RADS (Radiologist’s Score) for Smoke Inhalation Injury

Should be used with clinical history, examination, bronchoscopy, and arterial blood gas data to determine the full clinical picture.

• 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.

As always, clinical judgment is paramount. Management decisions should not be made based solely on RADS.