Inhalation injury: evaluation and management in a burn unit.

Abstract

In the period from 1974 through 1976, there were 243 patients treated in the Evanston Hospital Burn Unit. Seventy-eight of these patients, representing 33% of the total admissions, sustained significant inhalation injury. The overall mortality of the Burn Unit for the three-year period was 19%. The mortality rate for patients sustaining inhalation injury was 42%. House fires were the most common cause of inhalation injury, and the history of sustaining a flame burn in an enclosed space is most important. Physical assessment emphasizes singeing of the nasal hairs, the presence of soot in the mouth and hypopharynx, and the finding of wheezing on auscultation of the chest. Elevated blood carboxyhemoglobin (HbCO) values can signal the extent of exposure. Our current policy is to perform flexible fiberoptic bronchoscopy on all patients with known or suspected inhalation injury immediately upon admission to the Burn Unit. Endoscopic findings are of great value in defining the degree of inhalation injury, in predicting the course of the individual patient, and in planning patient management. Intravenous amino-phylline is administered to those patients with wheezing. If gross ulceration, significant edema about the glottis, or large quantities of soot are noted on admission, then pharmacologic doses of corticosteroids are given intravenously for up to 48 hours. Tracheal intubation is performed if edema about the glottis threatens airway obstruction. Those patients who required ventilator support and/or tracheostomy did poorly. Major emphasis is placed on adequate respiratory support with vigorous care directed toward mobilizing tracheobronchial secretions. Nasotracheal intubation is preferred over tracheostomy, and such intubation can usually be performed with an adequate diameter tube to permit proper tracheobronchial toilet, if the flexible fiberoptic bronchoscope is used.