ABSTRACT
The syndrome of toxic inhalation injury refers to the respiratory consequences of inhalation exposure to chemicals causing damage to lung tissue. The clinical spectrum is broad, ranging from mild irritation to temporary respiratory functional dysfunction and, in extreme cases, to acute respiratory failure, requiring intensive respiratory support and may be fatal. The underlying pathology is composed of neurogenic sensory response, cell and tissue damage, inammation, pulmonary edema,
17.1 Introduction .......................................................................................................................... 357 17.2 Toxic Inhalation Injury: General Considerations ................................................................. 359
17.2.1 Problem Characterization ......................................................................................... 359 17.2.2 Pathogenesis of Toxic Inhalation Injury ...................................................................360 17.2.3 Toxic Inhalation Injury and ALI/ARDS ................................................................... 361 17.2.4 Principles of Management and Medical Treatment .................................................. 362
17.2.4.1 Control Zones............................................................................................. 362 17.2.4.2 Exposure Control and Contamination Avoidance ..................................... 362 17.2.4.3 Current Therapy: Respiratory Support and Pharmacological Interventions .... 369 17.2.4.4 Experimental and Future Therapeutic Strategies ...................................... 378
17.3 Properties and Therapy of Selected Toxicants ..................................................................... 383 17.3.1 Chlorine .................................................................................................................... 383
17.3.1.1 General Properties and Exposure Assessment .......................................... 383 17.3.1.2 Clinical Manifestations and Pathogenesis .................................................384 17.3.1.3 Medical Treatment of Chlorine Inhalation: Current Therapy ................... 385 17.3.1.4 Experimental and Future Therapies .......................................................... 388
17.3.2 Phosgene ...................................................................................................................390 17.3.2.1 General Properties and Exposure Assessment ..........................................390 17.3.2.2 Clinical Manifestations and Pathogenesis .................................................390 17.3.2.3 Current Therapies ...................................................................................... 391 17.3.2.4 Experimental and Future Therapies .......................................................... 393
17.3.3 Smoke Inhalation Injury ........................................................................................... 398 17.3.3.1 General Properties and Exposure Assessment .......................................... 398 17.3.3.2 Clinical Manifestations and Pathogenesis ................................................. 398 17.3.3.3 Current Therapies ......................................................................................400 17.3.3.4 Experimental Pharmacological and Adjunct Therapies ............................402
