management of inhalational injury

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There are certain general steps that are relevant to the treatment of all inhalation injuries. However, they are modified according to the injurious agent and the main location of damage - see submenu.

Oxygen should be given humidified at 8 litres per minute. The patient should be nursed with the head end of the bed elevated. This will reduce pulmonary oedema and increase tidal volume. If the patient has difficulty ventilating due to unconsciousness, external burns or impending upper airway obstruction, intubation and ventilation should be considered. However, care must be taken to ensure that the endotracheal cuff pressure is not too high (>20 cmH20) else tracheomalacia and tracheal stenosis may develop. If ventilation is prolonged, a tracheostomy is a safer alternative. Often the PaCO2 is allowed to rise to minimise the risk of barotrauma. High frequency ventilation is an alternative.

Physiotherapy and regular suctioning improves sputum clearance; sputum should be sent regularly for culture. Antibiotics should be administered only in the presence of infection; prophylactic usage tends to select out resistant organisms.

Extra fluids should be administered when there is a concomitant cutaneous burn.

There is controversy over the use of stress ulcer prophylaxis. Sucralfate and H2 receptor antagonists are the standard agents. They are not thought to increase the risk of pneumonia as a result of aspiration.

Nebulised or systemic bronchodilators may be beneficial in the presence of bronchospasm. Aerosolized acetyl cysteine can be used as a mucolytic.

Last reviewed 01/2018

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