Abstract
Smoke inhalation injury is a major determinant of morbidity and mortality in burn and closed-space fire incidents. Its clinical course is often biphasic and unpredictable, with early airway edema followed by delayed parenchymal injury and infectious complications. Diagnosis is primarily clinical, supported by bronchoscopy and imaging. We reported a young female with initially mild symptoms who rapidly deteriorated to respiratory failure and pneumosepsis requiring critical care.
A previously healthy 22-year-old woman presented two hours after accidental closed-space smoke exposure with tachypnea and bilateral wheeze but preserved oxygen saturation and a normal chest radiograph. Carbon monoxide (CO) oximetry confirmed elevated carboxyhemoglobin, which normalized with high-flow oxygen. Despite initial stability on high-flow nasal cannula and corticosteroids, she developed abrupt desaturation with radiographic right-lung collapse. Urgent fiberoptic laryngoscopy excluded upper-airway burns; she required invasive mechanical ventilation. Bronchoscopy revealed extensive soot deposition. Within 48 hours, she developed fever and evolving bilateral consolidations with diffuse ground-glass opacities on a computed tomography (CT) scan. Bronchoalveolar lavage culture grew Acinetobacter, treated as ventilator-associated pneumonia. With broad-spectrum antibiotics, steroids, bronchodilators, and physiotherapy, she improved and was successfully extubated and discharged on room air.
This case illustrates the deceptive latency and rapid deterioration typical of inhalation injury despite a benign initial examination. Smoke toxicity induced airway cast formation, immunological dysfunction, and predisposition to early pneumonia. Conventional pulse oximetry was unreliable due to interference from carboxyhemoglobin, mandating CO oximetry. Chest imaging might remain normal initially; bronchoscopy was valuable both for diagnosis and for therapy.
Inhalation airway injury warrants mandatory 24–48-hour intensive monitoring, even in apparently mild presentations. Early bronchoscopy, aggressive sepsis surveillance, and multidisciplinary critical care are essential to prevent rapid progression to respiratory failure and pneumosepsis, as illustrated by this successfully managed case.
Sai Greeshma Battula, Vinod VG, Dhanasekar Thangaswamy
