What is the initial evaluation and treatment of inhalation burns?

Updated: Jan 10, 2018
  • Author: Robert L Sheridan, MD; Chief Editor: John Geibel, MD, DSc, MSc, AGAF  more...
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Answer

Answer

The diagnosis of inhalation injury is primarily clinical, based on a history of closed-space exposure, facial burns, singed nasal hairs, and carbonaceous debris in the mouth and pharynx or sputum. [20] Chest radiograph findings are routinely normal until complications (usually infection) develop. Bronchoscopy findings may include carbonaceous debris, ulceration, or erythema, but these changes are not always apparent.

The clinical consequences of inhalation injury include upper airway edema, bronchospasm, small airway occlusion, increased dead space and intrapulmonary shunting, decreased lung and chest wall compliance, and infection. Management is supportive only. [44]

Pneumonia or tracheobronchitis occurs in at least 30% of patients with inhalation injuries, due to the loss of the ciliary clearance mechanism, small airway occlusion, alveolar flooding, and endotracheal intubation. Vigorous pulmonary toilet, with toilet bronchoscopy in selected patients, is a very important component of therapy. The role of tracheostomy in the management of inhalation injury is controversial. It can be very useful if particularly prolonged intubation or difficult weaning is anticipated or if unusually thick secretions are unmanageable through an endotracheal tube. Tracheostomy in children is associated with a higher incidence of serious structural problems that require prolonged cannulation and reconstruction and, ideally, is avoided whenever possible. [45]


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