From the Research
The current evidence-based treatment for smoke inhalation injury involves a multifaceted approach focusing on airway management, oxygenation, and prevention of complications, with the most recent and highest quality study suggesting that extracorporeal membrane oxygenation (ECMO) should be considered for patients who fail conventional therapy 1.
Key Components of Treatment
- Initial management requires securing the airway, which may necessitate early intubation for patients with significant upper airway edema or respiratory distress.
- Humidified oxygen should be administered to maintain oxygen saturation above 94%.
- Bronchodilators such as albuterol (2.5-5 mg nebulized every 4-6 hours) are recommended to treat bronchospasm.
- For patients with carbon monoxide poisoning, 100% oxygen should be administered until carboxyhemoglobin levels fall below 5%.
- In severe cases, hyperbaric oxygen therapy may be considered.
- Fluid management is crucial, following the Parkland formula (4 mL/kg/% TBSA burn) for the first 24 hours in patients with concurrent burns.
- Prophylactic antibiotics are not routinely recommended unless there is evidence of infection.
- For chemical pneumonitis, corticosteroids such as methylprednisolone (1-2 mg/kg/day divided in 4 doses for 3-5 days) may be beneficial.
- Inhaled heparin (5,000-10,000 units every 4-6 hours) combined with N-acetylcysteine (3 mL of 20% solution every 4-6 hours) has shown promise in reducing airway cast formation and improving outcomes.
- Mechanical ventilation strategies should employ lung-protective approaches with low tidal volumes (6-8 mL/kg ideal body weight) and moderate PEEP.
Consideration of ECMO
- ECMO should be considered for patients with severe smoke inhalation injury who fail conventional therapy, as it has been shown to improve outcomes in these patients 1.
- The decision to initiate ECMO should be made on a case-by-case basis, taking into account the patient's overall clinical condition and the availability of resources.
Importance of Early Intervention
- Early intervention is critical in the management of smoke inhalation injury, as it can help prevent complications and improve outcomes.
- A high index of suspicion for concomitant traumatic injuries should be maintained, and diagnosis should be aided by bronchoscopy and other supplementary tests 2.