Current concepts in the management of burns with inhalation injury

The addition of smoke inhalation injury to major burns significantly increases the mortality. The pathophysiology of inhalation injury is due to direct damage to the airway by heat or smoke, and secondary injury to the pulmonary microcirculation from inflammatory mediators. Clinically it presents with upper airway obstruction, bronchospasm, oedema, consolidation, ARDS and pneumonia. The management of major burns must be undertaken by a multidisciplinary team dedicated to optimising the outcome. Early assessment, accurate resuscitation, and aggressive respiratory care, preserve the patient for surgery to reduce the ongoing effects of the burned tissue. This results in improved quality of survival. The complications of inhalation injury can be managed by pressure-supported ventilation, aggressive pulmonary toilet, and innovatory new therapies, which are discussed in this article.