What is the role of mechanical ventilation in the treatment of smoke inhalation injury?

Updated: Oct 15, 2021
  • Author: Keith A Lafferty, MD; Chief Editor: Joe Alcock, MD, MS  more...
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Answer

Mechanical ventilation may be necessary in patients with declining lung function, oxygenation levels, and ventilation. Use of positive pressure ventilation with low tidal volumes (3-5 mL/kg) and positive end-expiratory pressure (PEEP) and maintenance of plateau pressures below 30 cm water significantly increases short-term survival and is associated with decreased tracheobronchial cast formation. In fact, this treatment has been shown to increase the intensive care unit (ICU) survival rate from 29% to 62%.

PEEP may assist in opening obstructed closed alveoli and help ventilation in those patients with poor compliance by increasing functional residual capacity. Ideally, PEEP stents alveoli open, preventing the atelectasis and alveolar flooding that can result from surfactant dysfunction, increasing interstitial fluid, and third-spacing. [55]

High-frequency percussive ventilation (HFPV), while not as commonly used in the ED, is considered standard therapy in many burn centers. HFPV generates pulsatile flow at up to 600 cycles per minute, which entrains the humidified gas by its effect on molecular diffusion. It can improve clearance of airway secretions and allow continued patency of the lower airways. In patients with inhalation injury and burns involving less than 40% of total body surface area, HFPV decreases both morbidity and mortality. [55, 56, 57]


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