Dyamenahalli Kiran, Garg Gaurav, Shupp Jeffrey W, Kuprys Paulius V, Choudhry Mashkoor A, Kovacs Elizabeth J
Department of Surgery, Division of GI, Trauma and Endocrine Surgery, University of Colorado School of Medicine, Aurora.
Department of Surgery, Georgetown University School of Medicine, Washington, District of Columbia.
J Burn Care Res. 2019 Aug 14;40(5):570-584. doi: 10.1093/jbcr/irz055.
Pulmonary and systemic insults from inhalation injury can complicate the care of burn patients and contribute to significant morbidity and mortality. However, recent progress in diagnosis and treatment of inhalation injury has not kept pace with the care of cutaneous thermal injury. There are many challenges unique to inhalation injury that have slowed advancement, including deficiencies in our understanding of its pathophysiology, the relative difficulty and subjectivity of bronchoscopic diagnosis, the lack of diagnostic biomarkers, the necessarily urgent manner in which decisions are made about intubation, and the lack of universal recommendations for the application of mucolytics, anticoagulants, bronchodilators, modified ventilator strategies, and other measures. This review represents a summary of critical shortcomings in our understanding and management of inhalation injury identified by the American Burn Association's working group on Cutaneous Thermal Injury and Inhalation Injury in 2018. It addresses our current understanding of the diagnosis, pathophysiology, and treatment of inhalation injury and highlights topics in need of additional research, including 1) airway repair mechanisms; 2) the airway microbiome in health and after injury; and 3) candidate biomarkers of inhalation injury.
吸入性损伤导致的肺部和全身损害会使烧伤患者的护理变得复杂，并导致显著的发病率和死亡率。然而，吸入性损伤的诊断和治疗方面的最新进展未能跟上皮肤热损伤的护理步伐。吸入性损伤存在许多独特的挑战，这些挑战减缓了进展，包括我们对其病理生理学的理解不足、支气管镜诊断的相对难度和主观性、缺乏诊断生物标志物、关于插管决策的必要紧迫性，以及在应用黏液溶解剂、抗凝剂、支气管扩张剂、改良通气策略和其他措施方面缺乏通用建议。本综述总结了美国烧伤协会皮肤热损伤和吸入性损伤工作组在2018年确定的我们在吸入性损伤的理解和管理方面的关键缺陷。它阐述了我们目前对吸入性损伤的诊断、病理生理学和治疗的理解，并强调了需要进一步研究的主题，包括1）气道修复机制；2）健康状态和损伤后气道微生物群；3）吸入性损伤的候选生物标志物。
