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Kim, Kim, Shin, Chae, Choi, Shin, Park, Lee, Bahn, Park, Kim, Lee, Hyun, and Jung: The Findings of Pulmonary Function Test in Patients with Inhalation Injury
Original Article
Tuberculosis and Respiratory Diseases

Tuberculosis and Respiratory Diseases 2006; 60(6): 653-662.

Published online: 30 June 2006

DOI: https://doi.org/10.4046/trd.2006.60.6.653

The Findings of Pulmonary Function Test in Patients with Inhalation Injury

Jong Yeop Kim, M.D., Cheol Hong Kim, M.D., Hyun Won Shin, M.D., Young Je Chae, M.D., Chul Young Choi, M.D., Tae Rim Shin, M.D., Yong Bum Park, M.D., Jae Young Lee, M.D., Joon-Woo Bahn, M.D., Sang Myeon Park, M.D., Dong-Gyu Kim, M.D., Myung Goo Lee, M.D., In-Gyu Hyun, M.D., Ki-Suck Jung, M.D.

Department of Internal Medicine, Hallym University College of Medicine, Seoul, Korea.

Address for correspondence: In-Gyu Hyun, M.D. Department of Internal Medicine, Hallym University Hangang Sacred Heart Hospital, 94-200 Yeoungdeungpo-dong, Yeoungdeungpo-gu, Seoul, 150-020, Korea. Phone: 02-2639-5001, Fax: 02-2677-9756, ighyun@hallym.ac.kr

Received 14 February 2006       Accepted 5 June 2006

Copyright © 2006 The Korean Academy of Tuberculosis and Respiratory Diseases

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.

Keywords: Burn, Inhalation, Pulmonary function test

Figures and Tables

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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Table 1
Demographic characteristics in burn patients with inhalation injury (n=37)
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Values are means±standard deviation.

TBSA, total body surface area; COHb, carboxyhemoglobin

Table 2
Initial findings* of pulmonary function test after inhalation injury
trd-60-653-i002

Values are means±standard deviation.

*:post-burn 6 day(2-56), †: 23 patients

FVC, forced vital capacity; FEV1, forced expiratory volume in 1 second; FEF25-75%, forced expiratory flow rate between 25% and 75%; PEF, peak expiratory flow; MVV, maximum voluntary ventilation; DLco, diffusing capacity of the lung for carbon monoxide,

Table 3
Follow-up Findings* of Pulmonary Function Test after Inhalation Injury
trd-60-653-i003

Values are means±standard deviation.

*:post-burn 59 day (31-264), †:6 patients

FVC, forced vital capacity; FEV1, forced expiratory volume in 1 second; FEF25-75%, forced expiratory flow rate between 25% and 75%; PEF, peak expiratory flow; MVV, maximum voluntary ventilation; DLco, diffusing capacity of the lung for carbon monoxide.

Table 4
Clinical outcomes and Chest X-ray findings in patients with inhalation injury
trd-60-653-i004

*: 1 closure after resolved and 1 tracheal stenosis, †: including ground glass appearance, bronchial attenuation, bronchial thickening, consolidation, atelectasis, edema, bronchiectasis.

Appendix 1
Bronchoscopic grades for inhalation injury13
trd-60-653-a001

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