Tuberc Respir Dis.  2006 Jun;60(6):653-662. 10.4046/trd.2006.60.6.653.

The Findings of Pulmonary Function Test in Patients with Inhalation Injury

• Kim JY
• Kim CH
• Shin HW
• Chae YJ
• Choi CY
• Shin TR
• Park YB
• Lee JY
• Bahn JW
• Park SM
• Kim DG
• Lee MG
• Hyun IG
• Jung KS

• KMID: 1630804
• DOI: http://doi.org/10.4046/trd.2006.60.6.653

Abstract

BACKGROUND: The changes in the pulmonary function observed in burn patients with an inhalation injury are probably the result of a combination of airway inflammation, chest wall and muscular abnormalities, and scar formation. In addition, it appears that prolonged ventilatory support and an episode of pneumonia contribute to the findings. This study investigated the changes in the pulmonary function in patients with inhalation injury at the early and late post-burn periods.
METHODS
From August 1, 2002, to August 30, 2005, surviving burn patients who had an inhalation injury were enrolled prospectively. An inhalation injury was identified by bronchoscopy within 48hours after admission. Spirometry was performed at the early phase during admission and the recovery phase after discharge, and the changes in the pulmonary function were compared.
RESULTS
37 patients (M=28, F=9) with a total burn surface area (% TBSA), ranging from 0 to 18%, were included. The initial PaO2/FiO2ratio and COHb were 286.4+/-129.6 mmHg and 7.8+/-6.6 %. Nine cases (24.3%) underwent endotracheal intubation and 3 cases (8.1%) underwent mechanical ventilation. The initial X-ray findings revealed abnormalities in, 18 cases (48.6%) with 15 (83.3%) of these being completely resolved. However, 3 (16.7%) of these had residual sequela. The initial pulmonary function test, showed an obstructive pattern in 9 (24.3%) with 4 (44.4%) of these showing a positive bronchodilator response, A restrictive pattern was also observed in 9 (24.3%) patients. A lower DLco was observed in only 4 (17.4%) patients of which 23 had undergone DLco. In the follow-up study, an obstructive and restrictive pattern was observed in only one (2.7%) case each. All the decreased DLco returned to mormal.
CONCLUSIONS
Most surviving burn patients with an inhalation injury but with a small burn size showed initial derangements in the pulmonary function test that was restored to a normal lung function during the follow up period.

Keyword

Burn; Inhalation; Pulmonary function test

MeSH Terms

Bronchoscopy
Burns
Cicatrix
Follow-Up Studies
Humans
Inflammation
Inhalation*
Intubation, Intratracheal
Lung
Pneumonia
Prospective Studies
Respiration, Artificial
Respiratory Function Tests*
Spirometry
Thoracic Wall

Figure

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  Figure 1 Bronchoscopy performed 1 day after inhalation injury showed some soots and hemorrhagec spots in trachea (A) and right upper lobes (B), in 54 years old female patient

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  Figure 2 Correlation between bronchoscopic grades for inhalation injury and initial pulmonaty function tests; % predicted values of FVC, FEV1, FEF25-75% and PEF, FVC, forced vital capacity; FEV1, forced expiratory volume in 1 second; FEF25-75, forced expiratory flow rate between 25% and 75%; REF, peak expiratory flow, Gr, grade.

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  Figure 3 The changes of obstructive and restrictive patterns according to initial and follow-up spirometric values. Mod, moderate; BDR, bronchodilator response.

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