Guidelines for Treatment of Inhalation Injury

100% oxygen until COhb levels < 2%
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Pressure controlled ventilation, permissive hypercapnia, PEEP (>7.5)
Keep PAP < 35cm H2O

Administer nebules hourly as described. Ensure a salbutamol nebule is
given before the first acetycysteine dose. Cessation of therapy only
when bronchoscopy shows no further soot present or at request of the
Intensivist/ Anaesthetist.
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Nebulised Salbutamol, 2.5. – 5mg every FOUR hours
Nebulised Acetylcysteine 20% -3ml neat solution every
FOUR hours (may be irritant to airway and should be
discontinued if bronchospasm, unresponsive to salbutamol.
Nebulised Sodium Bicarbonate 2.1%, 2.5 – 5ml every TWO
hours. Instructions: Put 50ml sodium bicarbonate 8.4%
solution from a Minijet into a bottle, add 150ml of water for
irrigation, label clearly and shake the bottle before use.
Aggressive pulmonary toilet – at least every four hours – 30 minutes after
acetylcysteine nebulisation

Chest physiotherapy at least four times a day. More frequently if
persistent plugging or poor gas exchange. Daily sputum bacterial
surveillance

Consider Daily Bronchoscopy
References
J Burn Care Rehabilitation (1998) 19: 210 – 2
British Burn Association 32nd Annual Meeting (Oral Presentation)