From the Guidelines
Inhalation injuries should be suspected in patients with a history of fire in an enclosed space, presence of soot on the face, dysphonia, dyspnea, wheezing, and/or blackish sputum, as these signs and symptoms are indicative of potential smoke inhalation 1. The diagnosis of inhalation injury is crucial, as it can lead to severe morbidity and mortality, especially in children, where smoke inhalation increases paediatric mortality three-fold and raises the risk of morbidity, especially respiratory and infectious problems 1.
Signs and Symptoms
Some common signs and symptoms of inhalation injury include:
- Dysphonia (hoarseness)
- Dyspnea (shortness of breath)
- Wheezing
- Blackish sputum
- Soot on the face
- Presence of soot or carbonaceous deposits in the mouth or throat These symptoms can be indicative of smoke inhalation, and further evaluation with bronchial flexible fibroscopy, considered the gold standard for diagnosing smoke inhalation, may be necessary 1.
Diagnosis and Management
Bronchial flexible fibroscopy is generally considered the gold standard for diagnosing smoke inhalation, and its use can help identify the severity of the lesions, which is correlated with morbidity, length of stay in the intensive care unit, duration of mechanical ventilation, and severity of hypoxemia 1. However, the impact of fibroscopy on outcomes is uncertain, and it should probably only be performed in patients who have already been intubated, due to the risk of clinical deterioration after the procedure 1. Early intubation should be considered in patients with signs of upper airway compromise or severe respiratory distress, as it can help prevent further complications and improve outcomes 1.
From the Research
Signs and Symptoms of Inhalation Injury
The signs and symptoms of an inhalation injury can vary depending on the severity of the injury and the substances inhaled. Some common signs and symptoms include:
- Cough and breathlessness, which can range from mild to severe 2
- Thermal burns of the upper airway, which can cause edema and impede airflow 3, 4
- Carbon monoxide poisoning, which can cause symptoms such as headache, dizziness, and confusion, and can be life-threatening 4
- Smoke inhalation, which can cause damage to the respiratory tract and lead to conditions such as pulmonary edema, pneumonia, and acute respiratory distress syndrome (ARDS) 2, 5, 4, 6
- Partial to complete airway obstruction, which can be life-threatening 6
Diagnosis and Treatment
Diagnosis of inhalation injury is typically made through a combination of physical examination, medical history, and diagnostic tests such as:
- Direct visualization of the upper airway to look for signs of thermal injury 4
- Arterial blood gases to determine the degree of carbon monoxide intoxication 4
- Fiberoptic bronchoscopy to assess the extent of airway damage 4
- Bronchoscopy and xenon 133 ventilation-perfusion scans to identify burn patients with inhalation injury 6 Treatment for inhalation injury typically involves supportive care, such as:
- Humidified oxygen and attentive pulmonary toilet 4
- Bronchodilators as needed 4
- Prophylactic endotracheal intubation as indicated 4
- Mechanical ventilation for patients with severe respiratory failure 2, 5
- Careful attention to fluid resuscitation in patients with burns 4