Airway and Breathing Management

in Inhalation Injury
Putu Anggia Dimitri Pramesti
1770121078
SGD 3

Block 4.6 Anesthesiology and Critical Care

Program Studi Pendidikan Dokter
Fakultas Kedokteran dan Ilmu Kesehatan Universitas Warmadewa
2021
Article
“Safety of Nebulized
Epinephrine in Smoke
Inhalation Injury”
 Introduction
• 95% of burn injuries are accidents, leading to 265 000 deaths

• 20% higher mortality rate when inhalation injury was present

• Frequency of smoke inhalation injury plus burns is as high

as 19.6% in burn centers

• Major pathophysiology following inhalation injury arises

from microvascular changes
 Smoke Inhalation Injury

Airway Mucus
Bronchospasm
narrowing secretion

Increased Pulmonary
airway blood Lung edema transvascular
flow fluid flux

Disminished
pulmonary Atelectasis Pneumonia
function
 Inhalation Injury Management
Aims to :

• Prevent airway occlusion

• Prevent ventilator induced lung injury

• Decrease bronchospasm

• Reduce airway wall edema

 Epinephrine
Non-specific adrenergic receptor agonist

Induces vasoconstriction via alpha-one receptor

stimulation

Induces bronchodilation via beta-two agonist effects

Decreases blood flow to glands and mucus secretion.

Low cost

Available in powder and liquid forms, easily aerosolized.

 Nebulized Epinephrine
• Well tolerated without any adverse effects (dual action)

• Diminishes the formation of mucus casts by reducing the

blood flow to the mucus glands.

• Reduces transvascular fluid flux and protein leakage into the

airway

• Bronchodilating effects that reduce inherent bronchospasm

arising after an inhalation injury.
 Summary
• Physiological processes underlying inhalation injury is
poorly understood

• Nebulized epinephrine for smoke inhalation injury is well

tolerated without any adverse effects

• A large-scale randomized clinical trial must be done

References
Foncerrada G, Lima F, Clayton R,
Mlcak R, Enkhbaatar P, Herndon D,
Suman O. 2017. Safety of
Nebulized Epinephrine in Smoke
Inhalation Injury. J Burn Care Res:
38(6); 396–402. Viewed 07 May
2021, from:
https://pubmed.ncbi.nlm.nih.gov/28
570317/
THANK YOU