Inhalation Injury Management in Burn Patients
Summary
Burn inhalation injuries arise from heat and chemical insults to the airway during smoke exposure. They are a leading contributor to morbidity and mortality in burn patients, compounding challenges of fluid management, respiratory support and infection control. Early recognition often relies on clinical findings such as facial burns, singed nasal hair, dyspnoea and voice changes, supplemented by bronchoscopic assessment and imaging. Securing the airway through timely intubation is paramount; indicators include progressive respiratory distress, significant cutaneous burn surface area and bronchoscopic evidence of injury. Protective ventilation strategies, such as low tidal volume and positive end-expiratory pressure, aim to minimise ventilator-induced lung injury. Adjunctive pharmacotherapies—including nebulised anticoagulants, bronchodilators and mucolytics—as well as targeted lavage help clear debris and reduce inflammatory mediators. Fluid resuscitation must balance circulatory support and pulmonary oedema risk, guided by precise protocols. Despite advances, optimal grading of inhalation severity and tailored interventions for specific chemical toxins remain areas of ongoing enquiry. Interdisciplinary collaboration between intensivists, burn surgeons and respiratory therapists underpins current best practice, while emerging approaches in drug-eluting airway devices and microbiome modulation hold promise for future care pathways.
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Inhalation Injury Management in Burn Patients publication trend
The graph below shows the total number of articles in inhalation injury management in burn patients across all publications each year (not limited to Nature Index journals).
Technical terms
Bronchoscopic lavage: Washing of the bronchial airways under direct visualisation to remove soot and secretions.
Lung-protective ventilation: A mechanical ventilation approach using low tidal volumes and limited airway pressures to reduce ventilator-induced lung injury.
Positive end-expiratory pressure (PEEP): The pressure maintained in the lungs at the end of expiration to improve oxygenation and prevent alveolar collapse.
Fluid resuscitation protocol: A structured regimen of intravenous fluids administered to restore circulatory volume while minimising tissue oedema.
References
- An international RAND/UCLA expert panel to determine the optimal diagnosis and management of burn inhalation injury. Critical Care (2023).
- Burn inhalation injury and intubation with dexamethasone-eluting endotracheal tubes modulate local microbiome and alter airway inflammation. Frontiers in Bioengineering and Biotechnology (2025).
- The impact of inhalation injury on fluid resuscitation in major burn patients: a 10-year multicenter retrospective study. European Journal of Medical Research (2024).
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