[Toxicity of fire smoke. Apropos of 2 pediatric cases]

Smoke inhalation is one of the main cause of respiratory problems in fire-related accidents.

Case 1. A girl, aged 11 months, was found in her apartment 15 minutes after the start of accidental fire. She was in a stage I coma with cyanosis and covered with soot. She was placed on oxygen and given hydroxocobalamin. Aggravation of respiratory problems led to mechanical ventilation. Tracheobronchoscopy showed deposits of soots with moderate burnt lesions. Intubation was discontinued 12 hours later, but the child remained oxygen-dependent, with persistent tracheobronchitis, despite steroid therapy for 2 weeks. Case 2. Another girl, aged 4 1/2 years, was found in the same room as the preceding patient. She was also covered with soot, and in a coma (Glascow score = 11). She was intubated, placed on mechanical ventilation, and given hydroxocobalamin. Tracheobronchoscopy revealed similar changes to those seen in the preceding patient. Despite repeated tracheobronchial washings and steroid therapy, respiratory problems persisted with thoracic distension and pneumothorax. Mechanical ventilation was discontinued 16 days later but at 5 1/2 years, this child still has dyspnea and has developed bronchiectasis.

Bronchopulmonary changes can be a severe complication of smoke inhalation during fires, and require early mechanical ventilation and repeated tracheobronchoscopy.