Burns Inhalation Injury

Abstract

Abstract Summary Burn-related inhalation injury refers to damage to the respiratory tract and/or lung parenchyma by heat, smoke, or chemical irritants. Burn inhalation injury also causes systemic toxicity by toxic gases (particularly carbon monoxide, CO; and hydrogen cyanide, HCN). Anything more than mild injury is associated with increased mortality in critically ill burn patients. Bronchoscopy confirms diagnosis, defines the severity, and aids therapeutic airway clearance. Treatment of inhalation injury is mainly supportive: securing a definitive airway early, protective mechanical ventilation, airway clearance strategies, surveillance for pulmonary infection, inhalation strategies of 4-hourly inhaled heparin, and N-acetylcysteine plus bronchodilators. Post-recovery respiratory sequelae require follow-up. Future therapeutic strategies may address the complex pathophysiology that involves control of the inflammatory, oxidative stress and coagulation pathways, and their effects on the respiratory tract at the molecular level. A simple, validated prognostic tool that incorporates standardized grades of bronchoscopic images would be desirable in the future.