Abstract
Smoke inhalation may cause thermal injury to the upper airways, chemical injury to the tracheobronchial tree, and systemic poisoning with carbon monoxide or hydrogen cyanide. Inhalation injury, a determinant of mortality in burn patients, requires management from a multidisciplinary team and consultation with a burn center. Early diagnosis and immediate treatment of associated life-threatening conditions may improve outcome. Flexible bronchoscopy remains the current standard for diagnosis of inhalation injury. Treatment is largely supportive, and the keys to therapy are ensuring a patent airway and to prevent worsening of the inhalation injury.
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References
Ahuja RB, Gibran N, Greenhalgh D, et al. ISBI practice guidelines for burn care. Burns. 2016;42(5):953–1021. https://doi.org/10.1016/j.burns.2016.05.013.
Walker PF, Buehner MF, Wood LA, et al. Diagnosis and management of inhalation injury: an updated review. Crit Care. 2015;19(1) https://doi.org/10.1186/s13054-015-1077-4.
Endorf FW, Gamelli RL. Inhalation injury, pulmonary perturbations, and fluid resuscitation. J Burn Care Res. 2007;28(1):80–3. https://doi.org/10.1097/bcr.0b013e31802c889f.
Bai C, Huang H, Yao X, et al. Application of flexible bronchoscopy in inhalation lung injury. Diagn Pathol. 2013;8(174):1–5. https://doi.org/10.1186/1746-1596-8-174.
Foster KN, Holmes JH. Inhalation Injury. J Burn Care Res. 2017;38(3):137–41. https://doi.org/10.1097/bcr.0000000000000539.
Reid A, Ha JF. Inhalational injury and the larynx: a review. Burns. 2019;45(6):1266–74. https://doi.org/10.1016/j.burns.2018.10.025.
Jones SW, Williams FN, Cairns BA, Cartotto R. Inhalation injury. Clin Plast Surg. 2017;44(3):505–11. https://doi.org/10.1016/j.cps.2017.02.009.
Dyamenahalli K, Garg G, Shupp JW, Kuprys PV, Choudhry MA, Kovacs EJ. Inhalation injury: unmet clinical needs and future research. J Burn Care Res. 2019;40(5):570–84. https://doi.org/10.1093/jbcr/irz055.
Trunkey DD. Inhalation injury. Surg Clin N Am. 1978;58(6):1133–40. https://doi.org/10.1016/s0039-6109(16)41681-6.
Chao K, Lin Y, Chiang C, Tseng C. Respiratory management in smoke inhalation injury. J Burn Care Res. 2019;40(4):507–12. https://doi.org/10.1093/jbcr/irz043.
Galvagno SM, Nahmias JT, Young DA. Advanced trauma life Support® update 2019. Anesthesiol Clin. 2019;37(1):13–32. https://doi.org/10.1016/j.anclin.2018.09.009.
American College of Surgeons; 2021. https://www.facs.org.
Advanced Burn Life Support Course, Provider Manual by ABLS Advisory Committee. American Burn Association 2017–2018. https://ameriburn.org.
Orozco-Peláez YA. Airway burn or inhalation injury. Colombian J Anesthesiol. 2018;46:26–31. https://doi.org/10.1097/cj9.0000000000000042.
Bittner E, Shank E, Woodson L, Martyn J. Acute and perioperative care of the burn-injured patient. Anesthesiology. 2015;122(2):448–64.
Costa Santos D, Barros F, Frazao M, Maia M. Pre-burn center management of the airway in patients with face burns. Ann Burns Fire Disasters. 2015;XXVII(4):259–63.
Dyson K, Baker P, Garcia N, et al. To intubate or not to intubate? Predictors of inhalation injury in burn-injured patients before arrival at the burn centre. Emerg Med Austr. 2020; https://doi.org/10.1111/1742-6723.13604.
Cai AR, Hodgman EI, Kumar PB, Sehat AJ, Eastman AL, Wolf SE. Evaluating pre burn center intubation practices. J Burn Care Res. 2017;38(1):e23–9. https://doi.org/10.1097/bcr.0000000000000457.
Otterness K, Ahn C. Emergency department management of smoke inhalation injury in adults. Emerg Med Pract. 2020;20(3):1–24.
Robinson L, Miller R. Smoke inhalation injuries. Am J Otolaryngol. 1986;7:375–80.
Gigengack RK, Cleffken BI, Loer SA. Advances in airway management and mechanical ventilation in inhalation injury. Curr Opin Anaesthesiol. 2020; Publish Ahead of Print.; https://doi.org/10.1097/aco.0000000000000929.
Ching JA, Ching Y-H, Shivers SC, Karlnoski RA, Payne WG, Smith DJ. An analysis of inhalation injury diagnostic methods and patient outcomes. J Burn Care Res. 2016;37(1):e27–32. https://doi.org/10.1097/bcr.0000000000000313.
Kim Y, Kym D, Hur J, et al. Does inhalation injury predict mortality in burns patients or require redefinition? PloS One. 2017;12(9):e0185195. https://doi.org/10.1371/journal.pone.0185195.
Mosier MJ, Pham TN, Park DR, Simmons J, Klein MB, Gibran NS. Predictive value of bronchoscopy in assessing the severity of inhalation injury. J Burn Care Res. 2012;33(1):65–73. https://doi.org/10.1097/BCR.0b013e318234d92f.
Ikonomidis C, Lang F, Radu A, Berger MM. Standardizing the diagnosis of inhalation injury using a descriptive score based on mucosal injury criteria. Burns. 2012;38(4):513–9. https://doi.org/10.1016/j.burns.2011.11.009.
Aung M, Garner D, Pacquola M, Rosenblum S, Cleland H, Pilcher D. The use of a simple three-level bronchoscopic assessment of inhalation injury to predict in-hospital mortality and duration of mechanical ventilation in patients with burns. Anaesth Intensive Care. 2018;46(1):67–73.
Hassan Z, Wong J, Bush J, Bayat A, Dunn K. Assessing the severity of inhalation injuries in adults. Burns. 2010;36(2):212–6. https://doi.org/10.1016/j.burns.2009.06.205.
Shirani K, Pruitt B, Mason A. The influence of inhalation injury and pneumonia on burn mortality. Ann Surg. 1987;205:82–7.
Dries D, Endorf F. Inhalation injury: epidemiology, pathology, treatment strategies. Scand J Trauma Resusc Emerg Med. 2013;12(31)
Romanowski KS, Palmieri TL, Sen S, Greenhalgh DG. More than one third of intubations in patients transferred to burn centers are unnecessary. J Burn Care Res. 2016;37(5):e409–14. https://doi.org/10.1097/bcr.0000000000000288.
Hogg G, Goswamy J, Khwaja S, Khwaja N. Laryngeal trauma following an inhalation injury: a review and case report. J Voice. 2017;31(3):388.e27–31. https://doi.org/10.1016/j.jvoice.2016.09.017.
Dingle LA, Wain RAJ, Bishop S, Soueid A, Sheikh Z. Intubation in burns patients: a 5-year review of the Manchester regional burns centre experience. Burns. 2020; https://doi.org/10.1016/j.burns.2020.07.019.
Mayglothling J, Duane T, Gibbs M, et al. Emergency tracheal intubation immediately following traumatic injury: an Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute Care Surg. 2012;5(Suppl 4):S333–40. https://doi.org/10.1097/TA.0b013e31827018a5.
Madnani D, Steele N, de Vries E. Factors that predict the need for intubation in patients with smoke inhalation injury. ENT-Ear Nose Throat J. 2006;85(4):278–80.
Badulak JH, Schurr M, Sauaia A, Ivashchenko A, Peltz E. Defining the criteria for intubation of the patient with thermal burns. Burns. 2018;44(3):531–8. https://doi.org/10.1016/j.burns.2018.02.016.
Apfelbaum JL, Hagberg CA, Connis RT, et al. 2022 American Society of Anesthesiologists practice guidelines for management of the difficult airway. Anesthesiology. 2022;136(1):31–81. https://doi.org/10.1097/ALN.0000000000004002.
Sheridan RL, Ingelfinger JR. Fire-related inhalation injury. N Engl J Med. 2016;375(5):464–9. https://doi.org/10.1056/NEJMra1601128.
Woodson L, Sherwood E, Kinsky M, Talon M, Martinello C, Woodson S. Anesthesia for burned patients. In: Herndon DN, editor. Total burn care. 5th ed. Elsevier Inc; 2018. p. 131–54.
Hemmes SN, Serpa Neto A, Schultz MJ. Intraoperative ventilatory strategies to prevent postoperative pulmonary complications: a meta-analysis. Curr Opin Anaesthesiol. 2013;26(2):126–33. https://doi.org/10.1097/ACO.0b013e32835e1242.
Sabri A, Dabbous H, Dowli A, Barazi R. The airway in inhalational injury: diagnosis and management. Ann Burns Fire Disasters. 2017;30(1):24–9.
Desai SR, Zeng D, Chong SJ. Airway management in inhalation injury: a case series. Singapore Med J. 2020;61(1):46–53. https://doi.org/10.11622/smedj.2019048.
Smollin C, Olson K. Carbon monoxide poisoning. In: Papadakis M, McPhee S, Rabow M, editors. Current medical diagnosis and treatment 2021. 60th ed. McGraw Hill; 2021.
Navar P, Saffle J, Warden G. Effect of inhalation injury on fluid resuscitation requirements after thermal injury. Am J Surg. 1985;150:716–20.
Patel B. Acute hypoxemic respiratory failure. Merck Manual Professional Version. Merck Sharp & Dohme Corp; 2020.
Enkhbaatar P, Pruitt BA, Suman O, et al. Pathophysiology, research challenges, and clinical management of smoke inhalation injury. Lancet. 2016;388(10052):1437–46. https://doi.org/10.1016/s0140-6736(16)31458-1.
Deutsch CJ, Tan A, Smailes S, Dziewulski P. The diagnosis and management of inhalation injury: An evidence based approach. Burns. 2018;44(5):1040–51. https://doi.org/10.1016/j.burns.2017.11.013.
Chung KK, Wolf SE, Renz EM, et al. High-frequency percussive ventilation and low tidal volume ventilation in burns: a randomized controlled trial. Crit Care Med. 2010;38(10):1970–7. https://doi.org/10.1097/CCM.0b013e3181eb9d0b.
Greenhalgh D. Steroids in the treatment of smoke inhalation injury. J Burn Care Res. 2009;30(1):165–9. https://doi.org/10.1097/BCR.0b013e3181923c08.
Herman J, Baram M. In the midst of turbulence, Heliox kept her alive. Ann Am Thorac Soc. 2017;14(3):452–5. https://doi.org/10.1513/AnnalsATS.201610-776CC.
Atkinson TM, Giraud GD, Togioka BM, Jones DB, Cigarroa JE. Cardiovascular and ventilatory consequences of laparoscopic surgery. Circulation. 2017;135(7):700–10. https://doi.org/10.1161/CIRCULATIONAHA.116.023262.
Carr J, Phillips B, Bowling W. The utility of bronchoscopy after inhalation injury complicated by pneumonia in burn patients: results from the National Burn Repository. J Burn Care Res. 2009;30:967–74. https://doi.org/10.1097/BCR.0b013e3181bfb77b.
Ziegler B, Hundeshagen G, Uhlmann L, et al. Impact of diagnostic bronchoscopy in burned adults with suspected inhalation injury. Burns. 2019;45(6):1275–82. https://doi.org/10.1016/j.burns.2019.07.011.
Woodson L. Diagnosis and grading of inhalation injury. J Burn Care Res. 2009;30(1):143–5. https://doi.org/10.1097/BCR.0b013e3181923b71.
Lam N, Hung T. ARDS among cutaneous burn patients combined with inhalation injury: early onset and bad outcome. Ann Burns Fire Disasters. 2019;32(1):37–42.
Bersten A, Bihari S. Acute respiratory distress syndrome. In: Bersten A, Handy J, editors. Oh’s intensive care manual. 8th ed. Elsevier Limited; 2019. p. 428–38.
Ainsworth CR, Dellavolpe J, Chung KK, Cancio LC, Mason P. Revisiting extracorporeal membrane oxygenation for ARDS in burns: a case series and review of the literature. Burns. 2018;44(6):1433–8. https://doi.org/10.1016/j.burns.2018.05.008.
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Rodriguez, A., McQuitty, A. (2023). Inhalation Injury. In: Lee, J.O. (eds) Essential Burn Care for Non-Burn Specialists. Springer, Cham. https://doi.org/10.1007/978-3-031-28898-2_5
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