Example of inhalation injury treatment protocol in nonintubated adults

Titrate humidified high-flow oxygen to maintain SaO₂ >90%

Cough, deep breathing exercises every two hours

Turn patient side to side every two hours

Chest physiotherapy every two hours

Alternate mucolytic and heparin/saline nebulization:*

Nebulize 3 mL of 20% N-acetylcysteine every four hours; add a bronchodilator if wheezing or bronchospasm occurs

Alternate with nebulized unfractionated heparin^¶ 5000 to 10,000 units in 3 mL of normal saline every four hours

Nasotracheal suctioning, as needed

Early ambulation

Sputum cultures for intubated patients every Monday, Wednesday, and Friday

Pulmonary function studies at discharge and at outpatient visits

Patient/family education about the disease process

PT: prothrombin time; PTT: partial thromboplastin time.
* This alternating regimen provides a nebulizer treatment every two hours and is usually continued for seven days.
¶ Preservative-free heparin is not required. Nebulized heparin typically does not affect systematic coagulation parameters; however, most clinicians managing burn patients monitor PT and PTT on a routine basis.

Adapted from: Mlcak RP, Hegde SD, Herndon DN. Respiratory Care. In: Total Burn Care, 4th ed, Herndon DN (Ed), Saunders Elsevier, Philadelphia 2012.

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Example of inhalation injury treatment protocol in nonintubated adults