Inhalation injury to the respiratory tract of children.

Children with a history of exposure to smoke in a confined space or showing soot or burns, however minimal, on the face should be admitted to hospital. Respiratory distress may be delayed, but if it is progressive the patient should be curarized, intubated, and mechanically ventilated. Ventilation should be continued for a minimum of 48 hours, followed by 24 hours of spontaneous respiration against a positive airway pressure. It treatment is stopped sooner, a recurrence of stridor and pulmonary oedema is likely. It is mandatory to pass an endotracheal tube small enough to allow a leak between it and the oedematous mucosa, in order that laryngeal damage and subsequent subglottic stenosis may be avoided. It is important tu use high humidity of inspired gases to keep secretions fluid and the endotracheal tube patent. Dexamethasone should be given to minimise cerebral oedema and antibiotics to reduce the incidence of chest infections.