Pathophysiology and management of the complications resulting from fire and the inhaled products of combustion: review of the literature.

Respiratory dysfunction is a major consequence of smoke inhalation and significant surface burns. Carbon monoxide intoxication, asphyxia, and upper airway obstruction occur early, whereas pulmonary edema and bacterial pneumonia may be delayed for days or weeks. The noxious constituents of smoke are believed to stimulate irritant receptors producing bronchoconstriction and to cause chemical injury to the airway mucosa and the alveolar-capillary membrane producing pulmonary edema. Pneumonia occurs in most patients who survive the initial injury. Thorough history and physical and laboratory examinations may forecast the severity of injury. Treatment includes administration of oxygen, use of bronchodilators, and when necessary, mechanical ventilation. The long-term sequelae of smoke inhalation are unknown.