Journal article
Bronchoscopy-Derived Correlates of Lung Injury following Inhalational Injuries: A Prospective Observational Study
PloS one, Vol.8(5), pp.e64250-e64250
05/17/2013
DOI: 10.1371/journal.pone.0064250
PMCID: PMC3656836
PMID: 23691180
Abstract
Background: Acute lung injury (ALI) is a major factor determining morbidity following burns and inhalational injury. In experimental models, factors potentially contributing to ALI risk include inhalation of toxins directly causing cell damage; inflammation; and infection. However, few studies have been done in humans.
Methods: We carried out a prospective observational study of patients admitted to the NC Jaycees Burn Center who were intubated and on mechanical ventilation for burns and suspected inhalational injury. Subjects were enrolled over an 8-month period and followed till discharge or death. Serial bronchial washings from clinically-indicated bronchoscopies were collected and analyzed for markers of cell injury and inflammation. These markers were compared with clinical markers of ALI.
Results: Forty-three consecutive patients were studied, with a spectrum of burn and inhalation injury severity. Visible soot at initial bronchoscopy and gram negative bacteria in the lower respiratory tract were associated with ALI in univariate analyses. Subsequent multivariate analysis also controlled for % body surface area burns, infection, and inhalation severity. Elevated IL-10 and reduced IL-12p70 in bronchial washings were statistically significantly associated with ALI.
Conclusions: Independently of several factors including initial inhalational injury severity, infection, and extent of surface burns, high early levels of IL-10 and low levels of IL-12p70 in the central airways are associated with ALI in patients intubated after acute burn/inhalation injury. Lower airway secretions can be collected serially in critically ill burn/inhalation injury patients and may yield important clues to specific pathophysiologic pathways.
Details
- Title: Subtitle
- Bronchoscopy-Derived Correlates of Lung Injury following Inhalational Injuries: A Prospective Observational Study
- Creators
- Samuel W. Jones - University of North Carolina at Chapel HillHaibo Zhou - University of North Carolina at Chapel HillShiara M. Ortiz-Pujols - University of North Carolina at Chapel HillRobert Maile - University of North Carolina at Chapel HillMargaret Herbst - University of North Carolina at Chapel HillBenny L. Joyner - University of North Carolina at Chapel HillHongtao Zhang - University of North Carolina at Chapel HillMatthew Kesic - University of North Carolina at Chapel HillIlona Jaspers - University of North Carolina at Chapel HillKathleen A. Short - University of North Carolina HospitalsAnthony A. Meyer - University of North Carolina at Chapel HillDavid B. Peden - University of North Carolina at Chapel HillBruce A. Cairns - University of North Carolina at Chapel HillTerry L. Noah - University of North Carolina at Chapel Hill
- Resource Type
- Journal article
- Publication Details
- PloS one, Vol.8(5), pp.e64250-e64250
- DOI
- 10.1371/journal.pone.0064250
- PMID
- 23691180
- PMCID
- PMC3656836
- NLM abbreviation
- PLoS One
- ISSN
- 1932-6203
- eISSN
- 1932-6203
- Publisher
- Public Library Science
- Number of pages
- 7
- Grant note
- P30ES010126 / UNC Center for Environmental Health and Susceptibility Center for Environmental Medicine UL1RR02574 / National Institutes of Health [North Carolina TraCS Institute NIH] Asthma and Lung Biology at the University of North Carolina at Chapel Hill T32ES007126 / NATIONAL INSTITUTE OF ENVIRONMENTAL HEALTH SCIENCES; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Institute of Environmental Health Sciences (NIEHS) CR83346301 / United States Environmental Protection Agency through cooperative agreement; United States Environmental Protection Agency
- Language
- English
- Date published
- 05/17/2013
- Academic Unit
- Surgery
- Record Identifier
- 9984756264702771
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