Inhalation Injury in the Burned Patient

Guillermo Foncerrada, Derek M. Culnan, Karel D. Capek, Sagrario González-Trejo, Janos Cambiaso-Daniel, Lee C. Woodson, David N. Herndon, Celeste Finnerty, Jong O. Lee

Research output: Contribution to journalReview article

4 Citations (Scopus)

Abstract

Inhalation injury causes a heterogeneous cascade of insults that increase morbidity and mortality among the burn population. Despite major advancements in burn care for the past several decades, there remains a significant burden of disease attributable to inhalation injury. For this reason, effort has been devoted to finding new therapeutic approaches to improve outcomes for patients who sustain inhalation injuries.The three major injury classes are the following: supraglottic, subglottic, and systemic. Treatment options for these three subtypes differ based on the pathophysiologic changes that each one elicits.Currently, no consensus exists for diagnosis or grading of the injury, and there are large variations in treatment worldwide, ranging from observation and conservative management to advanced therapies with nebulization of different pharmacologic agents.The main pathophysiologic change after a subglottic inhalation injury is an increase in the bronchial blood flow. An induced mucosal hyperemia leads to edema, increases mucus secretion and plasma transudation into the airways, disables the mucociliary escalator, and inactivates hypoxic vasocontriction. Collectively, these insults potentiate airway obstruction with casts formed from epithelial debris, fibrin clots, and inspissated mucus, resulting in impaired ventilation. Prompt bronchoscopic diagnosis and multimodal treatment improve outcomes. Despite the lack of globally accepted standard treatments, data exist to support the use of bronchoscopy and suctioning to remove debris, nebulized heparin for fibrin casts, nebulized N-acetylcysteine for mucus casts, and bronchodilators.Systemic effects of inhalation injury occur both indirectly from hypoxia or hypercapnia resulting from loss of pulmonary function and systemic effects of proinflammatory cytokines, as well as directly from metabolic poisons such as carbon monoxide and cyanide. Both present with nonspecific clinical symptoms including cardiovascular collapse. Carbon monoxide intoxication should be treated with oxygen and cyanide with hydroxocobalamin.Inhalation injury remains a great challenge for clinicians and an area of opportunity for scientists. Management of this concomitant injury lags behind other aspects of burn care. More clinical research is required to improve the outcome of inhalation injury.The goal of this review is to comprehensively summarize the diagnoses, treatment options, and current research.

Original languageEnglish (US)
Pages (from-to)S98-S105
JournalAnnals of plastic surgery
Volume80
Issue number3
DOIs
StatePublished - Mar 1 2018

Fingerprint

Inhalation
Wounds and Injuries
Mucus
Cyanides
Carbon Monoxide
Fibrin
Therapeutics
Hydroxocobalamin
Elevators and Escalators
Combined Modality Therapy
Hypercapnia
Poisons
Bronchodilator Agents
Hyperemia
Acetylcysteine
Bronchoscopy
Airway Obstruction
Research
Ventilation
Heparin

ASJC Scopus subject areas

  • Surgery

Cite this

Foncerrada, G., Culnan, D. M., Capek, K. D., González-Trejo, S., Cambiaso-Daniel, J., Woodson, L. C., ... Lee, J. O. (2018). Inhalation Injury in the Burned Patient. Annals of plastic surgery, 80(3), S98-S105. https://doi.org/10.1097/SAP.0000000000001377

Inhalation Injury in the Burned Patient. / Foncerrada, Guillermo; Culnan, Derek M.; Capek, Karel D.; González-Trejo, Sagrario; Cambiaso-Daniel, Janos; Woodson, Lee C.; Herndon, David N.; Finnerty, Celeste; Lee, Jong O.

In: Annals of plastic surgery, Vol. 80, No. 3, 01.03.2018, p. S98-S105.

Research output: Contribution to journalReview article

Foncerrada, G, Culnan, DM, Capek, KD, González-Trejo, S, Cambiaso-Daniel, J, Woodson, LC, Herndon, DN, Finnerty, C & Lee, JO 2018, 'Inhalation Injury in the Burned Patient', Annals of plastic surgery, vol. 80, no. 3, pp. S98-S105. https://doi.org/10.1097/SAP.0000000000001377
Foncerrada G, Culnan DM, Capek KD, González-Trejo S, Cambiaso-Daniel J, Woodson LC et al. Inhalation Injury in the Burned Patient. Annals of plastic surgery. 2018 Mar 1;80(3):S98-S105. https://doi.org/10.1097/SAP.0000000000001377
Foncerrada, Guillermo ; Culnan, Derek M. ; Capek, Karel D. ; González-Trejo, Sagrario ; Cambiaso-Daniel, Janos ; Woodson, Lee C. ; Herndon, David N. ; Finnerty, Celeste ; Lee, Jong O. / Inhalation Injury in the Burned Patient. In: Annals of plastic surgery. 2018 ; Vol. 80, No. 3. pp. S98-S105.
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