The acute pulmonary inflammatory response to the graded severity of smoke inhalation injury*

Abstract

Objective To determine if the graded severity of smoke inhalation is reflected by the acute pulmonary inflammatory response to injury. Design In a prospective observational study we assessed the bronchoalveolar lavage fluid (BALF) for both leukocyte differential and concentration of 28 cytokines, chemokines, and growth factors. Results were then compared to the graded severity of inhalation injury as determined by Abbreviated Injury Score criteria (0: None, 1: Mild, 2: Moderate, 3: Severe, 4: Massive). Setting All patients were enrolled at a single tertiary burn center. Patients The BALF was obtained from 60 patients within 14 hours of burn injury who underwent bronchoscopy for suspected smoke inhalation. Interventions None. Measurements and Main Results Those who presented with worse grades of inhalation injury had higher plasma levels of carboxyhemoglobin and enhanced airway neutrophilia. Patients with the most severe inhalation injuries also had a greater requirement for tracheostomy, longer time on the ventilator, and a prolonged stay in the intensive care unit. Of the 28 inflammatory mediators assessed in the BALF, 21 were at their highest in those with the worst inhalation injury scores (Grades 3 and 4), the greatest of which was interleukin (IL)-8 (92,940 pg/ml, Grade 4). When compared in terms of low inhalation injury (Grades 1–2) versus high inhalation injury (Grades 3–4), we found significant differences between groups for IL-4, IL-6, IL-9, IL-15, interferon-γ, granulocyte-macrophage colony-stimulating factor, and monocyte chemotactic protein-1 (p<0.05 for all). Conclusions These data reveal that the degree of inhalation injury: 1) has basic and profound effects on burn patient morbidity; 2) evokes complex changes of multiple alveolar inflammatory proteins; and 3) is a determinant of the pulmonary inflammatory response to smoke inhalation. Accordingly, future investigations should consider inhalation injury to be a graded phenomenon.

Indications and Efficacy of Fiberoptic Bronchoscopy in the ICU: Have They Changed Since Its Introduction in Clinical Practice?

“…This series demonstrates a high level of utility of FOB, and complications, when present, were minor. Although diagnosis of VAP and treatment of atelectasis are the most common indications for bronchoscopy in the ICU, there are others such as hemoptysis, difficult airway intubation, and inhalational airway injury assessment that require a timely procedure [18][19][20]. VAP diagnosis requires BAL or protected brush sampling, techniques that imply some proficiency to obtain the highest sensitivity and specificity [21].…”

Pulmonary cytokine composition differs in the setting of alcohol use disorders and cigarette smoking

“…Acellular BAL fluid was used in assays to assess differences in cytokine/chemokine/growth factors within the alveolar space using a multiplex bead array (Bio-Rad Laboratories, Hercules, CA) according to manufacturer instructions and as previously described by our own laboratories (2,16). Multiplex bead array cytokines, chemokines, and growth factors included: IL-1␤, IL-1RA, IL-2, IL-4, IL-5, IL-6, IL-7, IL-8, IL-9, IL-10, IL-12, IL-13, IL-15, IL-17, eotaxin, fibroblast growth factor (FGF), granulocyte colony stimulating factor, granulocyte-monocyte colony stimulating factor, interferon (IFN)-␥, IFN-␥-induced protein 10 (IP-10, also known as CXCL10), monocyte chemotactic protein-1 (also known as CCL2), macrophage inflammatory protein (MIP)-1␣ (also known as CCL3), MIP-1␤ (also known as CCL4), platelet-derived growth factor, regulated and normal T cell expressed and secreted (RANTES, also known as CCL5), TNF-␣, and VEGF.…”

Mécanismes de toxicité des fumées d’incendie (monoxyde de carbone et cyanures exclus)

“…À l'inverse, chez les patients brûlés ayant inhalé des gaz toxiques, la fibroscopie peut faciliter l'intubation en pré-sence de lésions des voies aériennes supérieures, permettre une toilette bronchique en éliminant les débris muqueux et les sécrétions riches en suie difficiles à mobiliser et prédire le risque de décès des suites d'un SDRA [17,18]. Le profil proinflammatoire des cytokines mesurées dans le plasma ou le liquide de lavage bronchoalvéolaire de ces patients reflète la gravité des lésions bronchopulmonaires d'inhalation et est étroitement corrélé au pronostic final [18,19]. Néanmoins, une franche hyporéponse immune initiale à l'agression thermique semble associée à une évolution fatale [20].…”