From the Research
Management of intubation for smoke inhalation requires a systematic approach focusing on airway protection and ventilatory support, with early intubation recommended for patients with significant smoke exposure, especially those with facial burns, stridor, respiratory distress, carbonaceous sputum, or altered mental status, as supported by the most recent study 1. The procedure should be performed using rapid sequence intubation with medications such as etomidate (0.3 mg/kg) or ketamine (1-2 mg/kg) for induction, and succinylcholine (1-1.5 mg/kg) or rocuronium (1-1.2 mg/kg) for paralysis. Some key points to consider in the management of intubation for smoke inhalation include:
- A slightly larger endotracheal tube (7.5-8.5 mm for adults) is preferred to facilitate bronchoscopy and secretion clearance.
- Post-intubation management includes lung-protective ventilation strategies with tidal volumes of 6-8 ml/kg ideal body weight, PEEP of 5-10 cmH2O, and FiO2 titrated to maintain oxygen saturation above 92% 1.
- Bronchoscopy should be performed early to assess airway damage and remove debris.
- Humidified oxygen, bronchodilators like albuterol (2.5-5 mg nebulized every 4-6 hours), and chest physiotherapy are essential for secretion management, with studies showing the effectiveness of metered-dose inhaler albuterol in mechanically ventilated patients 2.
- Fluid resuscitation should be carefully monitored to avoid over-hydration, which can worsen pulmonary edema. These interventions are critical because smoke inhalation causes direct thermal injury to the upper airway, chemical irritation to the lower airways, and systemic toxicity from carbon monoxide and cyanide, leading to inflammation, bronchospasm, and increased secretions that can rapidly compromise the airway, as noted in studies 3, 4, 5.