Respiratory problems complicating burn injury: recognition, assessment, and treatment

Postburn pulmonary injury is a common and frequently overlooked concomitant of burn injury. The lesion may be secondary to direct damage to the respiratory apparatus from the inhalation of smoke or of toxic or superheated chemicals or from mechanical mechanisms or it may be secondary to indirect damage from hypovolemia, shock, central nervous system disturbances, or drug usage. Therapy comprises establishment of a clear airway and administration of humidity and oxygen in amounts appropriate to maintain adequate blood oxygen tension and pH. Sequential monitoring of oxygen and pH status is required. The diagnosis of postburn pulmonary injury is made on clinical grounds, and sequential management of the patient, closely supported by laboratory studies, is essential. Surface decompression of the thorax, antibiotics given systemically, and sequentially increasing respiratory support (with later de-escalation) may be needed.