Inhalation injury, a complex, a complex and deadly disease process, occurs when the heat and toxins in smoke make contact with airway mucosa and alveoli. The degree of injury depends on the composition of the smoke, which varies according to its source. Heat affects primarily the supraglottic area and causes edema and upper airway obstruction, whereas the gas and particle components of the smoke affect primarily the airway mucosa and cause the actual chemical burn. The initial smoke injury occurs shortly after exposure, but the ensuing intense inflammatory reaction evolves over a period of hours to days resulting in lung damage.

Inhalation injury should be suspected in:

• - Individuals who were injured in a closed space,
• - Patients with extensive burns or with burns of the face,
• - Patients who were unconscious at the time of injury,
• - Patients with singed nasal hairs, hoarseness, or wheezing, and
• - Patients who are coughing up carbonacious sputum.

Pulmonary injury is known to result in substantially increased burn mortality and morbidity. When indicated, early intubation and positive pressure ventilation has been shown to improve outcome.

A number of techniques have been used to assess the degree of supraglottic and subglottic injury and to determine the need for endotracheal intubation. Fiberoptic bronchoscopy of laryngoscopy will reveal physical evidence of mucosal injury. Because the injury process is progressive during the first 18 to 24 hours, initial appearance however does not accurately predict the severity of subsequent airway compromise. Usually with signs of damage, intubation is the safest approach.

INDICATION FOR ENDOTRACHEAL INTUBATION

1. Deep facial burns - especially of the mouth and oropharynx. Edema will impair patency.
2. Massive body burns, especially in the presence of circumferential chest burns, as ventilatory support is needed.