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Key Features

  • Among patients treated for burn injuries, 33% also have pulmonary injury from smoke inhalation

  • Inhalation injury occurs as a result of impaired oxygenation, thermal injury to the upper airway, and lung injury to the lower airways and lung parenchyma

Clinical Findings

  • Bronchorrhea and bronchospasm are seen early after exposure along with dyspnea, tachypnea, and tachycardia

  • Labored breathing and cyanosis may follow

  • Diffuse wheezing and rhonchi

  • Acute respiratory distress syndrome (ARDS) may develop 1–2 days after exposure

  • Sloughing of the airway mucosa may occur in 2–3 days, leading to airway obstruction, atelectasis, and worsening hypoxemia

  • Bacterial colonization and pneumonia are common 5–7 days after exposure

  • Complications become evident by 18–24 hours and include

    • Mucosal edema, upper airway obstruction, and impaired ability to clear secretions, all of which produce inspiratory stridor

    • Respiratory failure in severe cases

Diagnosis

  • Arterial blood gases (ABGs) are necessary to evaluate oxygenation and rule out carbon monoxide poisoning

  • Examination of the upper airway with a laryngoscope or bronchoscope is superior to physical examination

Treatment

  • Supplemental oxygen, humidified air, bronchodilators, and suctioning of mucosal debris and secretions, elevation of the head to 30 degrees, topical epinephrine

  • Endotracheal intubation often necessary to establish airway patency and likely needed with deep facial burns or oropharyngeal or laryngeal edema; tracheostomy should be avoided

  • Positive end-expiratory pressure has been advocated when there is pulmonary edema

  • Fluid management and close monitoring for secondary bacterial infection with daily sputum Gram stains

  • Helium-oxygen (Heliox) helpful if labored breathing

  • Corticosteroids may be harmful

  • Monitoring for bacterial infection is important, but prophylactic antibiotics are not recommended

  • Close monitoring with ABGs and oximetry

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