Severe Tracheobronchial Sequalae Following Inhalation Injury

We report a case of severe airway sequelae following inhalation injury. A 52 years old male was transferred to our hospital because of severe inhalation injury. Acute respiratory failure was treated by frequent tracheobronchial lavage using bronchofiberscope (BFS) under Pressure Support Ventilation with PEEP and superimposed high frequency jet ventilation. Severe tracheal stenosis and endobronchial multiple granuloma (polyposis) developed after one month. Life-threatening tracheal stenosis was treated by Nd-YAG Laser coagulation, and a silicone stent was inserted against recurrent stenosis up to the 693rd day. Endobronchial multiple granuloma subsided spontaneously following cicatrizational stenosis. After about one year from his admission, an ectatic change gradually developed in the peripheral bronchus and pulmonary fibrosis. The etiology of these airway sequelae were considered to be related to the destroyed basal membrane of the airways, and to the prolonged accompanying inflammation. The frequency of the sequelaelike cicatrizaional stenosis, inflammatory granuloma, peripheral bronchoectasia, pulmonary fibrosis will increase, as treatment in the acute phase improves. In cases of severe inhalation injury, it is important to investigate airway sequelae over a long follow-up period, and BFS is the most valuable means not only for treatment but also for investigation.