Smoke inhalation injury: a narrative review

Burn Units frequently provide care to patients who have burn injuries and concomitant smoke inhalation injury. Inhalation damage is a complex multifaceted lung and systemic disease process, and the leading cause of mortality and morbidity in victims of fire tragedies. The degree of airway injury depends on the composition of smoke and the duration of smoke exposure. The prevalence of inhalation damage and related mortality rates among fire victims is high all over the world. This article presents the potential clinical impacts of this syndrome and the most important factors to consider when examining patients that have survived the scene of an accident who require hospital admission. Anatomically, injuries are divided into three classes: (I) heat injury which is restricted to upper airway; (II) local chemical irritation throughout the respiratory tract and (III) systemic toxicity as may occur with inhalation of carbon monoxide or cyanide. Treatment options between these three subtypes differ based on the pathophysiologic changes that each one elicits. Supportive respiratory care remains essential in managing inhalation injury. In addition, we have also reviewed current treatment strategies and future lines of research in this field. These advances provide hope for reversal of specific mechanisms of morbidity and improvement in outcomes.