First-day computed tomography: does it has a role in the assessment of patients with inhalation lung injury?

• Published in: The Egyptian Journal of Bronchology 2023-12, Vol.17 (1), p.18-13, Article 18
• Main Authors: Megahed, Mohammad A., Elhelbawy, Rana H., Agha, Mohammed A., Abdelatty, Nehad B., El-Koa, Amal A., El-Kalashy, Mai M.
• Format: Article
• Language: English
• Subjects: Bronchial wall thickening; Bronchoscopy; Computed tomography; Creatinine; Critical Care Medicine; Hemoglobin; Inhalation injury; Injuries; Intensive; Laboratories; Males; Medical imaging; Medicine; Medicine & Public Health; Patients; Pneumology/Respiratory System; Radiologist score; Tomography; Ventilators
• ISSN: 2314-8551; 1687-8426; 2314-8551
• DOI: 10.1186/s43168-023-00191-9

Background Inhalation lung injury occurs in almost one-third of all serious burns and is responsible for a considerable proportion of burn patient fatalities each year. History of closed space fire or unconsciousness at the accident site, occurrence of pharyngeal or facial burns, hoarseness, and wheezing, and laboratory tests that include blood gas abnormalities or Carboxyhemoglobin levels in blood ˃ 10% are used to diagnose inhalation lung injury. It is also characterized by radiological findings of alveolar or interstitial edema, atelectasis, and/or consolidations, as well as the presence of erythema with laryngeal or tracheal edema in the bronchoscope. Objectives To study the diagnostic and prognostic efficacy of radiologist score and bronchial wall thickening as radiological CT findings in inhalation lung injury. Methods This prospective case–control study included 48 patients with inhalation lung injury (ILI) as a case group and 10 patients without ILI were selected as the control group, all recruited from the burn and plastic department. Within the first 12 h of suspected ILI, a fiberoptic bronchoscope was done to confirm the diagnosis. An initial chest X-ray was done followed by computed tomography through which the radiologist score (RADS) together with bronchial wall thickening (BWT) was done. Results Duration of ventilation was higher in cases than in controls (8.50 ± 3.94 vs 3.25 ± 0.50). The hospital duration was higher in cases than in controls (13.6 ± 4.68 vs9.50 ± 4.52). The BWT was 2.12 ± 0.66 (mean ± SD) in the ILI group while the control group was 1.32 ± 0.48 (mean ± SD). Correlating between baseline PaO2 and RADS score and BWT, it was found that there was a highly significant negative correlation between PaO2 and RADS score and BWT among inhalation lung injury patients ( P value 0.001). The sensitivity of BWT in the detection of the need for mechanical ventilation was 83% at a cut-off point of 1.65. Its specificity was 78% and accuracy 75%. Conclusion CT done within 24 h of burn patients has a good role in the diagnosis and management of ILI from the burn.