Robinson L, Miller R H
Am J Otolaryngol. 1986 Sep-Oct;7(5):375-80. doi: 10.1016/s0196-0709(86)80028-x.
Up to a third of all victims of major burns suffer smoke-related injury and may die as a result of inhalation injury. The management of the upper airway depends on a thorough understanding of the mechanisms of injury, including carbon monoxide toxicity, thermal injury, and smoke inhalation. Establishing and maintaining an airway for resuscitation requires a high index of suspicion, as early and severe upper airway swelling may preclude safe intubation under direct vision. Nasotracheal intubation is preferred in burn patients but is only indicated for patients in acute respiratory distress and a select group at high risk for developing progressive upper airway compromise and pulmonary injury. The use of the flexible bronchoscope and nasopharyngoscope is a safe and effective means of evaluating the respiratory tract and assisting in pulmonary therapy. Early tracheotomy is indicated only in rare cases because of increased morbidity and mortality in burn patients. The use of steroids is still controversial and is probably indicated only for refractory bronchospasm or secretions. Aggressive evaluation and management of inhalation burns will reduce the mortality rate of a frequently fatal injury.
高达三分之一的严重烧伤患者会遭受与烟雾相关的损伤，可能因吸入性损伤而死亡。上呼吸道的处理取决于对损伤机制的透彻理解，包括一氧化碳中毒、热损伤和烟雾吸入。为复苏建立并维持气道需要高度的怀疑意识，因为早期严重的上呼吸道肿胀可能会妨碍在直视下进行安全插管。鼻气管插管是烧伤患者的首选，但仅适用于急性呼吸窘迫患者以及一小部分有发生进行性上呼吸道梗阻和肺损伤高风险的患者。使用可弯曲支气管镜和鼻咽喉镜是评估呼吸道和辅助肺部治疗的安全有效方法。由于烧伤患者的发病率和死亡率会增加，早期气管切开仅在极少数情况下适用。类固醇的使用仍存在争议，可能仅适用于难治性支气管痉挛或分泌物增多的情况。积极评估和处理吸入性烧伤将降低这种常致命损伤的死亡率。
