Skip to main content
SpringerLink
Log in

Behandlungsstrategien des akuten Rauchgasinhalationstraumas

Treatment strategies for acute smoke inhalation injury

  • Intensivmedizin
  • Published:
Der Anaesthesist Aims and scope Submit manuscript

Zusammenfassung

Die Mehrzahl der tödlichen Brandunfälle ist nicht auf Brandwunden, sondern auf die Inhalation toxischer Gase während des Verbrennungsvorgangs zurückzuführen. Feuer erzeugt eine komplizierte toxische Umgebung durch Hitze, Sauerstoffverbrauch und die Entstehung toxischer Gase, wie Kohlenmonoxid und Zyanid. Die zunehmende Nutzung synthetischer Baumaterialien in Gebäuden, Möbeln, Teppichböden, elektrischen Kabelsträngen und Dekorationen erhöht das potenzielle Risiko der Inhalation toxischer Brandgase. Dieser Übersichtsartikel beschreibt die pathophysiologischen Prozesse nach Inhalationsverletzungen, die durch toxische Substanzen und Chemikalien in Rauchgasen ausgelöst werden, sowie Strategien für die notärztliche Versorgung an der Unfallstelle und die weiterführende intensivmedizinische Behandlung.

Abstract

Most fatalities from fires are not due to burns, but are a result of inhalation of toxic gases produced during combustion. Fire produces a complex toxic environment, involving flame, heat, oxygen depletion, smoke and toxic gases such as carbon monoxide and cyanide. As a wide variety of synthetic materials is used in buildings, such as insulation, furniture, carpeting, electric wiring covering as well as decorative items, the potential for poisoning from inhalation of products of combustion is continuously increasing. The present review describes the pathophysiologic effects from smoke inhalation injury as well as strategies for emergency treatment on scene and in the intensive care setting.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3

Literatur

  1. Alcorta R (2004) Smoke inhalation & acute cyanide poisoning. Hydrogen cyanide poisoning proves increasingly common in smoke-inhalation victims. JEMS 29 [Suppl]: 6–15

  2. Bastigkeit M (2000) Blausäureintoxikationen. Rettungsdienst 12(23): 56–59

    Google Scholar 

  3. Baud FJ, Barriot P, Toffis V et al. (1991) Elevated blood cyanide concentrations in victims of smoke inhalation. N Engl J Med 325: 1761–1766

    PubMed  Google Scholar 

  4. Becker CE (1985) The role of cyanide in fires. Vet Hum Toxicol 27: 487–490

    PubMed  Google Scholar 

  5. Blocker V, Blocker TG Jr (1949) The Texas City disaster; a survey of 3,000 casualties. Am J Surg 78: 756–771

    Article  PubMed  Google Scholar 

  6. Burns TR, Mace ML, Greenberg SD, Jachimczyk JA (1985) Ultrastructure of acute ammonia toxicity in the human lung. Am J Forensic Med Pathol 6: 204–210

    PubMed  Google Scholar 

  7. Charnock EL, Meehan JJ (1980) Postburn respiratory injuries in children. Pediatr Clin North Am 27: 661–676

    PubMed  Google Scholar 

  8. Clark CJ, Campbell D, Reid WH (1981) Blood carboxyhaemoglobin and cyanide levels in fire survivors. Lancet 1: 1332–1335

    Article  PubMed  Google Scholar 

  9. Cox RA, Burke AS, Soejima K et al. (2003) Airway obstruction in sheep with burn and smoke inhalation injuries. Am J Respir Cell Mol Biol 29: 295–302

    Article  PubMed  Google Scholar 

  10. Crapo RO (1981) Smoke-inhalation injuries. JAMA 246: 1694–1696

    Article  PubMed  Google Scholar 

  11. Deitch EA (1990) The management of burns. N Engl J Med 323: 1249–1253

    PubMed  Google Scholar 

  12. Eckstein M (2004) Cyanide as a chemical terrorism weapon. JEMS 29(8): 22–31

    Google Scholar 

  13. Fitzpatrick DF, Gioffi WG (2002) Diagnosis and treatment of inhalation injury. In: Herndon D (ed) Total burn care. Saunders, New York, pp 232–242

  14. Fodor L, Fodor A, Ramon Y et al. (2006) Controversies in fluid resuscitation for burn management: literature review and our experience. Injury 37(5): 374–379. Epub 2005 Aug 22

    Article  PubMed  Google Scholar 

  15. Fortin JL, Ruttima M, Domanski L, Kowalski JJ (2004) Hydroxocobalamin: treatment for smoke inhalation-associated cyanide poisoning. Meeting the needs of fire victims. JEMS 29(8): 18–21

    Google Scholar 

  16. Goldbaum LR, Orellano T, Dergal E (1976) Mechanism of the toxic action of carbon monoxide. Ann Clin Lab Sci 6: 372–376

    PubMed  Google Scholar 

  17. Hall AH, Rumack BH (1986) Clinical toxicology of cyanide. Ann Emerg Med 15: 1067–1074

    Article  PubMed  Google Scholar 

  18. Hampson NB (1998) Pulse oximetry in severe carbon monoxide poisoning. Chest 114(4): 1036–1041

    PubMed  Google Scholar 

  19. Haponik EF (1993) Clinical smoke inhalation injury: pulmonary effects. Occup Med 8: 430–468

    PubMed  Google Scholar 

  20. Hierl T, Nowak D (2005) What therapy options are reliable in smoke inhalation? Dtsch Med Wochenschr 130(50): 2912–2913

    Article  PubMed  Google Scholar 

  21. Jordan MH, Hollowed KA, Turner DG et al. (2005) The Pentagon attack of September 11, 2001: a burn center’s experience. J Burn Care Rehabil 26: 109–116

    Article  PubMed  Google Scholar 

  22. Khan AS, Morse S, Lillibridge S (2000) Public-health preparedness for biological terrorism in the USA. Lancet 356: 1179–1182

    Article  PubMed  Google Scholar 

  23. Kirk MA, Gerace R, Kulig KW (1993) Cyanide and methemoglobin kinetics in smoke inhalation victims treated with the cyanide antidote kit. Ann Emerg Med 22: 1413–1418

    Article  PubMed  Google Scholar 

  24. Maybauer DM, Maybauer MO, Traber DL (2006) Experimental therapies for hypoxic pulmonary vasoconstriction. Shock 25: 314

    Article  PubMed  Google Scholar 

  25. Maybauer MO, Maybauer DM, Herndon DN (2006) Incidence and outcomes of acute lung injury. N Engl J Med 26: 416–417

    Google Scholar 

  26. Maybauer MO, Maybauer DM, Herndon DN, Traber DL (2006) The role of superoxide dismutase in systemic inflammation. Shock 25(2): 206–207

    Article  PubMed  Google Scholar 

  27. Maybauer MO, Maybauer DM, Fraser JF et al. (2006) Recombinant human activated protein C improves pulmonary function in ovine acute lung injury following smoke inhalation injury and sepsis. Crit Care Med (in press)

  28. Moore SJ, Norris JC, Walsh DA, Hume AS (1987) Antidotal use of methemoglobin forming cyanide antagonists in concurrent carbon monoxide/cyanide intoxication. J Pharmacol Exp Ther 242: 70–73

    PubMed  Google Scholar 

  29. Moore SJ, Ho IK, Hume AS (1991) Severe hypoxia produced by concomitant intoxication with sublethal doses of carbon monoxide and cyanide. Toxicol Appl Pharmacol 109: 412–420

    Article  PubMed  Google Scholar 

  30. Murakami K, McGuire R, Cox RA et al. (2002) Heparin nebulization attenuates acute lung injury in sepsis following smoke inhalation in sheep. Shock 18: 236–241

    Article  PubMed  Google Scholar 

  31. Myers RA, Snyder SK, Linberg S, Cowley RA (1981) Value of hyperbaric oxygen in suspected carbon monoxide poisoning. JAMA 246: 2478–2480

    Article  PubMed  Google Scholar 

  32. Pace N, Strajman E, Walker EL (1950) Acceleration of carbon monoxide elimination in man by high pressure oxygen. Science 111: 652–654

    PubMed  Google Scholar 

  33. Piantadosi CA (2002) Carbon monoxide poisoning. N Engl J Med 347(14): 1054–1055

    Article  PubMed  Google Scholar 

  34. Pittman HS, Schatzki R (1949) Pulmonary effects of the Cocoanut Grove fire; a 5 year follow up study. N Engl J Med 241: 1008

    PubMed  Google Scholar 

  35. Prien T, Traber DL (1988) Toxic smoke compounds and inhalation injury – A review. Burns Incl Therm Inj 14: 451–460

    PubMed  Google Scholar 

  36. Pruitt BA Jr, Goodwin CW, Mason AD Jr (2002) Epidemiological, demographic, and outcome characteristics of burn injury. In: Herndon DN (ed) Total burn care. Saunders, New York, pp 16–30

  37. Purser DA, Grimshaw P, Berrill KR (1984) Intoxication by cyanide in fires: a study in monkeys using polyacrylonitrile. Arch Environ Health 39: 394–400

    PubMed  Google Scholar 

  38. Schwela D (1997) Cooking smoke: a silent killer. People Planet 6: 24–25

    Google Scholar 

  39. Shimazu T, Ikeuchi H, Sugimoto H et al. (2000) Half-life of blood carboxyhemoglobin after short-term and long-term exposure to carbon monoxide. J Trauma 49: 126–131

    PubMed  Google Scholar 

  40. Shirani KZ, Pruitt BA Jr, Mason AD Jr (1987) The influence of inhalation injury and pneumonia on burn mortality. Ann Surg 205: 82–87

    PubMed  Google Scholar 

  41. Silverman SH, Purdue GF, Hunt JL, Bost RO (1988) Cyanide toxicity in burned patients. J Trauma 28(2): 171–176

    PubMed  Google Scholar 

  42. Smith PW, Crane R, Sanders DC et al. (1976) Effects of exposure to carbon monoxide and hydrogen cyanide. National Academy of Science, Washington D.C., pp 75–78

  43. Smith RP (1986) Toxic responses of the blood. MacMillan, New York

  44. Steen M (1993) Präklinische Diagnostik und Erstversorgung bei Notfallpatienten mit Verbrennungen. Notfallmedizin 19: 17–23

    Google Scholar 

  45. Stewart RJ, Mason SW, Taira MT et al. (1994) Effect of radical scavengers and hyperbaric oxygen on smoke-induced pulmonary edema. Undersea Hyperb Med 21: 21–30

    PubMed  Google Scholar 

  46. Terrill JB, Montgomery RR, Reinhardt CF (1978) Toxic gases from fires. Science 200: 1343–1347

    PubMed  Google Scholar 

  47. Thierbach A, Maybauer M, Piepho T, Wolcke B (2003) Monitoring in der Notfallmedizin. Notfall Rettungsmed 6: 206–218

    Article  Google Scholar 

  48. Thom SR (1992) Dehydrogenase conversion to oxidase and lipid peroxidation in brain after carbon monoxide poisoning. J Appl Physiol 73: 1584–1589

    PubMed  Google Scholar 

  49. Thompson PB, Herndon DN, Traber DL, Abston S (1986) Effect on mortality of inhalation injury. J Trauma 26: 163–165

    PubMed  Google Scholar 

  50. Traber DL, Herndon DN, Soejima K (2002) The pathophysiology of inhalation injury. In: Herndon DN (ed) Total burn care. Saunders, New York, pp 221–231

  51. Villanueva E, Bennett E, Wasiak J, Lehm JP (2005) Hyperbaric oxygen therapy for thermal burns. Cochrane Library, John Wiley & Sons, Chichester, UK

  52. Weaver LK, Hopkins RO, Chan KJ et al. (2002) Hyperbaric oxygen for acute carbon monoxide poisoning. N Engl J Med 347(14): 1057–1067

    Article  PubMed  Google Scholar 

  53. Westphal M, Morita N, Enkhbaatar P et al. (2003) Carboxyhemoglobin formation following smoke inhalation injury in sheep is interrelated with pulmonary shunt fraction. Biochem Biophys Res Commun 311: 754–758

    Article  PubMed  Google Scholar 

  54. Yurt RW, Bessey PQ, Bauer GJ et al. (2005) A regional burn center’s response to a disaster: September 11, 2001, and the days beyond. J Burn Care Rehabil 26: 117–124

    Article  PubMed  Google Scholar 

Download references

Interessenkonflikt

Es besteht kein Interessenkonflikt. Der korrespondierende Autor versichert, dass keine Verbindungen mit einer Firma, deren Produkt in dem Artikel genannt ist, oder einer Firma, die ein Konkurrenzprodukt vertreibt, bestehen. Die Präsentation des Themas ist unabhängig und die Darstellung der Inhalte produktneutral.

Author information

Authors and Affiliations

  1. Sektion Anästhesiologische Pathophysiologie und Verfahrensentwicklung, Universitätsklinik für Anästhesiologie, Parkstraße 11, 89075, Ulm

    D. M. Maybauer & P. Radermacher

  2. Departments of Anesthesiology and Surgery, The University of Texas Medical Branch and Shriners Burns Hospital for Children, Galveston, USA

    D. M. Maybauer, D. L. Traber, D. N. Herndon & M. O. Maybauer

  3. Orthopädische Universitätsklinik mit Querschnittgelähmtenzentrum am Rehabilitationskrankenhaus Ulm

    M. O. Maybauer

Authors
  1. D. M. Maybauer
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. D. L. Traber
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. P. Radermacher
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. D. N. Herndon
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. M. O. Maybauer
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to D. M. Maybauer.

Additional information

Wichtiger Hinweis: Die Erkenntnisse in der Medizin unterliegen laufendem Wandel durch Forschung und klinische Erfahrungen. Die Autoren dieser Übersichtsarbeit haben große Sorgfalt darauf verwendet, dass die gemachten (therapeutischen) Angaben – insbesondere hinsichtlich Indikation, Dosierung und unerwünschter Wirkungen – dem derzeitigen Wissensstand entsprechen. Dies entbindet den Benutzer nicht von der Verpflichtung, anhand der Beipackzettel zu verschreibender Präparate zu überprüfen, ob die dort gemachten Angaben von denen in diesem Artikel abweichen, und seine Verordnung in eigener Verantwortung zu bestimmen.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Maybauer, D.M., Traber, D.L., Radermacher, P. et al. Behandlungsstrategien des akuten Rauchgasinhalationstraumas. Anaesthesist 55, 980–988 (2006). https://doi.org/10.1007/s00101-006-1050-3

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00101-006-1050-3

Schlüsselwörter

Keywords

Search

Navigation