Abstract
The patient was a 66-year-old man. He had deep dermal burns on his face, back, palms, and soles from a fire at home (burn area: 17%) . His nasal hair was burnt, and soot was observed in the oral cavity and larynx. There was no laryngeal edema. The patient was admitted to the intensive care unit for observation without tracheal intubation. On the second sick day, the patient became insufficiently ventilated due to a large amount of mucus in the airway, and tracheal intubation was performed. Bronchoscopy showed a large amount of soot and mild pallor of the tracheal mucosa. Heparin and N-acetyl cysteine inhalation were started to cope with the large amount of tracheal secretions and mucus plugs. Respiratory physiotherapy and expectorant treatment were continued. The patient was extubated on the 7th sick day and discharged from the intensive care unit on the 13th sick day.
Inhalation of heparin and N-acetylcysteine is weakly recommended in the third edition of the Burn Care Guidelines. Multicenter studies and randomized controlled trials are needed.
We report a case of inhalation injury treated with heparin and N-acetylcysteine nebulization with good outcome for ventilatory failure caused by obstruction of airway secretions and mucus plugs.
