Highlights & Basics
- Inhalation injury occurs when noxious stimuli such as heat, gases, or particulate matter come into contact with the respiratory system.
- Residential fires and workplace accidents are common events that lead to inhalation injury.
- Pathophysiology includes thermal injury, systemic absorption of toxic compounds, and direct cellular injury.
- Clinical manifestations include upper airway obstruction, carbon monoxide poisoning, airflow obstruction, and acute respiratory distress syndrome.
- Therapy is largely supportive, although targeted therapies are the subject of active investigation.
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History & Exam
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Definition
Epidemiology
Etiology
Pathophysiology
Citations
Rabinowitz, PM, Siegel MD. Acute inhalational injury. Clin Chest Med. 2002 Dec;23(4):707-15.[Abstract]
Miller K, Chang A. Acute inhalation injury. Emerg Med Clin North Am. 2003 May;21(2):533-57.[Abstract]
McCall JE, Cahill TJ. Respiratory care of the burn patient. J Burn Care Rehabil. 2005 May-Jun;26(3):200-6.[Abstract]
ISBI Practice Guidelines Committee, Steering Subcommittee, Advisory Subcommittee. ISBI practice guidelines for burn care. Burns. 2016 Aug;42(5):953-1021.[Abstract][Full Text]
Summerhill EM, Hoyle GW, Jordt SE, et al; ATS Terrorism and Inhalational Disasters Section of the Environmental, Occupational, and Population Health Assembly. An official American Thoracic Society Workshop report: chemical inhalational disasters. Biology of lung injury, development of novel therapeutics, and medical preparedness. Ann Am Thorac Soc. 2017 Jun;14(6):1060-72.[Abstract][Full Text]
Weaver LK, Hopkins RO, Chan KJ, et al. Hyperbaric oxygen for acute carbon monoxide poisoning. N Engl J Med. 2002 Oct 3;347(14):1057-67.[Abstract][Full Text]
1. Rabinowitz, PM, Siegel MD. Acute inhalational injury. Clin Chest Med. 2002 Dec;23(4):707-15.[Abstract]
2. McCall JE, Cahill TJ. Respiratory care of the burn patient. J Burn Care Rehabil. 2005 May-Jun;26(3):200-6.[Abstract]
3. Woodson LC. Diagnosis and grading of inhalation injury. J Burn Care Res. 2009 Jan-Feb;30(1):143-5.[Abstract]
4. US Bureau of Labor Statistics. Injuries, illnesses, and fatalities. Table R33. Number of nonfatal occupational injuries and illnesses involving days away from work by event or exposure leading to injury or illness and selected sources of injury or illness, private industry, 2019. Nov 2020 [internet publication].[Full Text]
5. US Bureau of Labor Statistics. Injuries, illnesses, and fatalities. Table A-9. Fatal occupational injuries by event or exposure for all fatal injuries and major private industry sector, all United States, 2019. Dec 2020 [internet publication]. [Full Text]
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7. US Fire Administration. US fire deaths, fire death rates and risk of dying in a fire (2010 - 2019). May 2021 [internet publication]. [Full Text]
8. Colohan SM. Predicting prognosis in thermal burns with associated inhalational injury: a systematic review of prognostic factors in adult burn victims. J Burn Care Res. 2010 Jul-Aug;31(4):529-39.[Abstract]
9. Rabinowitz, PM, Siegel MD. Acute inhalational injury. Clin Chest Med. 2002 Dec;23(4):707-15.[Abstract]
10. Palmieri TL. Inhalation injury: research progress and needs. J Burn Care Res. 2007 Jul-Aug;28(4):549-54.[Abstract]
11. Miller K, Chang A. Acute inhalation injury. Emerg Med Clin North Am. 2003 May;21(2):533-57.[Abstract]
12. Miller K, Chang A. Acute inhalation injury. Emerg Med Clin North Am. 2003 May;21(2):533-57.[Abstract]
13. McCall JE, Cahill TJ. Respiratory care of the burn patient. J Burn Care Rehabil. 2005 May-Jun;26(3):200-6.[Abstract]
14. Pruitt BA, Flemma RJ, DiVincenti FC, et al. Pulmonary complications in burn patients. A comparative study of 697 patients. J Thorac Cardiovasc Surg. 1970 Jan;59(1):7-20.[Abstract]
15. Balakrishnan C, Tijunelis AD, Gordon DM, et al. Burns and inhalation injury caused by steam. Burns. 1996 Jun;22(4):313-5.[Abstract]
16. Kealey GP. Carbon monoxide toxicity. J Burn Care Res. 2009 Jan-Feb;30(1):146-7.[Abstract]
17. Enkhbaatar P, Traber DL. Pathophysiology of acute lung injury in combined burn and smoke inhalation injury. Clin Sci (Lond). 2004 Aug;107(2):137-43.[Abstract][Full Text]
18. US Fire Administration. National fire data center. Fire in the United States 2008-2017. 20th Edition. Nov 2019 [internet publication]. [Full Text]
19. Mlcak RP, Suman OE, Herndon DN. Respiratory management of inhalation injury. Burns. 2007 Feb;33(1):2-13.[Abstract]
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21. Cochran A. Inhalation injury and endotracheal intubation. J Burn Care Res. 2009 Jan-Feb;30(1):190-1.[Abstract]
22. Barillo DJ. Diagnosis and treatment of cyanide toxicity. J Burn Care Res. 2009 Jan-Feb;30(1):148-52.[Abstract]
23. Ma J, Ohira S, Mishra SK, et al. Rapid point of care analyzer for the measurement of cyanide in blood. Anal Chem. 2011 Jun 1;83(11):4319-24.[Abstract][Full Text]
24. Sheini A, Aseman MD, Bordbar MM. Origami paper analytical assay based on metal complex sensor for rapid determination of blood cyanide concentration in fire survivors. Sci Rep. 2021 Feb 10;11(1):3521.[Abstract][Full Text]
25. Barillo DJ, Goode R. Substance abuse in victims of fire. J Burn Care Rehabil. 1996 Jan-Feb;17(1):71-6.[Abstract][Full Text]
26. ISBI Practice Guidelines Committee, Steering Subcommittee, Advisory Subcommittee. ISBI practice guidelines for burn care. Burns. 2016 Aug;42(5):953-1021.[Abstract][Full Text]
27. NHS. Care of Burns in Scotland. Guideline for inhalation injury in burns patients: adult guideline. March 2021 [internet publication].[Full Text]
28. NHS. Care of Burns in Scotland. Management of airway burns and inhalation injury: paediatric guideline. Oct 2020 [internet publication].[Full Text]
29. Anseeuw K, Delvau N, Burillo-Putze G, et al. Cyanide poisoning by fire smoke inhalation: a European expert consensus. Eur J Emerg Med. 2013 Feb;20(1):2-9.[Abstract][Full Text]
30. Mintegi S, Clerigue N, Tipo V, et al. Pediatric cyanide poisoning by fire smoke inhalation: a European expert consensus. Toxicology Surveillance System of the Intoxications Working Group of the Spanish Society of Paediatric Emergencies. Pediatr Emerg Care. 2013 Nov;29(11):1234-40.[Abstract][Full Text]
31. Summerhill EM, Hoyle GW, Jordt SE, et al; ATS Terrorism and Inhalational Disasters Section of the Environmental, Occupational, and Population Health Assembly. An official American Thoracic Society Workshop report: chemical inhalational disasters. Biology of lung injury, development of novel therapeutics, and medical preparedness. Ann Am Thorac Soc. 2017 Jun;14(6):1060-72.[Abstract][Full Text]
32. Weaver LK. Clinical practice. Carbon monoxide poisoning. N Engl J Med. 2009 Mar 19;360(12):1217-25.[Abstract]
33. Buckley NA, Juurlink DN, Isbister G, et al. Hyperbaric oxygen for carbon monoxide poisoning. Cochrane Database Syst Rev. 2011 Apr 13;(4):CD002041.[Abstract][Full Text]
34. Weaver LK, Hopkins RO, Chan KJ, et al. Hyperbaric oxygen for acute carbon monoxide poisoning. N Engl J Med. 2002 Oct 3;347(14):1057-67.[Abstract][Full Text]
35. Huang CC, Ho CH, Chen YC, et al. Hyperbaric oxygen therapy is associated with lower short- and long-term mortality in patients with carbon monoxide poisoning. Chest. 2017 Apr 17 [Epub ahead of print].[Abstract][Full Text]
36. Yeoh MJ, Braitberg G. Carbon monoxide and cyanide poisoning in fire related deaths in Victoria, Australia. J Toxicol Clin Toxicol. 2004;42(6):855-63.[Abstract]
37. Kallet RH, Branson RD. Should oxygen therapy be tightly regulated to minimize hyperoxia in critically ill patients? Respir Care. 2016 Jun;61(6):801-17.[Abstract][Full Text]
38. Palmieri TL. Use of beta-agonists in inhalation injury. J Burn Care Res. 2009 Jan-Feb;30(1):156-9.[Abstract]
39. Enkhbaatar P, Herndon DN, Traber DL. Use of nebulized heparin in the treatment of smoke inhalation injury. J Burn Care Res. 2009 Jan-Feb;30(1):159-62.[Abstract]
40. Traber DL, Traber MG, Enkhbaatar P, et al. Tocopherol as treatment for lung injury associated with burn and smoke inhalation. J Burn Care Res. 2009 Jan-Feb;30(1):164-5.[Abstract]
41. Greenhalgh DG. Steroids in the treatment of smoke inhalation injury. J Burn Care Res. 2009 Jan-Feb;30(1):165-9.[Abstract]
42. The Acute Respiratory Distress Syndrome Network. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med. 2000 May 4;342(18):1301-8.[Abstract][Full Text]
43. Wolf SE. Vitamin C and smoke inhalation injury. J Burn Care Res. 2009 Jan-Feb;30(1):184-6. [Abstract]
44. Latenser, BA. Use of antithrombin III in inhalation injury. J Burn Care Res. 2009 Jan-Feb;30(1):186-8.[Abstract]
45. Asmussen S, Maybauer DM, Fraser JF, et al. Extracorporeal membrane oxygenation in burn and smoke inhalation injury. Burns. 2013 May;39(3):429-35.[Abstract]
46. ISBI Practice Guidelines Committee, Advisory Subcommittee, Steering Subcommittee. ISBI practice guidelines for burn care, part 2. Burns. 2018 Nov;44(7):1617-706.[Abstract][Full Text]
47. Shehabi Y, Howe BD, Bellomo R, et al. Early sedation with dexmedetomidine in critically ill patients. N Engl J Med. 2019 Jun 27;380(26):2506-17.[Abstract][Full Text]
48. European Medicines Agency. Meeting highlights from the Pharmacovigilance Risk Assessment Committee (PRAC) 7-10 March 2022. March 2022 [internet publication].[Full Text]
49. Miller AC, Elamin EM, Suffredini AF. Inhaled anticoagulation regimens for the treatment of smoke inhalation-associated acute lung injury: a systematic review. Crit Care Med. 2014 Feb;42(2):413-9.[Abstract]
50. Elsharnouby NM, Eid HE, Abou Elezz NF, et al. Heparin/N-acetylcysteine: an adjuvant in the management of burn inhalation injury: a study of different doses. J Crit Care. 2014 Feb;29(1):182.e1-4.[Abstract]
51. de Lange DW, Meulenbelt J. Do corticosteroids have a role in preventing or reducing acute toxic lung injury caused by inhalation of chemical agents? Clin Toxicol (Phila). 2011 Feb;49(2):61-71.[Abstract]
52. Bartley AC, Edgar DW, Wood FM. Pharmaco-management of inhalation injuries for burn survivors. Drug Des Devel Ther. 2009 Feb 6;2:9-16.[Abstract]
53. Rocker GM. Acute respiratory distress syndrome: different syndromes, different therapies? Crit Care Med. 2001 Jan;29(1):202-219.[Abstract]
54. Alberts WM, Brooks SM. Reactive airways dysfunction syndrome. Curr Opin Pulm Med. 1996 Mar;2(2):104-10.[Abstract]
55. Herridge MS, Cheung AM, Tansey CM, et al. One-year outcomes in the survivors of the acute respiratory distress syndrome. N Engl J Med. 2003 Feb 20;348(8):683-93.[Abstract][Full Text]
56. Weaver LK, Hopkins RO, Chan KJ, et al. Hyperbaric oxygen for acute carbon monoxide poisoning. N Engl J Med. 2002 Oct 3;347(14):1057-67.[Abstract][Full Text]
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