J A Carr1, N Crowley2. 1. Hurley Medical Center, One Hurley Plaza, Flint, MI, 48503, USA. heartandbones@yahoo.com. 2. Hurley Medical Center, One Hurley Plaza, Flint, MI, 48503, USA.
Abstract
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.
RCT Entities:
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.
Authors: Atul C Mehta; Udaya B S Prakash; Robert Garland; Edward Haponik; Leonard Moses; William Schaffner; Gerard Silvestri Journal: Chest Date: 2005-09 Impact factor: 9.410