Point-of-care endoscopic optical coherence tomography detects changes in mucosal thickness in ARDS due to smoke inhalation and burns Jae Hyek Choi a, b, * , Li-Dek Chou c , Teryn R. Roberts a, b , Brendan M. Beely a, b , Daniel S. Wendorff a, b , Mark D. Espinoza b , Kyle Sieck a, b , Alexander T. Dixon a, b , David Burmeister b , Bryan S. Jordan b , Matthew Brenner c , Zhongping Chen c , Corina Necsoiu b , Leopoldo C. Cancio b , Andriy I. Batchinsky a, b a The Geneva Foundation, Tacoma WA, United States b United States Army Institute of Surgical Research, JBSA Ft. Sam Houston, TX, United States c Beckman Laser Institute, University of California Irvine, Irvine, CA, United States a b s t r a c t Background: The prevalence of acute respiratory distress syndrome (ARDS) in mechanically ventilated burn patients is 33%, with mortality varying from 11 –46% depending on ARDS severity. Despite the new Berlin definition for ARDS, prompt bedside diagnosis is lacking. We developed and tested a bedside technique of fiberoptic-bronchoscopy-based optical coherence tomography (OCT) measurement of airway mucosal thickness (MT) for diagnosis of ARDS following smoke inhalation injury (SII) and burns. Methods: 16 female Yorkshire pigs received SII and 40% thermal burns. OCT MT and PaO 2 -to- FiO 2 ratio (PFR) measurements were taken at baseline, after injury, and at 24, 48, and 72h after injury. Results: Injury led to thickening of MT which was sustained in animals that developed ARDS. Significant correlations were found between MT, PFR, peak inspiratory pressure (PIP), and total infused fluid volume. Conclusions: OCT is a useful tool to quantify MT changes in the airway following SII and burns. OCT may be effective as a diagnostic tool in the early stages of SII-induced ARDS and should be tested in humans. © 2018 Elsevier Ltd and ISBI. All rights reserved. a r t i c l e i n f o Article history: Accepted 15 October 2018 Available online xxx Keywords: Acute respiratory distress syndrome Smoke inhalation injury Burns Optical coherence tomography Bronchoscopy 1. Introduction Smoke inhalation injury (SII) is diagnosed in 10 –35% of patients admitted into burn units. Of the patients with SII, almost 40% subsequently develop pneumonia [1,2]. Presence of SII increases mortality by 20% over that predicted by age and burn size alone, and by up to 60% when pneumonia is also present [1]. The prevalence of ARDS in mechanically ventilated burn patients is about 33%, with mortality varying from 11 –46% * Corresponding author at: United States Army Institute of Surgical Research, 3600 Rawley E. Chambers Avenue, Building 3611, Ft. Sam Houston, Texas, 78209, United States E-mail address: jae-hyek.choi.ctr@mail.mil (J.H. Choi). https://doi.org/10.1016/j.burns.2018.10.014 0305-4179/© 2018 Elsevier Ltd and ISBI. All rights reserved. b u r n s x x x ( 2 0 1 8 ) x x x – x x x JBUR 5685 No. of Pages 9 Please cite this article in press as: J.H. Choi, et al., Point-of-care endoscopic optical coherence tomography detects changes in mucosal thickness in ARDS due to smoke inhalation and burns, Burns (2018), https://doi.org/10.1016/j.burns.2018.10.014 Available online at www.sciencedirect.com ScienceDirect jo u rn al h o mep age: w ww .elsevier .co m /loc ate/b u rn s