Mechanical Ventilation Treatment

August 26, 2019
The therapeutic approach for critically burned patients with an inhalation injury consists of maintaining airway permeability with intubation and mechanical ventilation.

Mechanical ventilation is a treatment option for burn patients who have suffered a severe inhalation injury. Often, inhalation injuries are common in burn victims. Basically, these involve burns in your respiratory system.

Typically, inhalation injuries occur because of trauma that affects many of the body’s organ systems. This trauma may include burns as well as carbon monoxide and cyanide poisoning. Ultimately, it results from the inhalation of very hot gas, usually during a fire.

Overall, 2% of burn patients have inhalation injuries. The larger the body surface area burned, the higher the chance for having an inhalation injury.

In burn patients, an inhalation injury is a critical determining factor of life or death. Unfortunately, about half of burn patient deaths result from inhalation injuries.

The damage to the airway and the lungs depends on the components of the inhaled smoke, the degree of exposure, and the response of the human body.

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Respiratory Trauma

Mechanical ventilation in burn patients

Overall, trauma due to heat and toxic gases tends to cause injury and obstruction of the upper airway.

The younger the patient, the more severe their symptoms usually are. Also, symptoms usually appear in the first 12-18 hours, although the onset may take up to 72 hours.

Respiratory injury is the leading cause of immediate death among burn victims.

That said, there are several different types of burns:

  • Thermal injury: Usually, an injury due to high temperatures is limited to the oropharynx. This is because of the reflex closure of the glottis and these tissues’ high capacity to dissipate heat.
  • Inhalation injury of products of the composition: In this case, water-soluble gases react with the water from mucous membranes. This releases strong acids and produces respiratory alkalosis, edema, and bronchospasm. Also, less soluble gases can reach the farthest points of the respiratory system and produce trauma there. Typically, the main toxin of combustion is carbon monoxide. However, another toxic gas that contributes to a burn trauma is hydrogen cyanide.
  • Endogenous lung injury: Patients with extensive burns may develop progressive respiratory failure after the initial stages. This may occur even if they do not have direct damage to the airway due to inhalation.

Diagnosis

More than anything, the diagnosis of inhalation injury is clinical. Overall, doctors should expect it whenever the patient has been unconscious in a closed space where there has been a fire or hot gas leak.

Upon physical examination, the warning signs of inhalation injury include burned nose hair, dark sputum, burns on the face and in the nostrils, cough, hoarseness, and wheezing.

Also, it is important to examine the oropharynx to assess mucosal alteration. Complementary diagnostic methods can help assess lung and systemic damage.

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Mechanical Ventilation Treatment

Nurse working in an operating room mechanical ventilation

Typically, the symptoms of a lung injury usually manifest after several hours. For this reason, it’s very important that if a burn victim is suspected of having lung trauma, doctors must perform mechanical ventilation right away.

However, there’s no specific treatment for critical burn patients with inhalation injuries. Usually, doctors focus on maintaining airway permeability through intubation and mechanical ventilation.

In severe cases, medical professionals will clean the patient’s lungs and administer antibiotics if there is an infection.

Intubation and mechanical ventilation

Overall, intubation is necessary for up to 50% of patients with inhalation injuries. As you can see, severe cases require early intubation with a large caliber tube to:

  • Keep the airway permeable.
  • Prevent aspiration.
  • Allow the elimination of secretions and mucus congestion.
  • Aid ventilation.

However, when intubation isn’t performed in time for patients who have severe airway edema, it may not be possible. In this case, a tracheotomy is the last resort.

The purpose of mechanical ventilation is to maintain oxygenation and ventilation. Therefore, it helps prevent ventilation-induced damage.

The type of ventilation that doctors use will depend on the degree of lung damage. The different types include conventional ventilation with permissive hypercapnia, nitric oxide inhalation, high-frequency ventilation, and extracorporeal membrane oxygenation.

Other treatments

Unfortunately, preventative measures such as the administration of corticoids and antibiotics are not useful. In addition, some studies connect corticoids with an increased risk of lung infection and death.

On the other hand, the presence of an inhalation injury in patients in critical condition increases the need for fluid expansion.

  • Gutiérrez Muñoz, F. (2011). Ventilación mecánica. Acta Médica Peruana.
  • González-Cavero, J., Arévalo, J. M., & Lorente, J. A. (1999). Tratamiento prehospitalario del paciente quemado crítico Revisión. emergencias.
  • Cachafeiro Fuciños, L., Sánchez Sánchez, M., & García de Lorenzo y Mateos, A. (2019). Ventilación mecánica en el paciente quemado crítico con inhalación: ¿podemos evitarla? Medicina Intensiva. https://doi.org/10.1016/j.medin.2019.02.008