Abbreviated Injury Score (AIS) for Inhalation Injury
Use in adult patients with suspected inhalation injury undergoing flexible bronchoscopy.
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High AIS severity alone should not dictate management decisions, which should as always be made in conjunction with history, physical exam, and laboratory findings.
- Supportive treatment is the primary means of inhalation injury management, as there is very little in the way of pharmacologic treatment once the inhalation injury has occurred.
- Bronchoscopy can play a therapeutic role in airway clearance as necrotic tissue and eschar can form pseudomembranes, sloughing of mucosa, and bronchial obstruction.
- Other measures include intensive bronchial hygiene, including bronchodilators (e.g. inhaled β2 agonists), frequent chest physiotherapy, and early patient ambulation).
- Upper airway edema can progress, particularly over the first 24 hours after injury, necessitating intubation. If mechanical ventilation is required, a high frequency percussive mode of ventilation can be considered, as some studies have shown benefit to this patient population. A lung-protective, low tidal volume ventilation strategy (6-8 cc/kg of predicted body weight) is preferred in adults.
- Other supportive measures have been used with varied success, including prone positioning, extracorporeal membrane oxygenation (ECMO), inhaled anticoagulants (e.g. heparin, antithrombin), and inhaled N-acetylcysteine (NAC).
- Additionally, referral to a designated burn center should be considered if any inhalation injury is present, according to American Burn Association guidelines.
Macroscopic manifestations of airway abnormalities may be delayed and hence, falsely reassure the clinician that inhalation injury has not occurred (Hunt 1975).
- Pujan H. Patel, MD