Smoke inhalation injuries

Abstract

Up to a third of all victims of major burns suffer smoke-related injury and may die as a result of inhalation injury. The management of the upper airway depends on a thorough understanding of the mechanisms of injury, including carbon monoxide toxicity, thermal injury, and smoke inhalation. Establishing and maintaining an airway for resuscitation requires a high index of suspicion, as early and severe upper airway swelling may preclude safe intubation under direct vision. Nasotracheal intubation is preferred in burn patients but is only indicated for patients in acute respiratory distress and a select group at high risk for developing progressive upper airway compromise and pulmonary injury. The use of the flexible bronchoscope and nasopharyngoscope is a safe and effective means of evaluating the respiratory tract and assisting in pulmonary therapy. Early tracheotomy is indicated only in rare cases because of increased morbidity and mortality in burn patients. The use of steroids is still controversial and is probably indicated only for refractory bronchospasm or secretions. Aggressive evaluation and management of inhalation burns will reduce the mortality rate of a frequently fatal injury.