Diagnosis and treatment of inhalation injury

Inhalation injury is a common feature of fire injuries. It is of utmost importance to recognize early because it is an independent risk factor for mortality alone, and in combination with cutaneous burns, can cause systemic toxicity, increase the fluid requirement for resuscitation, and can lead to pneumonia, respiratory failure, systemic inflammatory response syndrome, and associated multiorgan system dysfunction. Inhalation injury is also associated with laryngeal injury and long-term pulmonary dysfunction. Because there are no specific remedies, therapy is largely supportive. Progress in improving prognostic estimates and therapies is hampered by a number of hurdles, including a lack of consensus for diagnostic criteria and a lack of large-scale clinical trials. Multicenter studies are needed to capture sufficient numbers of severe injury for valid comparisons. Mechanical ventilation is often needed, but there is no consensus regarding optimal modes. However, it is agreed that care must be taken to avoid ventilator exacerbation of inhalation injury. Numerous preclinical studies provide evidence of potential therapies that await clinical trials.