Dilution Is Not Always the Solution: A Retrospective Study of Pulmonary Lavage in Inhalation Injury

稀释并非总是解决之道:吸入性损伤肺灌洗的回顾性研究

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Abstract

Burned patients with inhalation injury commonly undergo bronchoscopy, at times with pulmonary lavage (PL). We characterized the outcomes of burned patients with inhalation injury who underwent PL at a single burn center in a retrospective cohort study. We included all adult patients admitted between July 1, 2015 to June 30, 2023 who were on the ventilator and diagnosed with inhalation injury. Chemical inhalation, grade 0 inhalation injury, and diagnosis of inhalation injury without bronchoscopy were excluded. Demographics, burn size and anatomic location, and hospital course information were collected. Chi-square and Fisher's exact tests were used to compare categorical variables, and continuous variables were compared using the Mann-Whitney U test. Multivariate analyses were performed to identify variables associated with outcomes. P < .05 was considered significant. One hundred sixteen patients were included; 37 (31.9%) underwent PL. Univariate analysis showed no significant differences in age, total body surface area burned (TBSA) second or third degree TBSA, complication rates, or in-hospital mortality between the no-PL and PL groups. Patients in the PL group had increased ventilator days (6 [2.5-15.5] vs. 2 [1-6], P < .001) and hospital length of stay (LOS) (12 [4-37.5] vs. 5 [2-18], P = .003). Multivariate analysis showed that PL was associated with an increase in ventilator days (OR = 1.84 [1.14-2.98], P = .013), hospital LOS (OR = 1.717 [1.080-2.730], P = .022), and sepsis (OR = 7.216 [1.106-47.080], P = .039). In conclusion, PL was associated with longer ventilator days, longer LOS, and increased risk of sepsis.

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