Prophylactic sequential bronchoscopy after inhalation injury: results from a three-year prospective randomized trial

Objective

That the prophylactic, sequential use of bronchoscopy after inhalation injury as a therapeutic tool to remove secretions and carbonaceous material and to screen for the early detection of pneumonia will improve outcome.

Methods

A three-year prospective randomized trial at a regional burn center.

Results

Thirty-three patients with inhalation injury requiring mechanical ventilation were admitted over three years. The bronchoscopy group had a higher initial carboxyhemoglobin level at 11.9 % (95 % CI ± 9.6 %) versus the control group at 9.9 % (95 % CI ± 5.7 %, p = 0.7). There was no difference in the incidence of pneumonia between groups (p = 0.6). There was a trend toward fewer days of antibiotic use in the bronchoscopy group, at 4.5 days (95 % CI ± 4.5 days) versus 9.3 days (95 % CI ± 7.1 days, p = 0.3). Fewer patients were treated with antibiotics in the bronchoscopy group (4/13, 31 %) versus the control group (9/15, 60 %, p = 0.1). There was a statistically significant difference in the morbidity that favored the bronchoscopy group (3/13, 23 %) over the control group (9/15, 60 %, p = 0.04). There was no statistically significant difference between the two groups in days of mechanical ventilation (bronchoscopy 5.1 days, 95 % CI ± 3.6 days, control 6.7 days, 95 % CI ± 6.3 days, p = 0.7), ICU days (bronchoscopy 10 days, 95 % CI ± 10 days, control 18 days, 95 % CI ± 12 days, p = 0.4), and hospital days (bronchoscopy 21 days, 95 % CI ± 12 days, control 26 days, 95 % CI ± 12 days, p = 0.5), although the trends favored the bronchoscopy group for all of the endpoints.

Conclusions

In conclusion, this program of scheduled, sequential bronchoscopy after inhalation injury showed several strong trends towards less morbidity, fewer days of mechanical ventilation, and a shorter length of stay. There was also a strong trend towards less antibiotic use and a shorter duration of treatment. This data is promising and should promote a larger, multi-institutional trial in the future.