From the Research
The current evidence-based treatment for smoke inhalation injury prioritizes supportive care, airway management, and addressing specific toxicities, with a recent study suggesting the consideration of extracorporeal membrane oxygenation (ECMO) for severe cases that fail conventional therapy 1. The management of smoke inhalation injury is multifaceted and includes:
- Immediate removal from the smoke source and administration of humidified 100% oxygen
- Careful assessment for airway compromise and early intubation for significant upper airway edema, respiratory distress, or decreased level of consciousness
- Bronchoscopy for diagnostic and therapeutic purposes to remove carbonaceous debris
- Fluid management balanced to avoid pulmonary edema, with the Parkland formula as a starting point adjusted based on clinical response
- High-flow oxygen therapy for carbon monoxide poisoning until carboxyhemoglobin levels fall below 5%, with hyperbaric oxygen therapy for severe cases
- Prompt treatment of cyanide toxicity with hydroxocobalamin
- Use of bronchodilators like albuterol to manage bronchospasm
- Consideration of nebulized heparin and N-acetylcysteine to reduce airway cast formation, though this remains somewhat controversial
- Avoidance of corticosteroids and prophylactic antibiotics unless there is evidence of infection
- Employment of lung-protective mechanical ventilation strategies with low tidal volumes and moderate PEEP A recent study published in 2024 1 highlights the potential benefit of ECMO in severe smoke inhalation injury, suggesting its consideration for patients who fail conventional therapy. This approach aligns with the goal of minimizing morbidity, mortality, and improving quality of life for patients with smoke inhalation injuries. Key aspects of care include:
- Early recognition and intervention for airway compromise
- Aggressive management of specific toxicities such as carbon monoxide and cyanide poisoning
- Supportive care to prevent further lung injury and promote recovery
- Consideration of advanced therapies like ECMO for severe cases, as supported by the most recent evidence 1.