Immune and pulmonary biomarkers in inhalation injury following burns: Diagnostic advances and prognostic implications in the ICU

Inhalation injury remains a critical determinant of morbidity and mortality among patients with severe burns, particularly in burn intensive care unit (ICU) settings. The coexistence of inhalation injury with cutaneous burns significantly increases the risk of acute respiratory distress syndrome (ARDS), prolonged mechanical ventilation, secondary infections, and multi-organ dysfunction. Despite advances in critical care, early diagnosis and accurate prognostic stratification of inhalation injury continue to pose major clinical challenges, as conventional diagnostic tools such as bronchoscopy and imaging provide limited insight into underlying biological processes. Over the past decade, growing evidence has highlighted the role of immune and pulmonary biomarkers as valuable adjuncts for improving diagnostic accuracy and outcome prediction in burn-related inhalation injury. This narrative review summarizes current knowledge on key inflammatory and lung-specific biomarkers associated with inhalation injury following burns, with a focus on their diagnostic and prognostic implications in the ICU. Circulating inflammatory mediators, including cytokines and acute-phase reactants, reflect systemic immune activation and have been linked to disease severity, ARDS development, and mortality. In parallel, pulmonary-specific biomarkers such as surfactant proteins and markers of alveolar–capillary injury provide insight into local lung damage and respiratory failure progression. The integration of immune and pulmonary biomarkers with established diagnostic modalities offers a more comprehensive approach to risk stratification and clinical decision-making in critically ill burn patients. Furthermore, biomarker-guided strategies may support personalized ICU management and optimize infection control and antimicrobial stewardship practices. Future multicenter studies are warranted to validate biomarker panels, standardize assessment protocols, and facilitate their routine implementation in burn ICUs.Inhalation injury remains a critical determinant of morbidity and mortality among patients with severe burns, particularly in burn intensive care unit (ICU) settings. The coexistence of inhalation injury with cutaneous burns significantly increases the risk of acute respiratory distress syndrome (ARDS), prolonged mechanical ventilation, secondary infections, and multi-organ dysfunction. Despite advances in critical care, early diagnosis and accurate prognostic stratification of inhalation injury continue to pose major clinical challenges, as conventional diagnostic tools such as bronchoscopy and imaging provide limited insight into underlying biological processes. Over the past decade, growing evidence has highlighted the role of immune and pulmonary biomarkers as valuable adjuncts for improving diagnostic accuracy and outcome prediction in burn-related inhalation injury. This narrative review summarizes current knowledge on key inflammatory and lung-specific biomarkers associated with inhalation injury following burns, with a focus on their diagnostic and prognostic implications in the ICU. Circulating inflammatory mediators, including cytokines and acute-phase reactants, reflect systemic immune activation and have been linked to disease severity, ARDS development, and mortality. In parallel, pulmonary-specific biomarkers such as surfactant proteins and markers of alveolar–capillary injury provide insight into local lung damage and respiratory failure progression. The integration of immune and pulmonary biomarkers with established diagnostic modalities offers a more comprehensive approach to risk stratification and clinical decision-making in critically ill burn patients. Furthermore, biomarker-guided strategies may support personalized ICU management and optimize infection control and antimicrobial stewardship practices. Future multicenter studies are warranted to validate biomarker panels, standardize assessment protocols, and facilitate their routine implementation in burn ICUs.

کلیدواژه ها:

Inhalation injury ، Burns ، Immune biomarkers ، Pulmonary biomarkers ، Intensive care unit