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.