V.  SUMMARY

Pulmonary problems are a major source of morbidity and mortality in the burn patient.  The most common types of lung dysfunction have been described.  Although each process can result in a similar impairment in gas exchange, the etiologic and also the approach to prevention and treatment are different.

The lung manifestations, of an underlying disorder, change with the time period post burn injury.  The changing pulmonary problems over time are in large part the result of the evolution of the systemic response to the burn.

The initial resuscitation period with burn edema formation and mediator induced lung injury can lead to pulmonary problems, especially with smoke inhalation injury.  The lung response to inhalation injury also changes over time as the initial response to smoke toxins is replaced with ongoing injury from intense inflammation.  Lung infection in the form of an initial tracheobronchitis, is followed by a later bronchopneumonia.  The evolution of the hypermetabolic-catabolic state, with systemic inflammation brings its own set of pulmonary problems, especially in the presence of an existing lung dysfunction.

Anticipating the changing lung responses to a burn and inhalation injury over time, greatly assists in prevention of respiratory failure.  Treatment of an established respiratory failure is very difficult in the presence of a burn due to the ongoing inflammatory state.

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