Inhalational injury is a major cause of death in large burns. It may be classified
according to the site of injury:
• Supraglottic—hot gases injure the upper airway directly, causing oedema. The
obstruction may be delayed for up to 1–2 days and can resolve spontaneously after
a few days.
• Subglottic—thermal injury to the distal airway is rare but chemical injury can be
caused by noxious or irritant gases, such as acids or aldehydes.
• Systemic—inhaled gases may cause metabolic upset, e.g. carbon monoxide or cyanide
compounds. Carboxyhaemoglobin levels can be measured (threshold is higher in
smokers, 10% vs 5%), but depends on the time elapsed since the injury (half life
2–6 hours depending on which study you believe) and also on the oxygen delivered.
A high index of suspicion of possibility of an inhalational injury is required; intubating
prophylatically is preferable to performing emergency intubation for overt respiratory
according to the site of injury:
• Supraglottic—hot gases injure the upper airway directly, causing oedema. The
obstruction may be delayed for up to 1–2 days and can resolve spontaneously after
a few days.
• Subglottic—thermal injury to the distal airway is rare but chemical injury can be
caused by noxious or irritant gases, such as acids or aldehydes.
• Systemic—inhaled gases may cause metabolic upset, e.g. carbon monoxide or cyanide
compounds. Carboxyhaemoglobin levels can be measured (threshold is higher in
smokers, 10% vs 5%), but depends on the time elapsed since the injury (half life
2–6 hours depending on which study you believe) and also on the oxygen delivered.
A high index of suspicion of possibility of an inhalational injury is required; intubating
prophylatically is preferable to performing emergency intubation for overt respiratory
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