Fiberoptic bronchoscopy in acute inhalation injury.

Fiberoptic bronchoscopy proved to be a simple, safe, and accurate method of diagnosing acute inhalation injury. Both the anatomic level and the severity of large airway injury were easily identified. The identification of a supraglottic and infraglottic component to inhalation injury was not only helpful in determining the appropriate therapy but also in predicting ultimate pulmonary complications. When bronchoscopy was used in conjunction with the 133Xenon scintiphotoscan, both large and small airway injuries could be identified. The only clinical situation where bronchoscopy failed to identify an inhalation injury was in the immediate postburn period if the patient wasin hypovolemic shock. In this particular clinical circumstance the characteristic mucosal alterations may be absent; yet if bronchoscopy is performed after hypovolemic shock has been corrected, mucosal changes characteristic of inhalation injury will be seen.