Inhalation Injury

Abstract

Inhalation injury is defined as airway or pulmonary parenchymal injury caused by inhalation of smoke, toxin and chemical gases. Frequently, it results from inhalation of smoke and incomplete products of combustion. The mortality and morbidity of burn patients increase with the damaging effect of inhalation injury. Lung injury from smoke inhalation can be caused by chemical and thermal insults. In the early period, the upper airway obstruction may develop due to chemical or direct thermal injury. Pathophysiological changes in the lung associated with inhalation injury result from inhalation of incomplete products of combustion. Pulmonary oedema, hypoxia, ventilation-perfusion mismatching, increased airway resistance, decreased pulmonary compliance, increased pulmonary vascular resistance, and atelectasis occur due to inhalation injury. The risk of infection (pneumonia) is increased and consequently, acute respiratory disease syndrome (ARDS) may occur. Some clinical symptoms and signs are suggestive and fiberoptic bronchoscopy may be diagnostic. For treatment, sufficient oxygenation and patency of airway must be provided. Therapeutic coughing, chest physiotherapy, airway suctioning with nasotracheal aspiration or bronchoscopy have been effective in the removal of retained secretions. Medical treatment includes administration of bronchodilators, racemic epinephrine, mucolytics and analgesic drugs. Another important issue is sufficient fluid resuscitation. In conclusion, the objective of the management is maintaining the respiratory care and thus the morbidity and mortality associated with inhalation injury can be reduced.