Inhalation injury with burns: a lethal combination

Inhalation injury is known to add significant morbidity and mortality to patients with burns. Estimating the severity of inhalation injury is difficult, as signs of respiratory failure may occur hours or even days after the injury. We have reviewed 86 consecutive patients who were admitted to our Burn/Trauma Center with burns and evidence suggestive of smoke inhalation. Of these patients, 88% required endotracheal intubation. There was a 62% mortality. Admission chest x-rays studies, PAO2, and auscultation of the patient's lungs were normal in 90% of the study group. These factors could not be used to predict respiratory failure or death. Patients with as little as 15% total body surface burns with mild smoke inhalation are at significant risk of respiratory failure and the need for ventilatory support.