Fiberoptic Bronchoscopy in the Evaluation of Acute Chest and Upper Airway Trauma: Outcome
We found that FFB was useful in identifying other abnormalities encountered in trauma. Ongoing distal hemorrhage representing pulmonary contusion was found in 13 percent (seven) of our patients. In two patients, this prompted the placement of a doublelumen endotracheal tube and in one the placement of a Fogarty balloon catheter for tamponade. Aspirated material was found in 6 percent (three patients), and mucous plugging and thick secretions were found in 15 percent (eight patients). The importance of evaluation of the upper trachea, larynx, and supraglottic region was emphasized in our series. Fourteen percent of the positive findings involved this area. Angood et al have previously advocated the liberal use of FFB in the evaluation and management of injuries to the larynx and cervical trachea. In addition, these investigators noted the importance of performing bronchoscopy at the time of extubation in patients who had blind intubation done in the acute trauma setting, as 15 percent of their patients had laryngeal injury discovered in this way. avandia generic
The nature of trauma to the chest and upper airway involves a wide spectrum and range of severity of injuries from trivial to lethal. The retrospective nature of this study limits our ability to make many conclusions. The decision to perform bronchoscopy was made by the surgeon managing the patient. This surgeon could have been a surgical resident or an attending staff physician, and thus the experience and clinical judgment of the surgeon deciding on bronchoscopy was highly variable. Therefore, we were unable to produce a meaningful total or control number of patients with trauma to compare to our group. Understanding these limitations, we have compared our two groups of patients who underwent bronchoscopy within or after three days of the trauma.