Karen Anne Claridad 1, Albert Albay1, Pacifico Armando Cruz1, Isabel Luisa Acosta1
1Philippine General Hospital, Philippines
Inhalation injury is associated with significant morbidity and mortality among thermally injured patients. Along with age and percent total body surface area (TBSA) involvement, inhalation injury is a significant predictor of death. We present a case of a 42 year old male who came in for burn injury involving 35% TBSA. RT PCR for SARS‐COV‐2 taken on admission was positive. Baseline chest radiograph showed no active lung parenchymal infiltrates. Arterial blood gas showed PaO2/FiO2 ratio of 232. Fiberoptic bronchoscopy (FOB) was done post‐burn day 0 and revealed widespread plaque and soot formation with sloughed off mucosae in the trachea, carina and all bronchopulmonary segments. The severity of inhalation injury on the initial FOB was massive based on the Abbreviated Injury Score (AIS). Lavage with six vials of N‐acetylcysteine (NAC) was done. Repeat FOB on post‐burn day 1 showed markedly reduced adherent plaque and soot. Subsequent chest radiographs on post‐burn day 1, 2 and 4 remained unremarkable. PaO2/FiO2 ratio were 160, 167 and 261 respectively. Patient however expired on post‐burn day 6 from septic shock secondary to invasive burn wound infection. No relevant literature or evidence‐based guidelines were identified regarding NAC instillation during bronchoscopy for inhalation injury. Whether NAC lavage in this patient with massive inhalation injury has prevented the development of acute respiratory distress syndrome (ARDS) and pneumonia is still controversial. Indeed, the value of this approach are to be questioned by authors but evidence to disprove this is still lacking. Our case report adds to the limited literature on this.
