidification of inspired air, and antibiotics for documented infection.