Challenges in Research on the Pathophysiology of Smoke Inhalation Injury and Its Clinical Management

Smoke inhalation injury is a serious medical problem that increases morbidity and mortality after severe burns. The National Repository of the American Burn Association houses data from 203,422 patients treated at 99 U.S. burn hospitals and centers between 2005 and 2014. These data show that the presence of smoke inhalation injury increases mortality (by nearly 24-fold) in burn patients under 60 years and in those with a total burned surface area between 0.1 and 19.9%.(1) The incidence of smoke inhalation injury may increase exponentially in mass casualty, large-scale fires;(2,3) 14 (78%) of the 18 patients severely burned in the World Trade Center attack who were admitted to one burn center had inhalation injury.(4) However, relatively little attention has been paid to this devastating condition, and the bulk of research is limited to preclinical basic science studies. This review discusses our current understanding of the pathophysiology of smoke inhalation injury, the best evidence-based treatments, and challenges and future directions in diagnostics and management.