Inhalation injury

Last reviewed: June 2019

Last updated: April 2018

Summary

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.

Definition

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, and 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, including chronic consequences of inhalation injury.

History and exam

Key diagnostic factors

presence of risk factors
similarity of symptoms to those of others at site of exposure
cough
dyspnoea
hoarseness or dysphonia
headache
dizziness
tachypnoea
hypoxia
facial burns
upper airway oedema
stridor
wheezing
crackles
loss of consciousness
seizures

Full details

Other diagnostic factors

tachycardia
hypotension
nausea

Full details

Risk factors

known inhalation exposure

Full details

Diagnostic investigations

1st investigations to order

pulse oximetry
arterial blood gas
carboxyhaemoglobin (CO-Hb) level
CXR
ECG
cardiac telemetry monitoring
urine toxicology screen
serum ethanol level

Full details

Investigations to consider

pulmonary function tests (PFT)
laryngoscopy and bronchoscopy
serum lactate

Full details

Emerging tests

cyanide level

Full details

Treatment algorithm

ACUTE

all patients

Contributors

Authors VIEW ALL 

Karen C. Dugan, MD

Fellow

Section of Pulmonary and Critical Care Medicine

Department of Medicine

University of Chicago

Chicago

Disclosures

KCD declares that she has no competing interests.

Jason T. Poston, MD

Assistant Professor

Section of Pulmonary and Critical Care Medicine

Department of Medicine

University of Chicago

Chicago

Disclosures

JTP declares that he has no competing interests.

Acknowledgements

Dr Karen C. Dugan and Dr Jason T. Poston would like to gratefully acknowledge Dr John P. Kress, a previous contributor to this monograph. JPK declares that he has no competing interests.

Peer reviewers VIEW ALL 

Leopoldo C. Cancio, MD

Critical Care Fellow

US Army Burn Center

US Army Institute of Surgical Research

Brooke Army Medical Center

Fort Sam Houston

Disclosures

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

Disclosures

RT declares that he has no competing interests.

Brendan Madden, MD, MSc, FRCP, FRCPI

Professor of Cardiothoracic Medicine

St George's Hospital

London

Disclosures

BM declares that he has no competing interests.

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Inhalation injury

Summary

Definition

History and exam

Key diagnostic factors

Other diagnostic factors

Risk factors

Diagnostic investigations

1st investigations to order

Investigations to consider

Emerging tests

Treatment algorithm

all patients

Contributors

Authors VIEW ALL 

Karen C. Dugan, MD

Disclosures

Jason T. Poston, MD

Disclosures

Acknowledgements

Peer reviewers VIEW ALL 

Leopoldo C. Cancio, MD

Disclosures

Rhys Thomas, MD

Disclosures

Brendan Madden, MD, MSc, FRCP, FRCPI

Disclosures

Differentials

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