Inhalation Injury: Research Progress and Needs

Smoke inhalation continues to be a major source of morbidity and mortality in burn patients despite recent advances in critical care and wound management.1 Approximately 10% to 20% of patients admitted to burn centers have inhalation injury, and the incidence increases with burn size. Inhalation injury, in conjunction with age and burn size, is an important determinant of survival, prolonged ventilator dependence, hospital stay, and death in burn patients.2,–5 However, determining the extent of pulmonary injury and standardizing optimal therapy continue to be elusive. Mortality in combined burn/smoke inhalation injury remains high due to progressive pulmonary and cardiac dysfunction.6,–8 Treatment modalities used in inhalation injury range from specialized modes of ventilation to the use of nitric oxide. Research into the pathophysiology of inhalation injury has been productive, but there continue to be significant gaps in our understanding of inhalation injury. Although “inhalation injury” contributes to increasing mortality after burn injury, a universally accepted clinical definition and/or diagnostic criteria for inhalation injury is lacking. For practical purposes inhalation injury has been divided into different phases: 1) injury caused at the site of the fire as the result of noxious gases, 2) upper airway heat injury, and 3) lower airway chemical injury. Each aspect of inhalation injury has a different pathophysiology, treatment, and long-term implications. Laboratory and clinical advances have been made in each aspect of inhalation injury despite the current challenges. The goal of this paper is to discuss the major advances in our knowledge of inhalation injury, outline the areas requiring further study, determine the priorities for future inhalation injury research (as discussed in the break-out sessions), and discuss the resources that will be needed to accomplish those goals.