Bronchoscopic phenotypes of airway injury across burn severity: Mechanisms, classification, and clinical implications
Year: 2026
Type: article
Abstract: Burn-associated inhalation injury remains a major determinant of morbidity and mortality after thermal trauma, and bronchoscopy plays a central role in the direct assessment of airway injury. However, substantial heterogeneity persists in the interpretation of bronchoscopic findings across different injury severities. This structured narrative review examines bronchoscopic phenotypes in burn-related airway injury, with emphasis on underlying pathophysiologic mechanisms, current classification systems, severity stratification, temporal evolution, age-related modifiers, prognostic evidence, and clinical implications. English-language literature published from 2000 through 2025 was identified through topic-focused searches in Semantic Scholar and backward and forward reference-chain searching. Sources addressing bronchoscopic findings, grading systems, age-related variation, temporal changes, multimodal correlation, prognosis, and management were considered, and the evidence was synthesized qualitatively. The review was not designed as a systematic review or meta-analysis. Bronchoscopic findings encompass a continuum ranging from soot deposition, mild erythema, and limited edema to ulceration, mucosal sloughing, necrotic debris, cast formation, and airway obstruction, reflecting the interplay of thermal, chemical, inflammatory, and mechanical processes. Although existing grading systems facilitate communication and clinical and research stratification, their inter-rater reliability and ability to predict outcomes are variable. Interpretation of bronchoscopic phenotypes should therefore consider the timing of bronchoscopy, patient age, burn burden, pulmonary physiology, imaging findings, and the broader clinical trajectory. A phenotype-based framework may improve description, risk stratification, and multidisciplinary communication; however, bronchoscopic appearance should not be used as an isolated prognostic or treatment rule. Future priorities include standardized image acquisition and terminology, external validation of grading systems, age-sensitive assessment, and prospective evaluation of imaging-assisted and computational approaches.
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
OpenAlex ID: W7223570836