Inhalation injury - NYSORA

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Inhalation injury

Inhalation injury

Learning objectives 

  • Definition, classification, and management of inhalation injury

Definition and mechanisms

  • Refers to damage to the respiratory tract or lung tissue from heat, smoke, or chemical irritants carried into the airway during inspiration
  • The term is often used synonymously with smoke inhalation injury

Classification and causes

CauseEffect
Upper airway injury
Hot air
Steam
Laryngeal obstruction
Bronchospasm
Tracheobronchial injury
Chemicals in smoke
Inhalation of noxious gases (eg, chlorine) or liquids (eg, acid)
Direct airway fire (eg, intraoperative)
Aspiration
Mucosal slough
Infection
Bronchiolar plugging
Atelectasis
href="https://www.nysora.com/anesthesia/bronchospasm/">Bronchospasm
Parenchymal injuryIrritant gases
Pneumonia
Pulmonary edema
Alveolar capillary defect
Systemic toxicityCO poisoning
Hydrogen cyanide

Signs and symptoms

  • Voice changes
  • Hoarseness
  • Stridor
  • Cough
  • Respiratory distress
  • Decreased level of consciousness or confusion
  • Agitation
  • Clinical hypoxemia (SpO2 <94%)
  • Dizziness
  • Nausea
  • Vomiting

Management

Inhalation injury, 100% oxygen, tidal volume, plateau pressure, PEEP, FiO2, PaO2

Keep in mind

General burn considerations:

Suggested reading

  • Preea Gill, FRCA, Rebecca V Martin, FRCA FFICM, Smoke inhalation injury, BJA Education, Volume 15, Issue 3, June 2015, Pages 143–148.
  • Bittner EA, Shank E, Woodson L, Martyn JA. Acute and perioperative care of the burn-injured patient. Anesthesiology. 2015;122(2):448-464.

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