Pathophysiology, Management and Treatment of Smoke Inhalation Injury

Overview

Journal Expert Rev Respir Med

Specialty Pulmonary Medicine

Date 2010 Feb 18

PMID 20161170

Citations 48

Authors

Sebastian Rehberg

Marc O Maybauer

Perenlei Enkhbaatar

Dirk M Maybauer

Yusuke Yamamoto

Daniel L Traber

Affiliations

Soon will be listed here.

Abstract

Smoke inhalation injury continues to increase morbidity and mortality in burn patients in both the third world and industrialized countries. The lack of uniform criteria for the diagnosis and definition of smoke inhalation injury contributes to the fact that, despite extensive research, mortality rates have changed little in recent decades. The formation of reactive oxygen and nitrogen species, as well as the procoagulant and antifibrinolytic imbalance of alveolar homeostasis, all play a central role in the pathogenesis of smoke inhalation injury. Further hallmarks include massive airway obstruction owing to cast formation, bronchospasm, the increase in bronchial circulation and transvascular fluid flux. Therefore, anticoagulants, antioxidants and bronchodilators, especially when administered as an aerosol, represent the most promising treatment strategies. The purpose of this review article is to provide an overview of the pathophysiological changes, management and treatment options of smoke inhalation injury based on the current literature.

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References

Tredget E, Shankowsky H, Taerum T, Moysa G, ALTON J . The role of inhalation injury in burn trauma. A Canadian experience. Ann Surg. 1990; 212(6):720-7. PMC: 1358258. DOI: 10.1097/00000658-199012000-00011. View

Latenser B . Use of antithrombin III in inhalation injury. J Burn Care Res. 2008; 30(1):186-8. DOI: 10.1097/BCR.0b013e3181923f08. View

Taylor R, Zimmerman J, Dellinger R, Straube R, Criner G, Davis Jr K . Low-dose inhaled nitric oxide in patients with acute lung injury: a randomized controlled trial. JAMA. 2004; 291(13):1603-9. DOI: 10.1001/jama.291.13.1603. View

Zwischenberger J, Savage C, Witt S, Alpard S, Harper D, Deyo D . Arterio-venous CO2 removal (AVCO2R) perioperative management: rapid recovery and enhanced survival. J Invest Surg. 2002; 15(1):15-21. DOI: 10.1080/08941930252807741. View

Rue 3rd L, Cioffi W, Mason A, McManus W, PRUITT Jr B . Improved survival of burned patients with inhalation injury. Arch Surg. 1993; 128(7):772-8; discussion 778-80. DOI: 10.1001/archsurg.1993.01420190066009. View

Sakurai H, Soejima K, Nozaki M, Traber L, Traber D . Effect of ablated airway blood flow on systemic and pulmonary microvascular permeability after smoke inhalation in sheep. Burns. 2007; 33(7):885-91. DOI: 10.1016/j.burns.2006.10.394. View

Dai N, Chen T, Cheng T, Chen S, Chen S, Chou G . The comparison of early fluid therapy in extensive flame burns between inhalation and noninhalation injuries. Burns. 1999; 24(7):671-5. DOI: 10.1016/s0305-4179(98)00092-8. View

Palmieri T . Use of beta-agonists in inhalation injury. J Burn Care Res. 2008; 30(1):156-9. DOI: 10.1097/BCR.0b013e3181923bc3. View

Berger M, Shenkin A . Update on clinical micronutrient supplementation studies in the critically ill. Curr Opin Clin Nutr Metab Care. 2006; 9(6):711-6. DOI: 10.1097/01.mco.0000247466.41661.ba. View

10.

Nguyen T, Cox C, Traber D, Gasser H, Redl H, Schlag G . Free radical activity and loss of plasma antioxidants, vitamin E, and sulfhydryl groups in patients with burns: the 1993 Moyer Award. J Burn Care Rehabil. 1993; 14(6):602-9. DOI: 10.1097/00004630-199311000-00004. View

11.

CLARK C, Campbell D, Reid W . Blood carboxyhaemoglobin and cyanide levels in fire survivors. Lancet. 1981; 1(8234):1332-5. DOI: 10.1016/s0140-6736(81)92516-2. View

12.

Marek K, Piotr W, Stanislaw S, Stefan G, Justyna G, Mariusz N . Fibreoptic bronchoscopy in routine clinical practice in confirming the diagnosis and treatment of inhalation burns. Burns. 2007; 33(5):554-60. DOI: 10.1016/j.burns.2006.08.030. View

13.

Brower R, Matthay M, Morris A, Schoenfeld D, Thompson B, Wheeler A . 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; 342(18):1301-8. DOI: 10.1056/NEJM200005043421801. View

14.

Niedermayr M, Schramm W, Kamolz L, Andel D, Romer W, Hoerauf K . Antithrombin deficiency and its relationship to severe burns. Burns. 2006; 33(2):173-8. DOI: 10.1016/j.burns.2006.06.011. View

15.

Steudel W, Kirmse M, Weimann J, Ullrich R, Hromi J, Zapol W . Exhaled nitric oxide production by nitric oxide synthase-deficient mice. Am J Respir Crit Care Med. 2000; 162(4 Pt 1):1262-7. DOI: 10.1164/ajrccm.162.4.9909037. View

16.

Alpard S, Zwischenberger J, Tao W, Deyo D, Bidani A . Reduced ventilator pressure and improved P/F ratio during percutaneous arteriovenous carbon dioxide removal for severe respiratory failure. Ann Surg. 1999; 230(2):215-24. PMC: 1420864. DOI: 10.1097/00000658-199908000-00012. View

17.

Dries D . Key questions in ventilator management of the burn-injured patient (second of two parts). J Burn Care Res. 2009; 30(2):211-20. DOI: 10.1097/BCR.0b013e318198a33f. View

18.

Enkhbaatar P, Kikuchi Y, Traber L, Westphal M, Morita N, Maybauer M . Effect of inhaled nitric oxide on pulmonary vascular hyperpermeability in sheep following smoke inhalation. Burns. 2005; 31(8):1013-9. DOI: 10.1016/j.burns.2005.06.021. View

19.

Granger D . Role of xanthine oxidase and granulocytes in ischemia-reperfusion injury. Am J Physiol. 1988; 255(6 Pt 2):H1269-75. DOI: 10.1152/ajpheart.1988.255.6.H1269. View

20.

Fontan J, Cortright D, Krause J, Velloff C, Karpitskyi V, Carver Jr T . Substance P and neurokinin-1 receptor expression by intrinsic airway neurons in the rat. Am J Physiol Lung Cell Mol Physiol. 2000; 278(2):L344-55. DOI: 10.1152/ajplung.2000.278.2.L344. View