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Respiratory Complications in Burns: An Evolving Spectrum of Injury

Boots, Robert J. MBBS, PhD*†; Dulhunty, Joel M. MBBS, PhD*†; Paratz, Jennifer PhD*†; Lipman, Jeffrey MBBCh, MD*†

Clinical Pulmonary Medicine: May 2009 - Volume 16 - Issue 3 - p 132-138
doi: 10.1097/CPM.0b013e3181a39032
Interstitial, Inflammatory, and Occupational Lung Disease

Respiratory complications associated with burn injury are responsible for significant morbidity and mortality and occur in up to 41% of patients admitted to hospital after thermal injury. Inhalation injury can be due to a combination of thermal, chemical, and systemic effects and is the most significant complication in the early phase post-burn injury (first 48 hours), predisposing the patient to the development of pulmonary edema, acute respiratory distress syndrome, and pneumonia. Early management comprises oxygen delivery, assessment of carbon monoxide and cyanide toxicity, visualization of the airway, and repeated evaluation of the need for intubation. The middle phase (days to weeks post-burn injury) is associated with an increased risk of infection and venous thromboembolism. Principles of management include protocols for the avoidance and management of nosocomial pneumonia. Although the presence of long-term respiratory dysfunction is uncommon after nonfatal burn injury, late sequelae (months to years post-burn injury) include reactive airways dysfunction syndrome, bronchiolitis obliterans, and tracheal stenosis.

Airway and lung complications of burns are directly responsible for significant morbidity and mortality. This article reviews burn-related respiratory complications and practical management strategies across the continuum of care.

From the *Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia; and †Burns, Trauma and Critical Care Research Centre, University of Queensland, Brisbane, Australia.

Supported by a Queensland Health clinical research position (2008) during preparation of this manuscript (to J.M.D.).

Address correspondence to: Joel M. Dulhunty, MBBS, PhD, Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Herston QLD 4029, Australia. E-mail:

© 2009 Lippincott Williams & Wilkins, Inc.