Management of Inhalation Injuries in Emergency and Critical Care: A Systematic Review

Inhalation injuries occur in 20% of burns, leading to respiratory failure in 70% of patients, accounting for 30% of mortalities. The diagnosis of inhalation injury utilizes fiberoptic bronchoscopy, which is the gold standard for confirming a diagnosis of inhalation injury. Management involves timely airway stabilization via endotracheal intubation, tracheostomy, fluid resuscitation, and mechanical ventilation. This systematic review aims to synthesize evidence from studies reporting management approaches of inhalation injuries in the emergency department and critical care settings, and to evaluate the associated clinical outcomes. This systematic review was conducted according to the PRISMA checklist. Major outcomes included duration of mechanical ventilation, ventilator-free days, mortality rate, length of hospital stay, length of ICU stay, complications, and long-term pulmonary outcomes. A comprehensive search was conducted using a combination of electronic databases, including PubMed, ScienceDirect, and Cochrane Library. A total of 14 studies were included in the systematic review. The included studies showed that mechanical ventilation within the ICU was the most common management approach for inhalation injuries in emergencies and critical care settings. Intubation was associated with a shorter hospitalization period and fewer ICU days. In contrast, tracheostomy was associated with greater duration of mechanical ventilation, longer hospitalization, longer ICU stay, and more complications. The most reported complications were pneumonia, septic shock, thrombosis/pulmonary embolism, acute respiratory distress syndrome, multiple organ failure, and acute kidney failure. There was significant heterogeneity in management approaches, injury grading, and reported outcomes across the included studies. Mechanical ventilation, though proven beneficial, has yielded several complications. Intubation has shown better results regarding ICU and hospital stays, and ventilator-free days compared to tracheostomy. Inhaled heparin was associated with more ventilator-free days, more ICU-free days, and a shorter duration of mechanical ventilation.