Respiratory Complications in the Burned Patient: Pathophysiology and Management

A review of the published literature dealing with the burned patient from the respiratory viewpoint has been presented, with a classifi-cation of pulmonary complications into the following pathogenetic and therapeutic stages: an immediate stage, marked by acute respira-tory insufficiency, refractory hypoxemia, and extremely high mortality, is commonest in patients with facial flame burns sustained in enclosed spaces; it is managed supportively with endotracheal intubation and mechanical ventilation as dictated by arterial blood gases, with antibiotics and corticosteroids of unproven value; an intermediate stage consists of acute pulmonary edema following vigorous fluid re-suscitation; appropriate treatment consists of oxygen supplementation and assisted ventilation, with positive end-expiratory pressure if necessary; finally, a late stage of bacterial pneumonia, which may be airborne or hematogenous, affects patients who survive initial resuscita-tion; successful management depends on comprehensive efforts toward early detection, tracheotomy, appropriate antibiotics, meticulous nursing care, and vigorous attention to bronchial hygiene throughout its prolonged course.