Management of inhalation injuries in emergency and critical care: immediate interventions and long-term outcomes
DOI:
https://doi.org/10.18203/2394-6040.ijcmph20250039Keywords:
Inhalation injury, Smoke inhalation injury, Emergency treatment, Critical care, Long-term outcomesAbstract
Inhalation injury is respiratory injury caused by inhalation of substances such as toxic gas, fire fumes and chemical products. It can lead to hypoxia, ventilation dysfunction, increased airway resistance, and massive pulmonary edema. Immediate intervention is crucial for inhalation injuries. Current management strategies include endotracheal intubation, tracheostomy, fluid resuscitation, mechanical ventilation, and treatment of systemic toxicity. Many factors can affect the outcomes of inhalation injury such as age, severity of inhalation injury, and total body surface area burned. The following databases were used in systematic research: Medline (PubMed), Web of Science, and Scopus till 22 December 2024. Inclusion criteria is any study that discusses management of inhalation injuries in emergency and critical care and their outcomes and published in peer-reviewed journals was included with the inclusion of full-text articles, abstracts, and case series with the related topics are included. All languages are included. Animal studies, case reports, letters and comments were excluded. Endotracheal intubation, mechanical ventilation, and tracheostomy are considered important interventions in the inhalation injury emergency setting. However, studies reported poor long-term outcomes of these interventions. The objective of this review is to discuss the different approaches of management of inhalation injuries in emergency department and the obtained outcomes.
Metrics
References
Mosby CV. Mosby’s Medical Dictionary. Mosby; 8th Edition. 2009.
Witt CE, Stewart BT, Rivara FP, Mandell SP, Gibran NS, Pham TN, et al. Inpatient and Postdischarge Outcomes Following Inhalation Injury Among Critically Injured Burn Patients. J Burn Care Res. 2021;42(6):1168-75. DOI: https://doi.org/10.1093/jbcr/irab029
Dries DJ, Endorf FW. Inhalation injury: epidemiology, pathology, treatment strategies. Scand J Trauma Resusc Emerg Med. 2013;21:31. DOI: https://doi.org/10.1186/1757-7241-21-31
Xia ZF ZF, Sun Y. Burn and Trauma Associated Lung Injury. Chapter 12021. Springer. 2020. DOI: https://doi.org/10.1007/978-981-15-7056-8
Walker PF, Buehner MF, Wood LA, Boyer NL, Driscoll IR, Lundy JB, et al. Diagnosis and management of inhalation injury: an updated review. Crit Care. 2015;19:351. DOI: https://doi.org/10.1186/s13054-015-1077-4
Jones SW, Williams FN, Cairns BA, Cartotto R. Inhalation Injury: Pathophysiology, Diagnosis, and Treatment. Clin Plast Surg. 2017;44(3):505-11. DOI: https://doi.org/10.1016/j.cps.2017.02.009
Rehberg S, Maybauer MO, Enkhbaatar P, Maybauer DM, Yamamoto Y, Traber DL. Pathophysiology, management and treatment of smoke inhalation injury. Exp Rev Resp Med. 2009;3(3):283-97. DOI: https://doi.org/10.1586/ers.09.21
Endorf FW, Gamelli RL. Inhalation injury, pulmonary perturbations, and fluid resuscitation. J Burn Care Res. 2007;28(1):80-3. DOI: https://doi.org/10.1097/BCR.0B013E31802C889F
Woodson LC. Diagnosis and grading of inhalation injury. J Burn Care Res. 2009;30(1):143-5. DOI: https://doi.org/10.1097/BCR.0b013e3181923b71
Cochrane Training. Chapter 4: Searching for and selecting studies. Available at: https://training. cochrane.org/handbook/current/chapter-04. Accessed on 13 November 2024.
Wachtel TL. Major burns. What to do at the scene and en route to the hospital. Postgrad Med. 1989;85(1):178-83. DOI: https://doi.org/10.1080/00325481.1989.11700545
Tanizaki S. Assessing inhalation injury in the emergency room. Open Access Emerg Med. 2015;7:31-7. DOI: https://doi.org/10.2147/OAEM.S74580
Gupta K, Mehrotra M, Kumar P, Gogia AR, Prasad A, Fisher JA. Smoke Inhalation Injury: Etiopathogenesis, Diagnosis, and Management. Indian J Crit Care Med. 2018;22(3):180-8. DOI: https://doi.org/10.4103/ijccm.IJCCM_460_17
Madnani DD, Steele NP, de Vries E. Factors that predict the need for intubation in patients with smoke inhalation injury. Ear Nose Throat J. 2006;85(4):278-80. DOI: https://doi.org/10.1177/014556130608500421
Mlcak RP, Suman OE, Herndon DN. Respiratory management of inhalation injury. Burns. 2007;33(1):2-13. DOI: https://doi.org/10.1016/j.burns.2006.07.007
16. Enkhbaatar P, Pruitt BA, Jr., Suman O, et al. Pathophysiology, research challenges, and clinical management of smoke inhalation injury. Lancet (London, England). 2016;388(10052):1437-1446. DOI: https://doi.org/10.1016/S0140-6736(16)31458-1
Niculae A, Peride I, Tiglis M, Nechita AM, Petcu LC, Neagu TP. Emergency Care for Burn Patients-A Single-Center Report. J Pers Med. 2023;13(2):238. DOI: https://doi.org/10.3390/jpm13020238
Mlcak R, Cortiella J, Desai M, Herndon D. Lung compliance, airway resistance, and work of breathing in children after inhalation injury. J Burn Care Rehab. 1997;18(6):531-4. DOI: https://doi.org/10.1097/00004630-199711000-00011
Dries DJ. Key questions in ventilator management of the burn-injured patient (second of two parts). J Burn Care Res. 2009;30(2):211-20. DOI: https://doi.org/10.1097/BCR.0b013e318198a33f
Miller AC, Ferrada PA, Kadri SS, Nataraj-Bhandari K, Vahedian-Azimi A, Quraishi SA. High-Frequency Ventilation Modalities as Salvage Therapy for Smoke Inhalation-Associated Acute Lung Injury: A Systematic Review. J Intensive Care Med. 2018;33(6):335-45. DOI: https://doi.org/10.1177/0885066617714770
Hale DF, Cannon JW, Batchinsky AI, Cancio LC, Aden JK, White CE, et al. Prone positioning improves oxygenation in adult burn patients with severe acute respiratory distress syndrome. J Trauma Acute Care Surg. 2012;72(6):1634-9. DOI: https://doi.org/10.1097/TA.0b013e318247cd4f
Kalay N, Ozdogru I, Cetinkaya Y, Eryol NK, Dogan A, Gul I, et al. Cardiovascular effects of carbon monoxide poisoning. Am J Cardiol. 2007;99(3):322-4. DOI: https://doi.org/10.1016/j.amjcard.2006.08.030
Weaver LK, Howe S, Hopkins R, Chan KJ. Carboxyhemoglobin half-life in carbon monoxide-poisoned patients treated with 100% oxygen at atmospheric pressure. Chest. 2000;117(3):801-8. DOI: https://doi.org/10.1378/chest.117.3.801
Kao LW, Nañagas KA. Carbon monoxide poisoning. Emerg Med Clin North Am. 2004;22(4):985-1018. DOI: https://doi.org/10.1016/j.emc.2004.05.003
Annane D, Chadda K, Gajdos P, Jars-Guincestre MC, Chevret S, Raphael JC. Hyperbaric oxygen therapy for acute domestic carbon monoxide poisoning: two randomized controlled trials. Intensive Care Med. 2011;37(3):486-92. DOI: https://doi.org/10.1007/s00134-010-2093-0
Buckley NA, Juurlink DN, Isbister G, Bennett MH, Lavonas EJ. Hyperbaric oxygen for carbon monoxide poisoning. Cochrane Database Syst Rev. 2011;2011(4):CD002041. DOI: https://doi.org/10.1002/14651858.CD002041.pub3
Rose JJ, Wang L, Xu Q, McTiernan CF, Shiva S, Tejero J, et al. Carbon Monoxide Poisoning: Pathogenesis, Management, and Future Directions of Therapy. Am J Respir Crit Care Med. 2017;195(5):596-606. DOI: https://doi.org/10.1164/rccm.201606-1275CI
Nguyen L, Afshari A, Kahn SA, McGrane S, Summitt B. Utility and outcomes of hydroxocobalamin use in smoke inhalation patients. Burns. 2017;43(1):107-13. DOI: https://doi.org/10.1016/j.burns.2016.07.028
Inoue T, Okabayashi K, Ohtani M, Yamanoue T, Wada S, Iida K. Effect of smoke inhalation injury on fluid requirement in burn resuscitation. Hiroshima J Med Sci. 2002;51(1):1-5.
Toon MH, Maybauer MO, Greenwood JE, Maybauer DM, Fraser JF. Management of acute smoke inhalation injury. Crit Care Resuscit. 2010;12(1):53-61. DOI: https://doi.org/10.1016/S1441-2772(23)01358-3
Silverberg R, Johnson J, Gorga D, Nagler W, Goodwin C. A survey of the prevalence and application of chest physical therapy in U.S. burn centers. J Burn Care Rehab. 1995;16(2 Pt 1):154-9. DOI: https://doi.org/10.1097/00004630-199503000-00013
Ruiz S, Puyana S, McKenney M, Hai S, Mir H. Outcomes of Tracheostomy on Burn Inhalation Injury. Eplasty. 2023;23:e43. DOI: https://doi.org/10.1093/jbcr/irac012.145
Aggarwal A, Chittoria RK, Chavan V, Reddy CL, Gupta S, Mohan PB, et al. Prophylactic Tracheostomy for Inhalational Burns. World J Plast Surg. 2020;9(1):10-3.
Queiroz LF, Anami EH, Zampar EF, Tanita MT, Cardoso LT, Grion CM. Epidemiology and outcome analysis of burn patients admitted to an Intensive Care Unit in a University Hospital. Burns. 2016;42(3):655-62. DOI: https://doi.org/10.1016/j.burns.2015.08.002
Ganesamoni S, Kate V, Sadasivan J. Epidemiology of hospitalized burn patients in a tertiary care hospital in South India. Burns. 2010;36(3):422-9. DOI: https://doi.org/10.1016/j.burns.2009.06.212
Hahn B, Alex Roh S, Price C, Fu W, DiBello J, Barbara P, et al. Demographics and clinical patterns of burns requiring emergency hospitalization at a regional north-eastern us burn center. Hosp Pract (1995). 2020;48(3):137-45. DOI: https://doi.org/10.1080/21548331.2020.1760555
Nickel KJ, Omeis T, Papp A. Demographics and clinical outcomes of adult burn patients admitted to a single provincial burn centre: A 40-year review. Burns. 2020;46(8):1958-67. DOI: https://doi.org/10.1016/j.burns.2020.06.020
Edelman DA, Khan N, Kempf K, White MT. Pneumonia after inhalation injury. J Burn Care Res. 2007;28(2):241-6. DOI: https://doi.org/10.1097/BCR.0B013E318031D049
Liodaki E, Kalousis K, Mauss KL, Kisch T, Mailaender P, Stang F. Epidemiology of pneumonia in a burn care unit: the influence of inhalation trauma on pneumonia and of pneumonia on burn mortality. Ann Burns Fire Disasters. 2015;28(2):128-33.
Puyana S, Ruiz S, Amador F, Mckenney M, Young E, Lim R, et al. The Outcomes of Inhalation Injuries in Lesser Burns: Still a Deadly Injury. Eplasty. 2021;21:e7.
Vincent JL, Rello J, Marshall J, Silva E, Anzueto A, Martin CD, et al; EPIC II Group of Investigators. International study of the prevalence and outcomes of infection in intensive care units. JAMA. 2009;302(21):2323-9. DOI: https://doi.org/10.1001/jama.2009.1754
Chastre J, Fagon JY. Ventilator-associated pneumonia. Am J Resp Crit Care Med. 2002;165(7):867-903. DOI: https://doi.org/10.1164/ajrccm.165.7.2105078
Kim Y, Kym D, Hur J, Yoon J, Yim H, Cho YS, et al. Does inhalation injury predict mortality in burns patients or require redefinition? PLoS One. 2017;12(9):e0185195. DOI: https://doi.org/10.1371/journal.pone.0185195
Soni N, Williams P. Positive pressure ventilation: what is the real cost? Br J Anaesth. 2008;101(4):446-57. DOI: https://doi.org/10.1093/bja/aen240
Lund T, Goodwin CW, McManus WF, Shirani KZ, Stallings RJ, Mason AD Jr, et al. Upper airway sequelae in burn patients requiring endotracheal intubation or tracheostomy. Ann Surg. 1985;201(3):374-82. DOI: https://doi.org/10.1097/00000658-198503000-00021
Griffiths J, Barber VS, Morgan L, Young JD. Systematic review and meta-analysis of studies of the timing of tracheostomy in adult patients undergoing artificial ventilation. BMJ (Clin Res ed). 2005;330(7502):1243. DOI: https://doi.org/10.1136/bmj.38467.485671.E0
Saffle JR, Morris SE, Edelman L. Early tracheostomy does not improve outcome in burn patients. J Burn Care Rehab. 2002;23(6):431-8. DOI: https://doi.org/10.1097/00004630-200211000-00009
Huang H, Li Y, Ariani F, Chen X, Lin J. Timing of tracheostomy in critically ill patients: a meta-analysis. PLoS One. 2014;9(3):e92981. DOI: https://doi.org/10.1371/journal.pone.0092981
Szakmany T, Russell P, Wilkes AR, Hall JE. Effect of early tracheostomy on resource utilization and clinical outcomes in critically ill patients: meta-analysis of randomized controlled trials. Br J Anaesth. 2015;114(3):396-405. DOI: https://doi.org/10.1093/bja/aeu440