Inhalational Injury

Injury can occur due to inhalation of:

Hot gases
Rarely extend beyond the larynx, as gas is rapidly humidified and cooled by airway mucosa. Early intubation prior to laryngeal oedema formation is recommended.
Steam and liquids
Involve the lower airway as heat exchange mechanisms are insufficient.
Chemical smoke
Chemical injury and toxidromes from toxic smoke, classically due to exposure in a confined space.

Cyanide and carbon monoxide may both be produced during combustion, and may occur during inhalation in a confined space. They are covered in detail under Cyanide Toxicity and Carbon Monoxide.

Epidemiology and Risk Factors

Inhalational injury:

20% of burns
- 60% of facial burns

Pathophysiology

Toxic injury:

Tracheobronchial oedema
Cast formation
Small airway collapse
Hypoxic respiratory failure.

Aetiology

Clinical Features

History

Fuel
Enclosed
Risk of:
- CO toxicity
- CN poisoning
Duration
Loss of consciousness

Examination

All clinical signs are non-sensitive and non-specific.

Singed nasal hairs
Blisters in mouth
Voice changes/hoarseness
Sooty sputum

Diagnostic Approach and DDx

Investigations

Bedside:

Laboratory:

Imaging:

Other:

Management

Resuscitation:

Inflammation will get worse in the first few hours, particularly once fluid resuscitation commences.

A
- Secure airway if in doubt
  Especially in Australia, where retrieval times are long.
- Place a normal size tube
  Long duration of intubation is expected, and large ETT ↑ risk of vocal cord granuloma.
B
- Supplemental oxygen

Specific therapy:

Pharmacological
Procedural
- Bronchoscopic toileting
  - Daily to clear debris and ↓ infection
Physical

Supportive care:

Disposition:

Preventative:

Anaesthetic Considerations

Marginal and Ineffective Therapies

Complications

Toxin
- Carbon monoxide poisoning
- Cyanide poisoning

Prognosis

Leads to ↑↑ burns mortality.

Key Studies

References

Bersten, A. D., & Handy, J. M. (2018). Oh’s Intensive Care Manual. Elsevier Gezondheidszorg.