Dilution Is Not Always the Solution: A Retrospective Study of Pulmonary Lavage in Inhalation Injury

Burned patients with inhalation injury commonly undergo bronchoscopy, at times with pulmonary lavage (PL). We characterized the outcomes of burned patients with inhalation injury who underwent PL at a single burn center in a retrospective cohort study. We included all adult patients admitted between July 1, 2015 to June 30, 2023 who were on the ventilator and diagnosed with inhalation injury. Chemical inhalation, grade 0 inhalation injury, and diagnosis of inhalation injury without bronchoscopy were excluded. Demographics, burn size and anatomic location, and hospital course information were collected. Chi-square and Fisher's exact tests were used to compare categorical variables, and continuous variables were compared using the Mann-Whitney U test. Multivariate analyses were performed to identify variables associated with outcomes. P < .05 was considered significant. One hundred sixteen patients were included; 37 (31.9%) underwent PL. Univariate analysis showed no significant differences in age, total body surface area burned (TBSA) second or third degree TBSA, complication rates, or in-hospital mortality between the no-PL and PL groups. Patients in the PL group had increased ventilator days (6 [2.5-15.5] vs. 2 [1-6], P < .001) and hospital length of stay (LOS) (12 [4-37.5] vs. 5 [2-18], P = .003). Multivariate analysis showed that PL was associated with an increase in ventilator days (OR = 1.84 [1.14-2.98], P = .013), hospital LOS (OR = 1.717 [1.080-2.730], P = .022), and sepsis (OR = 7.216 [1.106-47.080], P = .039). In conclusion, PL was associated with longer ventilator days, longer LOS, and increased risk of sepsis.