From the Guidelines
Heavy smoke inhalation injury requires immediate medical attention in an emergency department or burn center, with treatment prioritizing airway security, supplemental oxygen, and management of potential carbon monoxide poisoning with 100% oxygen or hyperbaric oxygen therapy if necessary. The management of heavy smoke inhalation injury involves a multifaceted approach to address the various components of the injury, including thermal damage, chemical irritation, and systemic toxicity. According to the study by Weaver and colleagues 1, hyperbaric oxygen therapy has been shown to reduce the incidence of cognitive sequelae in patients with acute carbon monoxide poisoning, particularly in those without the APOE e4 allele.
Initial Assessment and Management
- Securing the airway is crucial, which may involve intubation if there is significant upper airway edema or respiratory distress.
- Supplemental oxygen should be administered to maintain oxygen saturation above 94%.
- Bronchodilators like albuterol (2.5-5mg nebulized every 4-6 hours) can help manage bronchospasm.
- For chemical irritation and inflammation, corticosteroids such as methylprednisolone (1-2mg/kg IV) may be given.
- Humidified oxygen helps moisturize damaged airways.
Carbon Monoxide Poisoning Management
- If carbon monoxide poisoning is suspected, 100% oxygen should be administered until carboxyhemoglobin levels normalize (below 3%) 1.
- For severe cases, hyperbaric oxygen therapy might be considered, especially in patients without the APOE e4 allele, as it has been shown to reduce cognitive sequelae 1.
Fluid Management and Infection Prevention
- Fluid management is crucial, following burn resuscitation protocols if thermal burns are present.
- Prophylactic antibiotics aren't routinely recommended but should be started if infection develops.
Monitoring and Follow-Up
- Close monitoring for 24-48 hours is essential as symptoms may worsen due to progressive inflammation and fluid shifts.
- All patients treated for acute accidental CO poisoning should be seen in clinical follow-up 1–2 months after the event 1.
From the Research
Diagnosis and Treatment of Heavy Smoke Inhalation Injury
- Heavy smoke inhalation injury can lead to various complications, including airway patency impairment and respiratory insufficiency, and requires adequate and timely airway management 2.
- A standardized diagnostic protocol for inhalation injury is lacking, and diagnosis is mostly clinical, aided by bronchoscopy and other supplementary tests 3, 4.
- Treatment includes airway and respiratory support, lung protective ventilation, 100% oxygen or hyperbaric oxygen therapy for carbon monoxide poisoning, and hydroxocobalamin for cyanide toxicity 3, 4.
Management of Smoke Inhalation Injury
- Smoke inhalation injury can be understood and treated in terms of the time period after injury, with different phases requiring different management strategies 5.
- The early phase (0 to 36 hrs) involves diagnosis and treatment of carbon monoxide and cyanide toxicity, as well as management of early airways edema, bronchorrhea, and bronchoconstriction with aggressive pulmonary toilet 5.
- Later phases involve management of airways mucosal slough, tracheobronchitis, and increasing lung water and impaired gas exchange, as well as infection control and close management of fluid shifts 5.
Supportive Care for Smoke Inhalation Injury
- Patients with smoke inhalation injury require supportive care, including oxygenation support using endotracheal intubation with mechanical ventilation, humidification of inspired air, early mobilization, chest physiotherapy, antibiotics for documented infection, and adequate systemic hydration 6.
- High-flow oxygen therapy can reduce the half-life of carbon monoxide to an acceptable period, and treatment should be directed toward supporting oxygenation and managing complications 6.