Burn With Intact Skin – Isolated Inhalation Injury: A Case Report

Isolated inhalational injury is an uncommon but potentially fatal presentation associated with significant respiratory and systemic complications. We report two previously healthy young women who sustained isolated smoke inhalational injuries following entrapment in a burning clothes store.
A 23-year-old woman presented in asystolic cardiorespiratory arrest and underwent immediate advanced cardiopulmonary resuscitation, endotracheal intubation, and intensive care admission following return of spontaneous circulation. Bronchoscopic examination demonstrated extensive carbonaceous deposits extending to the secondary bronchi, consistent with grade 4 inhalational injury. Despite serial bronchoalveolar lavage (BAL), ventilatory support, and vasopressor therapy, she remained neurologically compromised with radiological evidence of hypoxic brain injury and later developed multi-organ dysfunction, eventually succumbing on day 8 of admission.
The second patient, a 21-year-old co-worker, presented unconscious with severe respiratory depression but maintained spontaneous circulation. She underwent early elective intubation, ICU admission, bronchoscopic evaluation, and serial BAL. Similar extensive carbonaceous contamination of the bronchi was noted. Following supportive management and repeated lavage procedures, her respiratory function improved significantly, allowing successful extubation after the third BAL. She was transferred to the ward on day 4 with favourable recovery.
These cases demonstrate the variable clinical outcomes associated with isolated inhalational injury. Early airway control, intensive supportive management, and bronchoscopic assessment with lavage may aid airway clearance and guide severity assessment in selected patients. However, severe inhalational injury complicated by prolonged hypoxia and cardiac arrest continues to carry a poor prognosis despite aggressive management.