Summary
OBJECTIVE: Inhalation injury is a vitally threatening medical syndrome, which might appear in patients with or without burn injuries. Thus, knowledge about development, diagnosis and treatment of inhalation injury should be available for each physician working in an intensive care unit. METHODS: This review starts with the causal and formal pathogenesis of inhalation injuries. Furthermore, diagnosis and treatment in the critical care setting are presented, followed by the discussion of possible complications. Specific intoxications such as carbon monoxide are due to their importance separately discussed. CONCLUSIONS: Inhalation injury present with an attributable excess mortality and thus worsen the prognosis of burned patients. New insights into the pathogenesis of inhalation injury, however, have led to improved therapeutic possibilities with improved outcome. Necessary prerequisites are a timely diagnosis and restrictive volume management, especially in patients with extensive burns. Prospective studies are needed to be able to answer the many emerging questions.
Zusammenfassung
ZWECK: Das Inhalationstrauma ist ein intensivmedizinisches, lebensbedrohliches Zustandsbild, welches mit und ohne Brandverletzungen auftreten kann. Wissen über Entstehung, Diagnose und Behandlung des Inhalationstraumas sollte daher allen an Intensivstationen tätigen Ärzten zur Verfügung stehen. METHODEN: In dieser Übersichtsarbeit werden einleitend die kausale und formale Pathogenese des Inhalationstraumas beschrieben. In Folge werden Diagnose, intensivmedizinische Therapie des Inhalationstraumas sowie Komplikationen abgehandelt. Zusätzlich werden systemische Intoxikationen mit Kohlenmonoxid oder Zyanid detailliert behandelt. SCHLUSSFOLGERUNGEN: Inhalationstraumen erhöhen die Mortalität und verschlechtern damit die Prognose brandverletzter Patienten. Neue Einblicke in die Pathogenese haben die Therapie des Inhalationstraumas jedoch positiv beeinflusst, sodass diese Patienten heutzutage in den meisten Fällen erfolgreich mittels konventioneller Methoden behandelt werden können. Voraussetzung dafür sind einerseits eine rechtzeitige Diagnose, sowie eine restriktive Flüssigkeitssubstitution in den ersten Stunden. Letzteres ist vor allem bei Vorliegen ausgedehnter Brandverletzungen mit Entwicklung der sogenannten Verbrennungskrankheit von großer Bedeutung. Prospektive Studien wären notwendig um die vielen offenen Fragen beantworten zu können.
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Literatur
Statistik Austria – Jahrbuch der Gesundheitsstatistik. Verlag Österreich GmbH, Wien, 2007
Nugent N, Herndon DN (2007) Diagnosis and treatment of inhalation injury. In: Total Burn Care. 3 edn. Saunders
Hoppe U, Klose R (2005) Das Inhalationstrauma bei Verbrennungspatienten: Diagnostik und Therapie. Intensivmed 42: 425–429
Kincaid S, Sharar S, Hudson L (2008) Toxic gas, fume, and smoke inhalation. In: Parrillo J, Dellinger R (eds) Critical care medicine principles of diagnosis and management in the adult, 3rd edn. Mosby Elsevier , Philadelphia
Shirani KZ, Pruitt BA Jr, Mason AD Jr (1987) The influence of inhalation injury and pneumonia on burn mortality. Ann Surg 205 (1): 82–87
Ryan CM, Schoenfeld DA, Thorpe WP, Sheridan RL, Cassem EH, Tompkins RG (1998) Objective estimates of the probability of death from burn injuries. N Engl J Med 338 (6): 362–366
Godwin Y, Wood SH (1998) Major burns in Cape Town: a modified burns score for patient triage. Burns 24 (1): 58–63
Tobiasen J, Hiebert JM, Edlich RF (1982) The abbreviated burn severity index. Ann Emerg Med 11 (5): 260–262
Klose R (2007) Verbrennung. In: Van Aken H (ed) Intensivmedizin. Georg Thieme Verlag, Stuttgart
Davies JW (1986) Toxic chemicals versus lung tissue – an aspect of inhalation injury revisited. The Everett Idris Evans memorial lecture – 1986. J Burn Care Rehabil 7 (3): 213–222
Mlcak RP, Suman OE, Herndon DN (2007) Respiratory management of inhalation injury. Burns 33 (1): 2–13
Forth W (1996) Lungenreizstoffe. In: Forth W, Henschler D, Rummel W (Hrsg) Allgemeine und spezielle Pharmakologie und Toxikologie. Spektrum, Berlin
Enkhbaatar P, Cox RA, Traber LD, Westphal M, Aimalohi E, Morita N, et al (2007) Aerosolized anticoagulants ameliorate acute lung injury in sheep after exposure to burn and smoke inhalation. Crit Care Med 35 (12): 2805–2810
Wikipedia – Phosgen. Cited Available from: http://de.wikipedia.org/wiki/Phosgen
Woodson LC (2009) Diagnosis and grading of inhalation injury. J Burn Care Res 30 (1): 143–145
Liffner G, Bak Z, Reske A, Sjoberg F (2005) Inhalation injury assessed by score does not contribute to the development of acute respiratory distress syndrome in burn victims. Burns 31 (3): 263–268
Endorf FW, Gamelli RL (2007) Inhalation injury, pulmonary perturbations, and fluid resuscitation. J Burn Care Res 28 (1): 80–83
Thompson PB, Herndon DN, Traber DL, Abston S (1986) Effect on mortality of inhalation injury. J Trauma 26 (2): 163–165
Edelman DA, White MT, Tyburski JG, Wilson RF (2006) Factors affecting prognosis of inhalation injury. J Burn Care Res 27 (6): 848–853
Brooks DE, Lin E, Ahktar J (2002) What is cherry red, and who cares? J Emerg Med 22 (2): 213–214
Putman CE, Loke J, Matthay RA, Ravin CE (1977) Radiographic manifestations of acute smoke inhalation. AJR Am J Roentgenol 129 (5): 865–870
Park MS, Cancio LC, Batchinsky AI, McCarthy MJ, Jordan BS, Brinkley WW, et al (2003) Assessment of severity of ovine smoke inhalation injury by analysis of computed tomographic scans. J Trauma 55 (3): 417–427; discussion 427–419
Reske A, Bak Z, Samuelsson A, Morales O, Seiwerts M, Sjoberg F (2005) Computed tomography – a possible aid in the diagnosis of smoke inhalation injury? Acta Anaesthesiol Scand 49 (2): 257–260
Moylan JA Jr, Wilmore DW, Mouton DE, Pruitt BA Jr (1972) Early diagnosis of inhalation injury using 133 xenon lung scan. Ann Surg 176 (4): 477–484
Masanes MJ, Legendre C, Lioret N, Saizy R, Lebeau B (1995) Using bronchoscopy and biopsy to diagnose early inhalation injury. Macroscopic and histologic findings. Chest 107 (5): 1365–1369
Cochran A (2009) Inhalation injury and endotracheal intubation. J Burn Care Res 30 (1): 190–191
Trupkovic T, Giessler G (2008) Burn trauma. Part 1: pathophysiology, preclinical care and emergency room management. Anaesthesist 57 (9): 898–907
Gronert GA (1999) Succinylcholine hyperkalemia after burns. Anesthesiology 91 (1): 320–322
Han T, Kim H, Bae J, Kim K, Martyn JA (2004) Neuromuscular pharmacodynamics of rocuronium in patients with major burns. Anesth Analg 99 (2): 386–392, table of contents
Han TH, Martyn JA (2009) Onset and effectiveness of rocuronium for rapid onset of paralysis in patients with major burns: priming or large bolus. Br J Anaesth 102 (1): 55–60
MacLennan N, Heimbach DM, Cullen BF (1998) Anesthesia for major thermal injury. Anesthesiology 89 (3): 749–770
Eckhauser FE, Billote J, Burke JF, Quinby WC (1974) Tracheostomy complicating massive burn injury. A plea for conservatism. Am J Surg 127 (4): 418–423
Barret JP, Desai MH, Herndon DN (2000) Effects of tracheostomies on infection and airway complications in pediatric burn patients. Burns 26 (2): 190–193
Gravvanis AI, Tsoutsos DA, Iconomou TG, Papadopoulos SG (2005) Percutaneous versus conventional tracheostomy in burned patients with inhalation injury. World J Surg 29 (12): 1571–1575
Palmieri TL, Jackson W, Greenhalgh DG (2002) Benefits of early tracheostomy in severely burned children. Crit Care Med 30 (4): 922–924
Purdue GF (2009) To trach or not to trach. J Burn Care Res 30 (1): 192–193
Griffiths J, Barber VS, Morgan L, Young JD (2005) Systematic review and meta-analysis of studies of the timing of tracheostomy in adult patients undergoing artificial ventilation. BMJ 330 (7502): 1243
Nieszkowska A, Combes A, Luyt CE, Ksibi H, Trouillet JL, Gibert C, et al (2005) Impact of tracheotomy on sedative administration, sedation level, and comfort of mechanically ventilated intensive care unit patients. Crit Care Med 33 (11): 2527–2533
Cartotto RC, Innes M, Musgrave MA, Gomez M, Cooper AB (2002) How well does the Parkland formula estimate actual fluid resuscitation volumes? J Burn Care Rehabil 23 (4): 258–265
Saffle JI (2007) The phenomenon of "fluid creep" in acute burn resuscitation. J Burn Care Res 28 (3): 382–395
Demling RH (2005) The burn edema process: current concepts. J Burn Care Rehabil 26 (3): 207–227
Gaar KA Jr, Taylor AE, Owens LJ, Guyton AC (1967) Effect of capillary pressure and plasma protein on development of pulmonary edema. Am J Physiol 213 (1): 79–82
Darling GE, Keresteci MA, Ibanez D, Pugash RA, Peters WJ, Neligan PC (1996) Pulmonary complications in inhalation injuries with associated cutaneous burn. J Trauma 40 (1): 83–89
Palmieri TL (2009) Use of beta-agonists in inhalation injury. J Burn Care Res 30 (1): 156–159
Palmieri TL, Enkhbaatar P, Bayliss R, Traber LD, Cox RA, Hawkins HK, et al (2006) Continuous nebulized albuterol attenuates acute lung injury in an ovine model of combined burn and smoke inhalation. Crit Care Med 34 (6): 1719–1724
Perkins GD, McAuley DF, Thickett DR, Gao F (2006) The beta-agonist lung injury trial (BALTI): a randomized placebo-controlled clinical trial. Am J Respir Crit Care Med 173 (3): 281–287
Manocha S, Gordon AC, Salehifar E, Groshaus H, Walley KR, Russell JA (2006) Inhaled beta-2 agonist salbutamol and acute lung injury: an association with improvement in acute lung injury. Crit Care 10 (1): R12
Greenhalgh DG (2009) Steroids in the treatment of smoke inhalation injury. J Burn Care Res 30 (1): 165–169
Enkhbaatar P, Murakami K, Cox R, Westphal M, Morita N, Brantley K, et al (2004) Aerosolized tissue plasminogen inhibitor improves pulmonary function in sheep with burn and smoke inhalation. Shock 22 (1): 70–75
Enkhbaatar P, Herndon DN, Traber DL (2009) Use of nebulized heparin in the treatment of smoke inhalation injury. J Burn Care Res 30 (1): 159–162
Desai MH, Mlcak R, Richardson J, Nichols R, Herndon DN (1998) Reduction in mortality in pediatric patients with inhalation injury with aerosolized heparin/N-acetylcystine (correction of acetylcystine) therapy. J Burn Care Rehabil 19 (3): 210–212
Holt J, Saffle JR, Morris SE, Cochran A (2008) Use of inhaled heparin/N-acetylcystine in inhalation injury: does it help? J Burn Care Res 29 (1): 192–195
Niedermayr M, Schramm W, Kamolz L, Andel D, Romer W, Hoerauf K, et al (2007) Antithrombin deficiency and its relationship to severe burns. Burns 33 (2): 173–178
Enkhbaatar P, Esechie A, Wang J, Cox RA, Nakano Y, Hamahata A, et al (2008) Combined anticoagulants ameliorate acute lung injury in sheep after burn and smoke inhalation. Clin Sci (Lond) 114 (4): 321–329
Wolf SE (2009) Vitamin C and smoke inhalation injury. J Burn Care Res 30 (1): 184–186
Traber DL, Traber MG, Enkhbaatar P, Herndon DN (2009) Tocopherol as treatment for lung injury associated with burn and smoke inhalation. J Burn Care Res 30 (1): 164– 165
Sheridan RL, Hess D (2009) Inhaled nitric oxide in inhalation injury. J Burn Care Res 30 (1): 162–164
Malerba M, Ragnoli B (2008) Ambroxol in the 21st century: pharmacological and clinical update. Expert Opin Drug Metab Toxicol 4 (8): 1119–1129
Dellinger RP, Levy MM, Carlet JM, Bion J, Parker MM, Jaeschke R, et al (2008) Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008. Crit Care Med 36 (1): 296–327
Laffey JG, Tanaka M, Engelberts D, Luo X, Yuan S, Tanswell AK, et al (2000) Therapeutic hypercapnia reduces pulmonary and systemic injury following in vivo lung reperfusion. Am J Respir Crit Care Med 162 (6): 2287– 2294
Broccard AF, Hotchkiss JR, Vannay C, Markert M, Sauty A, Feihl F, et al (2001) Protective effects of hypercapnic acidosis on ventilator-induced lung injury. Am J Respir Crit Care Med 164 (5): 802–806
Gattinoni L, Caironi P (2008) Refining ventilatory treatment for acute lung injury and acute respiratory distress syndrome. JAMA 299 (6): 691–693
Dries DJ (2009) Key questions in ventilator management of the burn-injured patient (second of two parts). J Burn Care Res 30 (2): 211–220
Reper P, Wibaux O, Van Laeke P, Vandeenen D, Duinslaeger L, Vanderkelen A (2002) High frequency percussive ventilation and conventional ventilation after smoke inhalation: a randomised study. Burns 28 (5): 503–508
Cartotto R, Walia G, Ellis S, Fowler R (2009) Oscillation after inhalation: high frequency oscillatory ventilation in burn patients with the acute respiratory distress syndrome and co-existing smoke inhalation injury. J Burn Care Res 30 (1): 119–127
Thompson JT, Molnar JA, Hines MH, Chang MC, Pranikoff T (2005) Successful management of adult smoke inhalation with extracorporeal membrane oxygenation. J Burn Care Rehabil 26 (1): 62–66
Evans TW (2001) International Consensus Conferences in Intensive Care Medicine: non-invasive positive pressure ventilation in acute respiratory failure.Organised jointly by the American Thoracic Society, the European Respiratory Society, the European Society of Intensive Care Medicine, and the Societe de Reanimation de Langue Francaise, and approved by the ATS Board of Directors, December 2000. Intensive Care Med 27 (1): 166–178
Smailes ST (2002) Noninvasive positive pressure ventilation in burns. Burns 28 (8): 795–801
Oczenski W (2006) Nicht-invasive Beatmung. In: Atmen – Atemhilfen, 7 edn. Georg Thieme
Rouby JJ, Lu Q (2005) Bench-to-bedside review: adjuncts to mechanical ventilation in patients with acute lung injury. Crit Care 9 (5): 465–471
Barker SJ, Tremper KK (1987) The effect of carbon monoxide inhalation on pulse oximetry and transcutaneous PO2. Anesthesiology 66 (5): 677–679
Thom SR, Taber RL, Mendiguren, II, Clark JM, Hardy KR, Fisher AB (1995) Delayed neuropsychologic sequelae after carbon monoxide poisoning: prevention by treatment with hyperbaric oxygen. Ann Emerg Med 25 (4): 474–480
Juurlink DN, Buckley NA, Stanbrook MB, Isbister GK, Bennett M, McGuigan MA (2005) Hyperbaric oxygen for carbon monoxide poisoning. Cochrane Database Syst Rev 2005 (1): CD002041
Barillo DJ (2009) Diagnosis and treatment of cyanide toxicity. J Burn Care Res 30 (1): 148–152
Baud FJ, Barriot P, Toffis V, Riou B, Vicaut E, Lecarpentier Y, et al (1991) Elevated blood cyanide concentrations in victims of smoke inhalation. N Engl J Med 325 (25): 1761– 1766
Palmieri TL (2009) Inhalation injury consensus conference introduction. J Burn Care Res 30 (1): 141–142
Pruitt BA Jr (1984) The diagnosis and treatment of infection in the burn patient. Burns Incl Therm Inj 11 (2): 79–91
Edelman DA, Khan N, Kempf K, White MT (2007) Pneumonia after inhalation injury. J Burn Care Res 28 (2): 241– 246
Dancey DR, Hayes J, Gomez M, Schouten D, Fish J, Peters W, et al (1999) ARDS in patients with thermal injury. Intensive Care Med 25 (11): 1231–1236
Maybauer MO, Rehberg S, Traber DL, Herndon DN, Maybauer DM (2009) Pathophysiology of acute lung injury in severe burn and smoke inhalation injury. Anaesthesist 58 (8): 805–812
Casper JK, Clark WR, Kelley RT, Colton RH (2002) Laryngeal and phonatory status after burn/inhalation injury: a long term follow-up study. J Burn Care Rehabil 23 (4): 235– 243
Arakawa A, Fukamizu H, Hashizume I, Kasamatsu N, Nagayoshi M, Shinozuka N, et al (2007) Macroscopic and histological findings in the healing process of inhalation injury. Burns 33 (7): 855–859
Park GY, Park JW, Jeong DH, Jeong SH (2003) Prolonged airway and systemic inflammatory reactions after smoke inhalation. Chest 123 (2): 475–480
Palmieri TL (2009) Long term outcomes after inhalation injury. J Burn Care Res 30 (1): 201–203
Giessler GA, Mayer T, Trupkovic T (2009) Burn trauma – Part 2. Anesthesiological, surgical and intensive care management. Anaesthesist 58 (5): 474–484
Traber DL, Herndon DN, Enkhbaatar P, Maybauer MO, (2007) The Pathopysiology of Inhalation Injury. In: Total Burn Care. 3 edn. Saunders
Kafka G, Maybauer DM, Traber DL, Maybauer MO (2007) Treatment of inhalation injury in preclinical emergency medicine. Notfall Rettungsmed 2007 (10): 529–540
Maybauer DM, Traber DL, Radermacher P, Herndon DN, Maybauer MO (2006) Treatment strategies for acute smoke inhalation injury. Anaesthesist 55 (9): 980–982, 984–988
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Thaler, U., Kraincuk, P., Kamolz, LP. et al. Das Inhalationstrauma – Epidemiologie, Diagnostik und Therapie. Wien Klin Wochenschr 122, 11–21 (2010). https://doi.org/10.1007/s00508-010-1303-7
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DOI: https://doi.org/10.1007/s00508-010-1303-7