Diagnosis and Grading of Inhalation Injury

Patients with respiratory injury resulting from inhalation of smoke or other chemical irritants experience high rates of morbidity and mortality. Even isolated inhalation injury can carry a significant risk of mortality or permanent pulmonary dysfunction. When combined with cutaneous burns, inhalation injury increases fluid requirements for resuscitation,1 the incidence of pulmonary complications,2 and the mortality rate.2,–4 The diagnosis of inhalation injury is generally recognized as an important but inconsistent indicator of increased morbidity and mortality in burn patients.4 Remarkable progress has been achieved in the treatment of cutaneous burns. In recent decades, there has been a dramatic decline in the mortality from large burns. In contrast, despite considerable advances in our knowledge of the pathophysiology of inhalation injury, there are few specific therapeutic options and patient care is largely supportive. Although several studies have suggested a decrease in the mortality associated with inhalation injury, these changes would result from overall improvements in care and not so much from interventions aimed specifically at inhalation injury. There is general agreement that advances in the treatment of inhalation injury have not kept pace with improvements in the care of cutaneous burns. In our own institution the mortality rates for patients with inhalation injury have not changed in the past 20 years.