Inhalation Injuries

Smoke inhalation remains a serious and life-threatening problem in the pediatric population, with the combination of thermal injury and inhaled toxins triggering a cascade of morbidity and mortality. Consensus on how to manage children with smoke inhalation is problematic because there are no uniform definitions or diagnostic criteria and few interventions have been subjected to randomized controlled trials. Additionally, each fire produces a slightly different toxic profile, and the physiology of pediatric patients uniquely affects their response to smoke inhalation. Young children are most at risk because of their low physiological reserve, while small children are especially vulnerable because they are less likely to escape a confined space. Infants and children are at increased risk for toxic exposures because of their higher minute ventilation, while the relatively smaller diameter of the pediatric airway predisposes to airway obstruction due to edema and obstructing material. This article summarizes the clinical presentation and pathophysiology of pediatric smoke inhalation, and also reviews initial treatment strategies regarding intubation, ventilator management, and pharmacologic adjuncts.