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The acute pulmonary inflammatory response to the graded severity of smoke inhalation injury. Crit Care Med 2012 Apr;40(4):1113-21

Date

11/10/2011

Pubmed ID

22067627

Pubmed Central ID

PMC3290689

DOI

10.1097/CCM.0b013e3182374a67

Scopus ID

2-s2.0-84858776579   62 Citations

Abstract

OBJECTIVES: To determine whether the graded severity of smoke inhalation is reflected by the acute pulmonary inflammatory response to injury.

DESIGN: In a prospective observational study, we assessed the bronchoalveolar lavage fluid for both leukocyte differential and concentration of 28 cytokines, chemokines, and growth factors. Results were then compared to the graded severity of inhalation injury as determined by Abbreviated Injury Score criteria (0, none; 1, mild; 2, moderate; 3, severe; 4, massive).

SETTING: All patients were enrolled at a single tertiary burn center.

PATIENTS: The bronchoalveolar lavage fluid was obtained from 60 patients within 14 hrs of burn injury who underwent bronchoscopy for suspected smoke inhalation.

INTERVENTIONS: None.

MEASUREMENTS AND MAIN RESULTS: Those who presented with worse grades of inhalation injury had higher plasma levels of carboxyhemoglobin and enhanced airway neutrophilia. Patients with the most severe inhalation injuries also had a greater requirement for tracheostomy, longer time on the ventilator, and a prolonged stay in the intensive care unit. Of the 28 inflammatory mediators assessed in the bronchoalveolar lavage fluid, 21 were at their highest in those with the worst inhalation injury scores (grades 3 and 4), the greatest of which was interleukin-8 (92,940 pg/mL, grade 4). When compared in terms of low inhalation injury (grades 1-2) vs. high inhalation injury (grades 3-4), we found significant differences between groups for interleukin-4, interleukin-6, interleukin-9, interleukin-15, interferon-γ, granulocyte-macrophage colony-stimulating factor, and monocyte chemotactic protein-1 (p < .05 for all).

CONCLUSIONS: These data reveal that the degree of inhalation injury has basic and profound effects on burn patient morbidity, evokes complex changes of multiple alveolar inflammatory proteins, and is a determinant of the pulmonary inflammatory response to smoke inhalation. Accordingly, future investigations should consider inhalation injury to be a graded phenomenon.

Author List

Albright JM, Davis CS, Bird MD, Ramirez L, Kim H, Burnham EL, Gamelli RL, Kovacs EJ

Author

Christopher Stephen Davis MD, MPH Assistant Professor in the Surgery department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Adult
Aged
Bronchoalveolar Lavage Fluid
Chemokines
Cytokines
Female
Humans
Injury Severity Score
Male
Middle Aged
Pneumonia
Severity of Illness Index
Smoke Inhalation Injury
Treatment Outcome
jenkins-FCD Prod-482 91ad8a360b6da540234915ea01ff80e38bfdb40a