Inhalation of toxic gases in the kiss nightclub disaster: an example of inhalation injury from indoor fires

The Kiss Nightclub disaster, which occurred on January 27, 2013, in Santa Maria, Brazil, had an impact both on a national and global scale, as it was an accident with 230 immediate fatalities and can be compared to other indoors fires. In addition to bodily burns, inhalation injuries stood out, that is, thermal injuries of the airway, chemical injuries and intoxication by toxic gases. Carbon monoxide and cyanide are the main toxic gases produced in indoor fire situations and are formed from the incomplete combustion of hydrocarbons and carbonaceous and nitrogenous materials, respectively. While carbon monoxide, at high concentrations in the blood, promotes a shift of the oxyhemoglobin curve to the left and a consequent hypoxia condition, cyanide blocks the respiratory cycle, activating anaerobic respiration and evolving to an excessive production of lactic acid, which can lead the victim to death. Considering that in the accident of Santa Maria 169 individuals were hospitalized in a critical condition, it is necessary to understand the consequences and pathophysiology of inhalation injuries, being that the focus of this narrative review is the knowledge about poisoning by toxic gases. Moreover, it is essential to discuss proper diagnosis and treatment, in order to improve the prognosis of future victims of new fires in closed environments. Therefore, having knowledge about the potential causes of indoor fires helps in the prevention of similar disasters to the one that happened in the Kiss Nightclub.