Acute respiratory failure by smoke in burn victims.

Respiratory injuries by smoke inhalation are one of the most frequent reasons for acute respiratory failure in burn victims. They are most often of chemical origin and are responsible of a 20 to 70% increase of the mortality compared to the mortality of patients with similar burn injuries, but without inhalation lesions. They are often associated to a certain degree to other factors of acute respiratory failure: superior air way obstruction by oedema in face and neck bums, thoracic expansion hindrance due to thoracic bums, lung trauma lesions by blast injury, The generalized inflammatory reaction due to the extent of bums and an initial inadequate resuscitation are worsening factors. The inflammatory process may be responsible of lung injuries similar to those induced by smoke inhalation, even when there is no inhalation. The treatment remains symptomatic and based on the oxygen therapy, mechanical ventilation, prevention of infections and maintain of homeostasis by hydroelectrolytic adequate resuscitation. The nitric oxyde associated to the almitrin allows in a certain number of cases to minimize intra pulmonary shunting and to normalize the V-A/(O) over tilde ratio. The development of treatments allowing to modulate inflammatory mediators may lead to news therapies in the future. (C) 2002 Editions scientifiques et medicales Elsevier SAS.