Failure to clear casts and secretions following inhalation injury can be dangerous: report of a case.

A 27-year-old man suffered smoke inhalation during a fire. Three days later, he complained of respiratory difficulty and was admitted to our hospital. Bronchoscopy revealed a very large buildup of sputum mixed with soot extending from the left main bronchus to the bifurcation of the upper and lower lobe bronchi and causing both pulmonary atelectasis and pneumonia. The debris was successfully removed the next day with basket forceps via bronchoscopy. The patient's airway pressure dropped significantly, enabling extubation almost immediately. Because of the possibility for respiratory failure caused by viscous secretion, it is important to perform initial bronchoscopy in cases of suspected inhalation injury.