Emerging therapies for smoke inhalation injury: a review

Abstract

Background: Smoke inhalation injury increases overall burn mortality by up to 20 times. Current therapy remains supportive with a failure to identify an optimal or targeted treatment protocol for smoke inhalation injury. The goal of this review is to describe emerging therapies that are being developed to treat the pulmonary pathology induced by smoke inhalation injury with or without concurrent burn injury. Main body: A comprehensive literature search was performed using PubMed (1995-present) for therapies not approved by the U.S. Food and Drug Administration (FDA) for smoke inhalation injury with or without concurrent burn injury. Therapies were divided based on therapeutic strategy. Models included inhalation alone with or without concurrent burn injury. Specific animal model, mechanism of action of medication, route of administration, therapeutic benefit, safety, mortality benefit, and efficacy were reviewed. Multiple potential therapies for smoke inhalation injury with or without burn injury are currently under investigation. These include stem cell therapy, anticoagulation therapy, selectin inhibition, inflammatory pathway modulation, superoxide and peroxynitrite decomposition, selective nitric oxide synthase inhibition, hydrogen sulfide, HMG-CoA reductase inhibition, proton pump inhibition, and targeted nanotherapies. While each of these approaches shows a potential therapeutic benefit to treating inhalation injury in animal models, further research including mortality benefit is needed to ensure safety and efficacy in humans. Conclusions: Multiple novel therapies currently under active investigation to treat smoke inhalation injury show promising results. Much research remains to be conducted before these emerging therapies can be translated to the clinical arena.

Frequency, complications, and mortality of inhalation injury in burn patients: A systematic review and meta-analysis protocol

“…Specific treatments have been tested to prevent IMV, complications, and poor outcomes. Some studies observed that N acetylcysteine and inhaled anticoagulants (such as heparin) may effectively treat inhalation injury, significantly improving lung compliance and airway obstruction, reducing reintubation rates, increasing the number of ventilator-free days, and decreasing hospital length of stay, and mortality [40][41][42][43].…”

Clinical characteristics and predictors of burn complicated with smoke inhalation injury: A retrospective analysis

“…MODS, ARDS and shock are still considered the main causes of death in burns patients ( 29 ). Patients mortalities within 48 h after SII predominantly result from obstruction and asphyxia ( 1 ). Septic shock caused by exacerbated inflammatory reaction, rapid and extensive fluid transfer in burn and non-burn tissues leading to progressive hypovolemic shock forms an important cause of burn shock-related mortality ( 12 ).…”

“…Smoke inhalation injury (SII) is the most common cause of mortality in patients with fire burn injuries ( 1 ). Most hospitalized patients with burns usually have accompanying inhalation injury, and the incidence rate of SII is positively correlated with mortality rates ( 2 ).…”

Influence of Hyperbaric Oxygenation and Antioxidant Therapy on Oxidative Metabolism in Patients With Burns

“…The use of antioxidants in burns has a protective effect in oxidative tissue damage and organ failure [12]. The effect of hyperbaric oxygenation (HBO) in patients with burns provides an improvement in the gas exchange of body tissues with subsequent activation of metabolic processes and a decrease in the intensity of inflammatory reactions [4,6]. In addition, due to tissue hyperoxygenation, HBO contributes to maintaining the activity of antioxidant protection at a sufficient level [7][8][9]13].…”