Diagnosis and management of inhalation injury: an updated review.

Patrick F Walker,Jonathan B Lundy,Leslie A Wood,Kevin K Chung,Michelle F Buehner,Leopoldo C Cancio,Nathan L Boyer,Ian R Driscoll

doi:10.1186/s13054-015-1077-4

Abstract

In this article we review recent advances made in the pathophysiology, diagnosis, and treatment of inhalation injury. Historically, the diagnosis of inhalation injury has relied on nonspecific clinical exam findings and bronchoscopic evidence. The development of a grading system and the use of modalities such as chest computed tomography may allow for a more nuanced evaluation of inhalation injury and enhanced ability to prognosticate. Supportive respiratory care remains essential in managing inhalation injury. Adjuncts still lacking definitive evidence of efficacy include bronchodilators, mucolytic agents, inhaled anticoagulants, nonconventional ventilator modes, prone positioning, and extracorporeal membrane oxygenation. Recent research focusing on molecular mechanisms involved in inhalation injury has increased the number of potential therapies.

Highlights

Despite important advances in the care of patients with inhalation injury, which continues to be largely supportive, morbidity and mortality remain high [1]
For example, that smoke inhalation injury contributes to a hypercoagulable state in the lung by inducing plasminogen activator inhibitor 1 and stabilizing its mRNA [16]
We found that the detection of inhalation injury on bronchoscopy was associated with an 8.3-fold increase in the composite endpoint

Summary

Introduction

Despite important advances in the care of patients with inhalation injury, which continues to be largely supportive, morbidity and mortality remain high [1]. The resultant inflammatory response may cause higher fluid resuscitation volumes, progressive pulmonary dysfunction, prolonged ventilator days, increased risk of pneumonia, and acute respiratory distress syndrome (ARDS) [2, 3]. Pathophysiology Inhalation injury complicates burns in approximately 10 to 20 % of patients and significantly increases morbidity and mortality [2,3,4,5].

Results

Conclusion