Diagnosis of Inhalation Injury

Inhalation injury can feature supraglottic thermal injury, chemical irritation of the respiratory tract, systemic toxicity due to agents such as carbon monoxide (CO) and cyanide, or a combination of these insults. The resultant inflammatory response may cause higher fluid resuscitation volumes, progressive pulmonary dysfunction, prolonged ventilator days, increased risk of pneumonia, and acute respiratory distress syndrome (ARDS).

Diagnosis of Inhalation Injury

There are several modalities for confirming inhalation injury to include fiberoptic bronchoscopy (FOB), chest computed tomography (CT), carboxyhemoglobin measurement, radionuclide imaging with 133Xenon, and pulmonary function testing. The following gradation of morbidity and mortality risk was seen in order of increasing risk: (1) patients without inhalation injury; (2) patients with inhalation injury by 133Xenon scan only, but not by FOB; and (3) patients with inhalation injury by FOB. Also, presence of inhalation injury on FOB predicted risk of acute lung injury and the need for increased fluid resuscitation volumes.

The Abbreviated Injury Score grading scale for inhalation injury on bronchoscopy has been shown to correlate with an increase in mortality as well impaired gas exchange.

Injury Score grading scale for inhalation injury on bronchoscopy

Grade Class Description
0 No injury Absence of carbonaceous deposits, erythema, edema, bronchorrhea, or obstruction
1 Mild injury Minor or patchy areas of erythema, carbonaceous deposits, bronchorrhea, or bronchial obstruction
2 Moderate injury Moderate degree of erythema, carbonaceous deposits, bronchorrhea, or bronchial obstruction
3 Severe injury Severe inflammation with friability, copious carbonaceous deposits, bronchorrhea, or obstruction
4 Massive injury Evidence of mucosal sloughing, necrosis, endoluminal obstruction

 

 

References:

  1. Deutsch CJ, Tan A, Smailes S, Dziewulski P. The diagnosis and management of inhalation injury: An evidence based approach. Burns. 2018 Aug;44(5):1040-1051. [Medline]
  2. Walker PF, Buehner MF, Wood LA, Boyer NL, Driscoll IR, Lundy JB, Cancio LC, Chung KK. Diagnosis and management of inhalation injury: an updated review. Crit Care. 2015 Oct 28;19:351. [Medline]

Created Jul 03, 2019.