Inhalation injury

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

Last reviewed: 24 Sep 2025

Last updated: 04 Jul 2025

Inhalation injury occurs when noxious stimuli such as heat, gases, or particulate matter come into contact with the respiratory system.

Residential fires and workplace accidents are common events that lead to inhalation injury.

Pathophysiology includes thermal injury, systemic absorption of toxic compounds, and direct cellular injury.

Clinical manifestations include upper airway obstruction, carbon monoxide poisoning, airflow obstruction, and acute respiratory distress syndrome.

Therapy is largely supportive, although targeted therapies are the subject of active investigation.

Long-term sequelae and complications are common.

Definição

Inhalation injury is a spectrum of clinical disease that occurs when the respiratory system is exposed to extreme heat or toxic substances.[1] These exposures occur most commonly in the setting of occupational chemical accidents and residential fires. The severity and pathogenesis of clinical disease depends upon the toxins present and the level of exposure. Acute disease severity can range from mild to fatal. Chronic consequences of inhalation injury are common.

História e exame físico

Principais fatores diagnósticos

similarity of symptoms to those of others at site of exposure
cough
dyspnea
hoarseness or dysphonia
headache
dizziness
tachypnea
hypoxia
facial burns
upper airway edema
stridor
wheezing
crackles
loss of consciousness
seizures

Detalhes completos

Outros fatores diagnósticos

tachycardia
hypotension
nausea

Detalhes completos

Fatores de risco

known inhalation exposure

Detalhes completos

Investigações diagnósticas

Primeiras investigações a serem solicitadas

pulse oximetry
arterial blood gas
carboxyhemoglobin (CO-Hb) level
chest x-ray
ECG
cardiac telemetry monitoring
urine toxicology screen
serum ethanol level

Detalhes completos

Investigações a serem consideradas

pulmonary function tests (PFT)
laryngoscopy and bronchoscopy
serum lactate

Detalhes completos

Novos exames

cyanide level

Algoritmo de tratamento

AGUDA

all patients

Colaboradores

Autores

Jason T. Poston, MD

Associate Professor

Section of Pulmonary and Critical Care Medicine

Department of Medicine

University of Chicago

Chicago

Declarações

JTP declares that he has no competing interests.

Cathryn T. Lee, MD, MS

Instructor

Department of Medicine, Section of Pulmonary and Critical Care

University of Chicago

Chicago

Declarações

CL has received grants from the Pulmonary Fibrosis Foundation.

Agradecimentos

Dr Jason T. Poston and Dr Cathryn T. Lee would like to gratefully acknowledge Dr Matthew R. Stutz, Dr Karen C. Dugan, and Dr John P. Kress, previous contributors to this topic. We would like to gratefully acknowledge the late Dr Ian R. Driscoll, Associate Professor of Surgery and Anesthesiology at the University of Florida College of Medicine and Director of the UF Health Shands Burn Center, for his peer review of this topic in 2024.

Disclosures

MRS, KCD, JPK, and IRD declared that they had no competing interests.

Peer reviewers

Leopoldo C. Cancio, MD

Critical Care Fellow

US Army Burn Center

US Army Institute of Surgical Research

Brooke Army Medical Center

Fort Sam Houston

Declarações

LCC declares that he has no competing interests.

Rhys Thomas, MD

Honorary Consultant in Anesthesia and Intensive Care

Queen Victoria Hospital

East Grinstead

Honorary Consultant

Royal London Hospital

London

Declarações

RT declares that he has no competing interests.

Brendan Madden, MD, MSc, FRCP, FRCPI

Professor of Cardiothoracic Medicine

St George's Hospital

London

Declarações

BM declares that he has no competing interests.

Créditos aos pareceristas

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Declarações

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Referências

Nossas equipes internas de editoria e de evidências trabalham em conjunto com colaboradores internacionais especializados e pares revisores para garantir que forneçamos acesso às informações o mais clinicamente relevantes possível.

Principais artigos

ISBI Practice Guidelines Committee, Steering Subcommittee, Advisory Subcommittee. ISBI practice guidelines for burn care. Burns. 2016 Aug;42(5):953-1021.Texto completo Resumo

Anseeuw K, Delvau N, Burillo-Putze G, et al. Cyanide poisoning by fire smoke inhalation: a European expert consensus. Eur J Emerg Med. 2013 Feb;20(1):2-9.Texto completo Resumo

Summerhill EM, Hoyle GW, Jordt SE, et al; ATS Terrorism and Inhalational Disasters Section of the Environmental, Occupational, and Population Health Assembly. An official American Thoracic Society Workshop report: chemical inhalational disasters. Biology of lung injury, development of novel therapeutics, and medical preparedness. Ann Am Thorac Soc. 2017 Jun;14(6):1060-72.Texto completo Resumo

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.

Diagnósticos diferenciais
- Asthma
- COPD
- Cardiogenic edema
Mais Diagnósticos diferenciais
Diretrizes
- Guideline for inhalation injury in burns patients. Adult guidelines
- Management of airway burns and inhalation injury. Paediatric guidelines
Mais Diretrizes
Folhetos informativos para os pacientes
Burns
Mais Folhetos informativos para os pacientes
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Inhalation injury

Summary

Definição

História e exame físico

Principais fatores diagnósticos

Outros fatores diagnósticos

Fatores de risco

Investigações diagnósticas

Primeiras investigações a serem solicitadas

Investigações a serem consideradas

Novos exames

Algoritmo de tratamento

all patients

Colaboradores

Autores

Jason T. Poston, MD

Declarações

Cathryn T. Lee, MD, MS

Declarações

Agradecimentos

Disclosures

Peer reviewers

Leopoldo C. Cancio, MD

Declarações

Rhys Thomas, MD

Declarações

Brendan Madden, MD, MSc, FRCP, FRCPI

Declarações

Créditos aos pareceristas

Declarações

Referências

Principais artigos

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.

Diagnósticos diferenciais

Diretrizes

Folhetos informativos para os pacientes

Videos

Conectar-se ou assinar para acessar todo o BMJ Best Practice

Conectar-se ou assinar para acessar todo o BMJ Best Practice

Conectar-se para acessar todo o BMJ Best Practice