Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + Download Section PDF Listen ++ For further information, see CMDT Part 9-29: Smoke Inhalation + Key Features Download Section PDF Listen +++ ++ 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 Download Section PDF Listen +++ ++ 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 Download Section PDF Listen +++ ++ 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 Download Section PDF Listen +++ ++ 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 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