Acute clinical manifestations in toxic smoke inhalation victims: systematic review of observational studies

Costa, Damiana Lima; Santos, Tamires Daros dos; Real, Amanda Albiero; Sbruzzi, Graciele; Pasqualoto, Adriane Schmidt; Albuquerque, Isabella Martins de

doi:10.1590/1980-5918.031.AO03

Acessibilidade / Reportar erro

Brasil

Fisioterapia em Movimento

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

ORIGINAL ARTICLE • Fisioter. mov. 31 • 2018 • https://doi.org/10.1590/1980-5918.031.AO03 copy

Acute clinical manifestations in toxic smoke inhalation victims: systematic review of observational studies

Manifestações clínicas agudas em vítimas de inalação de fumaça tóxica: revisão sistemática de estudos observacionais

Manifestaciones clínicas agudas en víctimas de inhalación de humos: revisión sistemática de estudios observacionales

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Introduction:

Lung injuries from toxic smoke inhalation are the main causes of death in fire victims; however, information regarding the acute effects on the respiratory system after smoke inhalation and its constituents in closed environments are still scarce in literature.

Objective:

To investigate the acute clinical manifestations observed in victims of smoke inhalation during enclosed-space fires by means of systematic review.

Methods:

A systematic search was conducted in the following databases: MEDLINE (via PubMed), Lilacs, Scopus and Web of Science. There were no appliedrestrictions in terms of thepublication date. In addition, a manual search was performed on the references of published studies. Observational studies assessing the prevalence of acute clinical manifestations in victims of toxic smoke inhalation in closed environments were included.

Results:

Of the 4,603 articles identified, eight were included, comprising a total of 233 patients. The signs and symptoms were identified and ranked according to frequency. Dyspnea (58.80%, six studies), carbonaceous sputum (54.51%, four studies), hoarseness (39.91%, three studies), wheezing (34.33%, five studies) and sore throat (33.90%, two studies) were the most frequent acute clinical manifestations of smoke inhalation. Besides these, chest pain and pulmonary edema were observed, respectively in 13.30%, 5.15% of the studies.

Conclusion:

The results suggest that dyspnea, carbonaceous sputum, hoarseness, wheezing and sore throat were the most frequent acute clinical manifestations in victims of smoke inhalation. Further studies of a higher level of evidence and greater methodological rigor are required.

Keywords:
Smoke Inhalation Injury; Hydrogen Cyanide; Carbon Monoxide; Lung Injury

Author, year	Country	Type of study	Patient characteristics	Initial clinical manifestations
McArdle and Finlay, 1975 ¹⁴14. McArdle CS, Finlay WE. Pulmonary complications following smoke inhalation. Br J Anaesth. 1975;47(5):618-23.	Scotland	Case study	n = 2 (M)	- RF: pulmonary edema
			Age = 27 and 58 years
			Household fire
Putman et al., 1977 ¹⁵15. Putman CE, Loke J, Matthay RA, Ravin CE. Radiographic manifestations of acute smoke inhalation. AJR Am J Roentgenol. 1977;129(5):865-70.	Unites States of America	Case series	n = 21 (M = 11; F = 10)	- Dyspnea, carbonaceous sputum, and hoarseness.
			Age = 2-81 years	- PE: rhonchi, rales and wheezing.
			Household fire	- RF: focal infiltrates and pulmonary edema.
Lee and O’Connell, 1988 ¹⁶16. Lee MJ, O'Connell DJ. The plain chest radiograph after acute smoke inhalation. Clin Radiol. 1988;39(1):33-7.	Ireland	Case series	n = 45	- Dyspnea.
	Ireland	Case series	Nightclub fire	- RF: subglottic edema, bronchial wall thickening, pulmonary edema and consolidation.
Stenton et al., 1988 ¹⁷17. Stenton SC, Kelly CA, Walters EH, Hendrick DJ. Induction of bronchial hyperresponsiveness following smoke inhalation injury. Br J Dis Chest. 1988;82(4):436-8.	England	Case study	n = 2 (M)	- Dyspnea, dry cough, chest pain and tachypnea.
			Age = 30 years	- PE: wheezing.
			Household fire	- RF: pneumomediastinum.
Hantson et al., 1997 ¹⁸18. Hantson P, Butera R, Clemessy JL, Michel A, Baud FJ. Early complications and value of initial clinical and paraclinical observations in victims of smoke inhalation without burns. Chest. 1997;111(3):671-5.	France	Case series	n = 64 (M = 36; F = 28)	- Hoarseness, carbonaceous sputum.
			Age = 47.3 years (range 20-94 years)	- PE: rhonchi, rales and wheezing.
			Household fire
Cha et al., 2007 ¹⁹19. Cha SI, Kim CH, Lee JH, Park JY, Jung TH, Choi WI, et al. Isolated smoke inhalation injuries: acute respiratory dysfunction, clinical outcomes, and short-term evolution of pulmonary functions with the effects of steroids. Burns. 2007;33(2):200-8.	Republic of Korea	Case series	n = 96 (M = 43; F = 53)	- Cough, dyspnea, sore throat, carbonaceous sputum, hoarseness, and chest pain.
			Age = 35.2 ± 2.56 years	- PE: wheezing and stridor
			Subway station fire
Dinh and Rosini, 2014 ²⁰20. Dinh D, Rosini JM. Empiric treatment of cyanide toxicity in an enclosed-space fire survivor. J Emerg Nurs. 2014;40(3):282-5.	Unites States of America	Case study	n = 1 (F)	- Dyspnea, tachycardia, productive cough and nausea.
			Age = 50 years
			Household fire
Tyagi et al., 2015 ²¹21. Tyagi R, Ramasethu R, Mohanty CS, Singhal A. Two cases of acute lung injury following closed space smoke inhalation. Med J Armed Forces India. 2015;71(Suppl 2): S538-41.	India	Case study	n = 2 (M)	- Dyspnea, carbonaceous sputum, chest pain, tachycardia, tachypnea, desaturation and sore throat.
			Age: 21 and 24 years	- PE: rales and wheezing.
			Submarine fire	- RF: acute bilateral airspace opacification.
				- CT: ground glass opacities and patchy consolidation.

Pontifícia Universidade Católica do Paraná Rua Imaculada Conceição, 1155 - Prado-Velho -, Curitiba - PR - CEP 80215-901, Telefone: (41) 3271-1608 - Curitiba - PR - Brazil
E-mail: revista.fisioterapia@pucpr.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] * Master´s student, e-mail: damilimacosta@hotmail.com

#1	“Inhalation Exposure”, “Exposure, Inhalation”, “Exposures, Inhalation”, “Inhalation Exposures”, “Smoke Inhalation Injury”, “Inhalation Injury, Smoke”, “Injury, Smoke Inhalation”, “Inhalation Injuries, Smoke”, “Injuries, Smoke Inhalation”, “Smoke Inhalation Injuries”, “Burns, Inhalation”, “Inhalation Burns”, “Burn, Inhalation”, “Inhalation Burn”	Smoke Inhalation
#2	“Hydrogen Cyanide”, “Cyanide, Hydrogen”, “Hydrocyanic Acid”, “Acid, Hydrocyanic”, “Zyklon B”, “Carbon Monoxide”, “Monoxide, Carbon”, “Carbon Monoxide Poisoning”, “Poisoning, Carbon Monoxide”, “Carbon Monoxide Poisonings”, “Monoxide Poisoning, Carbon”, “Monoxide Poisonings, Carbon”, “Poisonings, Carbon Monoxide”, “Poisoning, Illuminating Gas”, “Gas Poisoning, Illuminating”, “Gas Poisonings, Illuminating”, “Illuminating Gas Poisonings”, “Poisonings, Illuminating Gas”, “Illuminating Gas Poisoning”, “cyanide poisoning”	Toxic gases
#3	“Lung Injury”, “Injuries, Lung”, “Injury, Lung”, “Pulmonary Injury”, “Injuries, Pulmonary”, “Injury, Pulmonary”, “Pulmonary Injuries”, “Lung Injuries”, “Chronic Lung Injury”, “Chronic Lung Injuries”, “Lung Injuries, Chronic”, “Lung Injury, Chronic”, “Pulmonary Complications”, “Acute Lung Injury”, “Acute Lung Injuries”, “Lung Injuries, Acute”, “Lung Injury, Acute”	Lung injury
#4	#1 OR #2
#5	#4 AND #3