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Application of flexible bronchoscopy in inhalation lung injury

Chong Bai1, Haidong Huang1, Xiaopeng Yao1, Shihui Zhu2, Bing Li3, Jingqing Hang4, Wei Zhang1, Paul Zarogoulidis56*, Andreas Gschwendtner7, Konstantinos Zarogoulidis6, Qiang Li1* and Michael Simoff8

Author affiliations

1 Department of Respiratory Medicine, Changhai Affiliated Hospital of the Second Military Medical University, Shanghai 200433, China

2 Department of Burn, Changhai Affiliated Hospital of the Second Military Medical University, Shanghai 200433, China

3 Department of Respiratory Medicine, Changzheng Affiliated Hospital of the Second Military Medical University, Shanghai 200003, China

4 Department of Respiratory Medicine, Shanghai Putuo District People’s Hospital, Shanghai 200060, China

5 Pulmonary Department, ``G. Papanikolaou´´ General Hopspital, Aristotle University of Thessaloniki, Thessaloniki, Greece

6 Department of Interventional Pneumology, Ruhrlandklinik, West German Lung Center, University Hospital, University Duisburg-Essen, Essen, Germany

7 Pathology Department, Hospital of Amberg, Amberg, Germany

8 Henry Ford Hospital, Pulmonary and Critical Care Medicine, Detroit, MI 48202, USA

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Citation and License

Diagnostic Pathology 2013, 8:174  doi:10.1186/1746-1596-8-174

Published: 21 October 2013



As acute inhalational injury is an uncommon presentation to most institutions, a standard approach to its assessment and management, especially using flexible bronchoscopy, has not received significant attention.


The objective of this study is to evaluate the value of using flexible bronchoscopy as part of the evaluation and management of patients with inhalational lung injury. Twenty-three cases of inhalational lung injury were treated in our three hospitals after a fire in a residential building. The twenty cases that underwent bronchoscopy as part of their management are included in this analysis. After admission, the first bronchoscopy was conducted within 18-72 hours post inhalational injury. G2-level patients were reexamined 24 hours after the first bronchoscopy, while G1-level patients were reexamined 72 hours later. Subsequently, all patients were re-examined every 2-3 days until recovered or until only tunica mucosa bronchi congestion was identified by bronchoscopy.


Twenty patients had airway injury diagnosed by bronchoscopy including burns to the larynx and glottis or large airways. Bronchoscopic classification of the inhalation injury was performed, identifying 12 cases of grade G1 changes and 8 cases of grade G2. The airway injury in the 12 cases of grade G1 patients demonstrated recovery in 2-8 days, in the airway injury of the 8 cases of grade G2 patients had a prolonged recovery with airway injury improving in 6-21 days averaged. The difference in recovery time between the two groups was significant (P <0.05).


The use of flexible bronchoscopy has great value in the diagnosis of inhalational injury without any complications. Its use should be incorporated into clinical practice.

Virtual slides

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Bronchoscopy; Inhalation; Smoke