gms | German Medical Science

Background: Inhalation injury is an important determinant of outcome in patients with major burns. However diagnostic criteria remain imprecise, which prevents comparisons of published data and analysis of the impact of inhalation injury on outcome. The study aims to evaluate the applicability of an inhalation score based on mucosal caustic injury diagnosis. It includes separate assessment of the oro-pharyngeal sphere (ENT) and tracheobronchial tree (TB) in burn patients admitted to the ICU with a suspicion of inhalation injury.

Methods: Prospective observational study in 168 patients admitted to the burn-ICU of a university teaching hospital. One hundred patients suspect of inhalation injury underwent an endoscopic airway assessment. ENT/TB lesion grading was 1. edema, hyperemia, hypersecretion, 2. bullous mucosal detachment, erosion, exudates, 3. profound ulcers, necrosis.

Results: Of the 100 examined patients (age 42±17y, burns 23±19% BSA), 79 patients presented an ENT inhalation injury >ENT1 (soot present in 24%): 36 had a tracheo-bronchial extension, 33 having a grade >TB1. Ten patients without burned vibrissae suffered an ENT inhalation injury suggesting that burned vibrissae are not a reliable sign for inhalation injury. Length of mechanical ventilation was significantly correlated with the presence of inhalation injury (p=0.03).

Conclusions: This new inhalation injury score was directly applicable and simple to use in daily management of burn patients, providing a unified language between the different specialists involved. A first prognostic impact could be demonstrated. Further multicentric studies are required to validate the score.