Deutsch CJ, Tan A, Smailes S, Dziewulski P, et al.
Burns : journal of the International Society for Burn Injuries. Date of publication 2018 Aug 1;volume 44(5):1040-1051.
1. Burns. 2018 Aug;44(5):1040-1051. doi: 10.1016/j.burns.2017.11.013.
The diagnosis and management of inhalation injury: An evidence based approach.
Deutsch CJ(1), Tan A(2), Smailes S(3), Dziewulski P(2).
Author information:
(1)St. Andrew's Centre for Plastic Surgery and Burns, Chelmsford, United Kingdom.
Electronic address: christopher.deutsch@doctors.org.uk.
(2)St. Andrew's Centre for Plastic Surgery and Burns, Chelmsford, United Kingdom;
StAAR Research Unit, Faculty of Medical Sciences, Anglia Ruskin University, 1-2
Bishop Hall Lane, CM1 1SQ, Chelmsford, United Kingdom.
(3)St. Andrew's Centre for Plastic Surgery and Burns, Chelmsford, United Kingdom.
INTRODUCTION: Smoke inhalation injury (II) is an independent risk factor for
mortality in burns and its management is inherently complex. We aim to make
recommendations for best practice in managing II and its sequelae by reviewing
all available current evidence in order to provide an evidence-based approach.
METHODS: We conducted a systematic search of the Cochrane database and Embase
using PRISMA guidelines with no patient population exclusion criteria. Published
work was reviewed and evidence levels graded.
RESULTS: We identified 521 abstracts for inclusion. Of the 84 articles identified
for secondary review, 28 papers were excluded leaving 56 papers suitable for
final inclusion.
CONCLUSIONS: We are able to identify a number of strategies in both diagnosis and
treatment of II that have support in the published literature, including the role
of bronchoscopy, permissive hypercapnia, nebulized heparin and hydroxycobalamin.
Other strategies have not been shown to be harmful, but their efficacy is also
not firmly established, such as high frequency oscillatory ventilation and
exogenous surfactant. Prophylactic antibiotics and corticosteroids are not
recommended. In general, published evidence for II is mostly Level 3 or below,
due to a noticeable lack of large-scale human studies. This represents a
challenge for evidence-based burns practice as a whole.
Copyright © 2017 Elsevier Ltd and ISBI. All rights reserved.
DOI: 10.1016/j.burns.2017.11.013
PMID: 29398078
