Nursing Management of Respiratory Complications of Burn Injury

Background: The airway and lung complications are responsible for significant morbidity and mortality in burn-injured patients. These complications may occur in different phases of burn management. . Initial phase complications include inhalation injury, reactive airway dysfunction syndrome, chest wall restriction, and pulmonary edema. Middle phase complications consist of pneumonia, sinusitis and vocal cord paralysis. Among late phase complications, lung function abnormalities and tracheal stenosis can be mentioned.Inhalation injury has high incidence and is associated with high mortality in burned patients.It can cause supraglottic thermal injury, chemical irritation of the respiratory tract, systemic toxicity due to agents such as carbon monoxide and cyanide, or a combination of these insults. The resultant inflammatory response may cause progressive pulmonary dysfunction, prolonged ventilator days, increased risk of pneumonia, and acute respiratory distress syndrome.Besides inhalation injury, mechanisms for the development of pneumonia in the severely burnt are atelectasis and hypostatic pneumonia due to altered ventilation in the chest or abdominal burns. Patients who require prolonged ventilation are at risk of developing ventilator-associated pneumonia (VAP). Burn victims have the highest relative risk of any category of ventilated patients.Thorough nursing respiratory assessment in different phases of burn management is highly important and can lead to proper nursing diagnoses. These include checking of face and neck wounds for swelling and circumferential burns, assessment of swallowing and coughing function, chest auscultation for rales and wheezing and monitoring respiratory rate and rhythm, spO2, PaO2, PaCO2, and pH.Following the assessment, nurses are tasked with various interventions including cleaning airway secretions and foreign bodies, preparing suction equipment. Different artificial airways and auxiliary ventilation items, elevation of head of bed and frequent position changes, if possible, In addition, suctioning should be done as indicated, endotracheal tube and tracheostomy care, oral care, chest physiotherapy and ventilator related nursing managements should be considered. In particular, control of medical environmental infection is of high importance.Conclusion: proper nursing assessment, diagnosis and goals and interventions in respiratory system complications in severe burn injures can help patients get desired outcomes.