Smoke Inhalation

Hyperbaric Oxygen Therapy Approval Status

No Clearance by US Food and Drug Administration (FDA)

No Approval by the Undersea and Hyperbaric Medical Society (UHMS)

About Clearance and Approval


Definition and Causes

Smoke inhalation is the leading cause of death related to fire. Victims of smoke inhalation suffer a combination of injuries from airborne particles, burns to the throat and lungs, and chemical poisoning.

The combustion of plastics, textiles, and other synthetic materials produces a highly toxic mix of cyanide and carbon monoxide. Both carbon monoxide (CO) and cyanide bind to hemoglobin in red blood cells and block their capacity to carry oxygen to cells and tissues.

Inhaling even small amounts of fire smoke can be fatal. Serious and sometimes permanent neurological effects may be delayed days or weeks after acute poisoning.

Evidence Index

FDA cleared, widely reimbursed
Strong body of evidence
Repeatedly favorable results
Early or mixed results
Unfavorable or no evidence
Strong evidence against HBOT

Treatment with Hyperbaric Oxygen Therapy

Hyperbaric oxygen therapy (HBOT) is indicated for the emergency treatment of carbon monoxide poisoning and carbon monoxide poisoning complicated by cyanide poisoning after smoke inhalation. HBOT dissolves additional oxygen in the blood plasma and has been shown to work effectively alone and in combination with hydroxocobalamin (Cyanokit) and other cyanide antidote kits.

Read the pages Carbon Monoxide Poisoning and Cyanide Poisoning in the Undersea and Hyperbaric Medical Society resource library to learn more about carbon monoxide poisoning and carbon monooxide poisoning complicated by cyanide poisoning, the rationale for hyperbaric oxygen therapy, and key clinical evidence, outcomes, and success factors.

HyperbaricLink Commentary

The emergency treatment of smoke inhalation offers perhaps the single best reason for the healthcare community to demand 24/7 access to hyperbaric chambers across the US. Cyanide, carbon monoxide, inhaled particulates, and thermal injuries together require speedy action to save the lives of firefighters and other fire victims. The clinical evidence for HBOT may not be as strong for nonfire cyanide poisoning as for nonfire carbon monoxide poisoning, but the benefits of oxygen are well established. As [ Medscape ] puts it:

Oxygen and sodium thiosulfate are the most widely accepted cyanide antidotes. The mechanism of action of oxygen as a cyanide antidote is unclear, but it potentiates the effect of other antidotes. When used in the setting of smoke inhalation, it is also therapeutic for CO poisoning. Thus, high concentrations of oxygen should be promptly delivered.

Ongoing surveillance projects and prospective trials may bolster the clinical case for HBOT in the routine treatment of smoke inhalation.

Patient Resources

HyperbaricLink recommends the following websites for anyone seeking authoritative information, patient advocacy, and community support for smoke inhalation.

Home and Recreational Safety: Fire Prevention
US Centers for Disease Control and Prevention (CDC)

The CDC is dedicated to protecting health and promoting quality of life through the prevention and control of disease, injury, and disability. Its programs reduce the health and economic consequences of the leading causes of death and disability. The CDC website includes resources on fire in its section on home and recreational safety.

National Fire Protection Association (NFPA)

A leading authority on fire, electrical, and building safety, the NFPA provides free PDF downloads with excellent carbon monoxide safety tips and CO detector guidelines.

US Consumer Product Safety Commission (CPSC)

Protecting consumers and families from products that pose a fire, electrical, chemical, or mechanical hazard, the CPSC provides information about smoke alarms and carbon monoxide detectors.

US Fire Administration (USFA)

Part of the Federal Emergency Management Administration (FEMA), the USFA provides firefighter training and professional development resourcs as well as public education resources on fire prevention. The USFA also sponsors research and studies to help fire departments and other first responders manage fire emergencies.

Clinical Resources

Start with the following resources to explore current research activities and the peer-reviewed medical literature on hyperbaric oxygen therapy for smoke inhalation.

 Use the search buttons below to go directly to research on hyperbaric oxygen therapy.
US National Institutes of Health keeps the official list of human clinical trials currently enrolling, in progress, and recently completed. One may reasonably question the size and legitimacy of any study not listed here.


Google Scholar

A specialized Google search engine, Google Scholar indexes scholarly articles, patents, and legal opinions and journals. Google Scholar may produce many search results, but entries provide easy access to full-text journal articles.

Search Google Scholar


A service of WebMD, Medscape offers specialists, primary care physicians, and other health professionals robust and integrated medical information and educational tools. The website devotes several well-referenced paragraphs to hyperbaric oxygen therapy under Emergency Department Care for smoke inhalation.
US National Library of Medicine, US National Institutes of Health

PubMed keeps the official list of scientific papers published in reputable peer-reviewed medical journals. One may reasonably question the importance and legitimacy of any study not listed here.



News About Smoke Inhalation and Hyperbaric Oxygen Therapy

Summer Reading List: Young Men and Fire, by Norman Maclean

Wednesday, 6/13

Across the western US today thousands of firefighters battle 19 active wildfires, on the ground, from the air, under thankfully improving weather conditions. Our thoughts with them. And to our readers once more we recommend read more...

More news from O2.0 – the HyperbaricLink blog

Complete smoke inhalation archive from O2.0 — the HyperbaricLink blog

Further Reading

HyperbaricLink suggests Young Men and Fire  by Norman Maclean (University of Chicago Press, 1992)

Young Men and Fire, Norman Maclean

Related Terms

  • Asphyxiation
  • Carbon monoxide (CO) poisoning
  • Cyanide antidote kit (CAK)
  • Cyanogen chloride (CNCl) (CK)
  • Emergency medical services (EMS)
  • Emergency medical technician (EMT)
  • Fire
  • Firefighter
  • Hydrogen cyanide (HCN) (AC)
  • Hydroxocobalamin (Cyanokit)
  • Paramedic
  • Potassium cyanide (KCN)
  • Sodium cyanide (NaCN)
  • Sodium thiosulfate
  • Vitamin B12
Undersea and Hyperbaric Medical Society, Indications, Carbon Monoxide Poisoning. Retrieved 26 November 2014.
Undersea and Hyperbaric Medical Society, Indications, Carbon Monoxide Poisoning Complicated by Cyanide Poisoning. Retrieved 02 May 2015.
WebMD, emedicinehealth, Smoke Inhalation. Retrieved 02 November 2014.
Page Data
Updated: 28 Jul 2015 03:22 PM
Created: 30 Nov 2011 02:48 PM
By: About the authors »