(114) Evaluation and Bronchoscope Categorization of Inhalation Injury in an Intensive Care Unit in Mexico

Introduction: Early identification , categorization , and management of airway injury secondary to thermal insult are important for comprehensive management of severe burn patients . Over the years, the mortality of this group of patients has not been able to decrease despite scientific advances. and there are few studies carried out in our country, since we have few specialized centers in the management of severe burns.

Methods: Patients admitted to the emergency department with suspected inhalation injury in the period from January 2022 to July 2023, who underwent diagnostic bronchoscopy within the first 24 hours of admission . hospital in the intensive care unit . Mechanism of injury and the signs and symptoms that led to protecting the airway were collected . The objective of the study was to evaluate the sensitivity and specificity of signs of inhalation injury and, secondarily, to evaluate the number and type of complications of bronchoscopy performed by intensivists

Results: During the study period, the data of 41 patients recruited in the study protocol were collected, of which 39 were analyzed. Regarding the burned body surface, 25.9% of the patients had burns of more than 50% of the total body surface and 33% patients that affected 31 to 40% of the total body surface. The most sensitive signs and symptoms correspond to facial burns (100% sensitivity) and burned vibrizas (89.4%), being not very specific. The signs and symptoms with greater specificity correspond to altered alertness (100%), dysphobia (87.5%), carbonaceous sputum (87.5%), and cough (87.5%). The risk of presenting the different clinical findings and having an inhalation injury was calculated. Burnt vibrizas showed a strong association with an OR 0.96 (CI 0.8-1.04). A total of 55 bronchoscopies were performed, only 5 complications occurred, which were resolved in the first 24 hours and were not associated with outcomes missed at 30 days

Conclusions: It was concluded the existence of two different categories of signs and symptoms in the differentiation of the presence of inhalation injury. They can be classified into highly sensitive but not very specific signs, such as facial and respiratory tract burns, and highly specific but not very sensitive symptoms, such as altered consciousness, hoarseness, carbonaceous sputum, and cough