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Inhalation injury — Clinical Guidelines

Overview

Inhalation injury involves damage to the respiratory tract due to smoke, heat, or chemical exposure, often complicating burn injuries and leading to significant pulmonary dysfunction and increased mortality. 2

Diagnosis

Clinical Presentation: Symptoms include respiratory distress, cough, and hypoxemia.

Diagnostic Tests: Bronchoscopy and imaging (chest X-ray, CT) are essential.

Grading: Utilizes Abbreviated Injury Score (AIS) with low-grade (AIS 1-2) and high-grade (AIS 3-4) injury classifications. 2

Management

Initial Support: Aggressive fluid resuscitation and mechanical ventilation as needed.

Ventilatory Strategies: Conventional ventilation; high-frequency percussive ventilation (HFPV) may improve gas exchange in refractory cases. 4

Infection Control: Early identification and treatment of pneumonia with appropriate antibiotics.

Monitoring: Frequent assessment for multiple organ dysfunction syndrome (MODS) and acute respiratory distress syndrome (ARDS). 2

Special Populations

No Specific Guidance: Abstracts do not provide detailed management insights for pregnancy, pediatrics, elderly, or specific comorbidities related to inhalation injury. 3

Key Recommendations

Assess Severity Early: Evaluate inhalation injury severity using AIS to guide management intensity (Evidence: Moderate 2).

Aggressive Fluid Resuscitation: Initiate promptly to address increased fluid requirements in high-grade injuries (Evidence: Moderate 2).

Consider Advanced Ventilation: For patients with refractory respiratory failure, consider high-frequency percussive ventilation (Evidence: Weak 4).

Prevent and Treat Infections: Actively monitor and manage pulmonary infections to reduce complications (Evidence: Moderate 2).

Monitor for MODS and ARDS: Closely monitor patients for signs of multiple organ dysfunction syndrome and acute respiratory distress syndrome (Evidence: Moderate 2).

References

1 Sindiani AM, Alkhatatbeh MJ, Abdul-Razzak KK. Hot Flashes in Adolescence and Young Adult Females: a Link to Vitamin D and Calcium. Medical archives (Sarajevo, Bosnia and Herzegovina) 2022. link 2 Sutton T, Lenk I, Conrad P, Halerz M, Mosier M. Severity of Inhalation Injury is Predictive of Alterations in Gas Exchange and Worsened Clinical Outcomes. Journal of burn care & research : official publication of the American Burn Association 2017. link 3 Brooks SM. Prospective and management: acute nonimmunologic inhalation injuries. Journal of occupational and environmental medicine 2013. link 4 Reper P, Dankaert R, van Hille F, van Laeke P, Duinslaeger L, Vanderkelen A. The usefulness of combined high-frequency percussive ventilation during acute respiratory failure after smoke inhalation. Burns : journal of the International Society for Burn Injuries 1998. link00037-5) 5 Barrow DM, Blehm KD. A predictive model for vapor concentration in a nose-only inhalation chamber. American Industrial Hygiene Association journal 1990. link

Inhalation injury