Smoke inhalation injury: bronchoscopy findings
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Smoke inhalation injury: bronchoscopy findings . Hiroshi Imamura, MD, PhD . Katsunori Mochizuki, MD, Kenichi Nitta, MD, PhD . PhD Michitaro Ichikawa, MD, PhD Received: 9 June 2020 / Revised: 17 June 2020 / Accepted: 20 June 2020 Ó Canadian Anesthesiologists’ Society 2020
A 64-yr-old man with no significant medical history presented with smoke inhalation after extinguishing a fire. He had soot deposits on the face, no cutaneous burns, a headache, and was without a sore throat or stridor. Initial chest radiography showed no significant changes. The carboxyhemoglobin level was 24%, consistent with carbon monoxide poisoning. Wheezing was present for the first 12 h after admission, and the patient was intubated on day 2 of hospitalization because of further respiratory deterioration. Laryngoscopy revealed soot deposits around the vocal cords. Repeat chest radiography showed bilateral opacities consistent with inhalation injury. This was also confirmed via bronchoscopy that revealed
carbonaceous deposits and edema of the large airways. Sequential bronchoscopy revealed ischemia and mucous membrane necrosis on day 3 (Figure, panel A); epithelium desquamation, necrosis, and erosion on day 5 (Figure, panel B); tenacious secretions and erythema on day 9 (Figure, panel C); and eventual resolution by day 12 (Figure, panel D). The patient was extubated on day 14 and discharged on day 28. At discharge, he had no symptoms except for a minor cough. Although bronchoscopy may be useful in pulmonary clearance, the value of immediate removal of debris visible on bronchoscopic examination has not been shown.1 Nevertheless, flexible bronchoscopy notably enables
K. Nitta, MD, PhD (&) H. Imamura, MD, PhD K. Mochizuki, MD, PhD M. Ichikawa, MD, PhD Shinshu University, Matsumoto, Japan e-mail: [email protected]
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K. Nitta et al. Figure (A) Flexible bronchoscopic image of the trachea showing ischemia and mucous membrane necrosis at the carina on day 3 after smoke inhalation injury caused by a fire. (B) Bronchoscopic image showing epithelium desquamation, necrosis, and erosion at the bifurcation of the left main bronchus on day 5. (C) Bronchoscopic image showing tenacious secretions and erythema at the carina on day 9. (D) Bronchoscopic image showing the near-complete resolution of the inhalational injury at the carina by day 12
physicians to identify the extent2 and healing process of an injury,3 and then remove the debris in cases of smoke inhalation injury without burns. Disclosures
None.
Funding statement
None.
Editorial responsibility This submission was handled by Dr. Hilary P. Grocott, Editor-in-Chief, Canadian Journal of Anesthesia.
References 1. Sheridan RL. Fire-related inhalation injury. N Engl J Med 2016; 375: 464-9. 2. Kawecki M, Wro´blewski P, Sakiel S, et al. Fibreoptic bronchoscopy in routine clinical practice in confirming the diagnosis and treatment of inhalation burns. Burns 2007; 33: 554-60. 3. Arakawa A, Fukamizu H, Hashizume I, et al. Macroscopic and histological findings in the healing p
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