Pneumonia Clinical Trial
Official title:
Prophylactic Bronchoscopy After Inhalation Injury in Burn Patients
The investigators hypothesize that the scheduled use of bronchoscopy on a regular basis after inhalation injury in burn patients will improve outcome by providing pulmonary hygiene, decrease the incidence of pneumonia, and detect pneumonia earlier than standard treatment without bronchoscopy.
The role of bronchoscopy in most hospitals has been limited to obtaining lavage fluid for
culture and assessing the degree of airway injury, which has been shown to be predictive of
outcome. Severe inhalation injury, which is characterized by pulmonary edema, bronchial
edema, and secretions, can occlude the airway and lead to atelectasis and pneumonia.
Aggressive use of bronchoscopy is highly effective in removing foreign particles and
accumulated secretions that worsen the inflammatory response and impede ventilation. While
it seems intuitive that bronchoscopy would improve pulmonary hygiene by removing secretions
and denuded epithelial slough in burn patients, there has not been any published data to
support or deter the use of bronchoscopy for inhalation injury nor document an improvement
in morbidity or mortality secondary to bronchoscopy as a therapeutic intervention.
Recent research has shown that the process of intubation for mechanical ventilation provides
a portal for bacterial contamination, after which the damaged tracheobronchial mucosa
quickly becomes colonized with pathogenic organisms in over 50% of the patients.
Furthermore, within 15 minutes of smoke inhalation, there is significant airway edema and
thickening, more prominently in the lower trachea than the upper portion. These factors
place the patient with inhalation injury at high risk for pneumonia.
We have used the National Burn Repository data to previously show that patients who receive
aggressive use of bronchoscopy after inhalation injury have an improved outcome in terms of
decreased ventilator days, decreased ICU length of stay, decreased incidence of pneumonia,
and a trend towards improved mortality. However, that data was unable to document why. It
was also unable to confirm that the findings were not due to institutional bias. Therefore,
one of the conclusions from that study was that a prospective trial is needed to confirm the
findings.
Our hypothesis is that a scheduled and sequential use of bronchoscopy after inhalation
injury as a therapeutic tool to remove secretions, slough, carbonaceous material, and screen
for the early detection of pneumonia by bronchoalveolar lavage (BAL) will improve outcome.
We will attempt to document this improvement by using the following endpoints: length of ICU
stay, length of hospital stay, ventilator days, incidence of pneumonia, overall morbidity
and mortality with and without bronchoscopy.
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Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment
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