Smoke inhalation injuries are the leading cause of fatalities from burn inj
ury. The major forms of inhalation injuries are carbon monoxide toxicity, i
njury to the upper airway, and pulmonary parenchymal damage. The compromise
d airway is protected by tracheal intubation, and respiratory failure is tr
eated with assisted ventilation. Maintenance of good pulmonary hygiene, opt
omized fluid resuscitation, and routine invasive hemodynamic monitoring are
the mainstays of therapy. The development of acute pulmonary insufficiency
, pulmonary edema, or bronchopneumonia requires a comprehensive approach to
all aspects of the illness. Acute pathophysiologic responses to inhalation
injury are complex. Future therapies will target improved ventilatory stra
tegies and the redundant host inflammatory response.