Eligible patients were victims of smoke inhalation from household fires admitted to the ICU over a 6-year period. Patients with cutaneous burns, multiple trauma, or blast injuries were excluded. 64 consecutive patients were studied. Increased duration of MV was associated with the presence of rhonchi on initial examination, elevated CO levels, and positive pulmonary cultures. Pulmonary injury is common in smoke inhalation victims without cutaneous burns, and is associated with the presence of dysphonia or rhonchi on initial examination.
Aspiration seems to be involved frequently.
The key point to remember from this paper is the frequency with which aspiration and positive pulmonary cultures are associated with increased morbidity. 75 sputum samples in 11 of 33 mechanically ventilated patients were ultimately positive. This fact will not, of course, change initial emergency management. An important issue for the emergency physician is at what point the patient needs intubation. The specific indications for this intervention are not clear from the data.