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Smoke Inhalation Injury: Etiopathogenesis, Diagnosis, and Management
Smoke inhalation injury is a major determinant of morbidity and mortality in fire victims. It is a complex multifaceted injury affecting initially the airway; however, in short time, it can become a complex life-threatening systemic disease affecting every organ in the body. In this review, we provi...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Medknow Publications & Media Pvt Ltd
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5879861/ https://www.ncbi.nlm.nih.gov/pubmed/29657376 http://dx.doi.org/10.4103/ijccm.IJCCM_460_17 |
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author | Gupta, Kapil Mehrotra, Mayank Kumar, Parul Gogia, Anoop Raj Prasad, Arun Fisher, Joseph Arnold |
author_facet | Gupta, Kapil Mehrotra, Mayank Kumar, Parul Gogia, Anoop Raj Prasad, Arun Fisher, Joseph Arnold |
author_sort | Gupta, Kapil |
collection | PubMed |
description | Smoke inhalation injury is a major determinant of morbidity and mortality in fire victims. It is a complex multifaceted injury affecting initially the airway; however, in short time, it can become a complex life-threatening systemic disease affecting every organ in the body. In this review, we provide a summary of the underlying pathophysiology of organ dysfunction and provide an up-to-date survey of the various critical care modalities that have been found beneficial in caring for these patients. Major pathophysiological change is development of edema in the respiratory tract. The tracheobronchial tree is injured by steam and toxic chemicals, leading to bronchoconstriction. Lung parenchyma is damaged by the release of proteolytic elastases, leading to release of inflammatory mediators, increase in transvascular flux of fluids, and development of pulmonary edema and atelectasis. Decreased levels of surfactant and immunomodulators such as interleukins and tumor-necrosis-factor-α accentuate the injury. A primary survey is conducted at the site of fire, to ensure adequate airway, breathing, and circulation. A good intravenous access is obtained for the administration of resuscitation fluids. Early intubation, preferably with fiberoptic bronchoscope, is prudent before development of airway edema. Bronchial hygiene is maintained, which involves therapeutic coughing, chest physiotherapy, deep breathing exercises, and early ambulation. Pharmacological agents such as beta-2 agonists, racemic epinephrine, N-acetyl cysteine, and aerosolized heparin are used for improving oxygenation of lungs. Newer agents being tested are perfluorohexane, porcine pulmonary surfactant, and ClearMate. Early diagnosis and treatment of smoke inhalation injury are the keys for better outcome. |
format | Online Article Text |
id | pubmed-5879861 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | Medknow Publications & Media Pvt Ltd |
record_format | MEDLINE/PubMed |
spelling | pubmed-58798612018-04-13 Smoke Inhalation Injury: Etiopathogenesis, Diagnosis, and Management Gupta, Kapil Mehrotra, Mayank Kumar, Parul Gogia, Anoop Raj Prasad, Arun Fisher, Joseph Arnold Indian J Crit Care Med Review Article Smoke inhalation injury is a major determinant of morbidity and mortality in fire victims. It is a complex multifaceted injury affecting initially the airway; however, in short time, it can become a complex life-threatening systemic disease affecting every organ in the body. In this review, we provide a summary of the underlying pathophysiology of organ dysfunction and provide an up-to-date survey of the various critical care modalities that have been found beneficial in caring for these patients. Major pathophysiological change is development of edema in the respiratory tract. The tracheobronchial tree is injured by steam and toxic chemicals, leading to bronchoconstriction. Lung parenchyma is damaged by the release of proteolytic elastases, leading to release of inflammatory mediators, increase in transvascular flux of fluids, and development of pulmonary edema and atelectasis. Decreased levels of surfactant and immunomodulators such as interleukins and tumor-necrosis-factor-α accentuate the injury. A primary survey is conducted at the site of fire, to ensure adequate airway, breathing, and circulation. A good intravenous access is obtained for the administration of resuscitation fluids. Early intubation, preferably with fiberoptic bronchoscope, is prudent before development of airway edema. Bronchial hygiene is maintained, which involves therapeutic coughing, chest physiotherapy, deep breathing exercises, and early ambulation. Pharmacological agents such as beta-2 agonists, racemic epinephrine, N-acetyl cysteine, and aerosolized heparin are used for improving oxygenation of lungs. Newer agents being tested are perfluorohexane, porcine pulmonary surfactant, and ClearMate. Early diagnosis and treatment of smoke inhalation injury are the keys for better outcome. Medknow Publications & Media Pvt Ltd 2018-03 /pmc/articles/PMC5879861/ /pubmed/29657376 http://dx.doi.org/10.4103/ijccm.IJCCM_460_17 Text en Copyright: © 2018 Indian Journal of Critical Care Medicine http://creativecommons.org/licenses/by-nc-sa/3.0 This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms. |
spellingShingle | Review Article Gupta, Kapil Mehrotra, Mayank Kumar, Parul Gogia, Anoop Raj Prasad, Arun Fisher, Joseph Arnold Smoke Inhalation Injury: Etiopathogenesis, Diagnosis, and Management |
title | Smoke Inhalation Injury: Etiopathogenesis, Diagnosis, and Management |
title_full | Smoke Inhalation Injury: Etiopathogenesis, Diagnosis, and Management |
title_fullStr | Smoke Inhalation Injury: Etiopathogenesis, Diagnosis, and Management |
title_full_unstemmed | Smoke Inhalation Injury: Etiopathogenesis, Diagnosis, and Management |
title_short | Smoke Inhalation Injury: Etiopathogenesis, Diagnosis, and Management |
title_sort | smoke inhalation injury: etiopathogenesis, diagnosis, and management |
topic | Review Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5879861/ https://www.ncbi.nlm.nih.gov/pubmed/29657376 http://dx.doi.org/10.4103/ijccm.IJCCM_460_17 |
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