The medical records of 21 patients with smoke inhalation admitted to a medical ICU (MICU) were reviewed. Of 21 patients, 6 (29%) died. Of 21 patients, 13 (62%) had facial burns and 11 of the 13 (85%) later developed pneumonia. Only 1 of 8 patients (12%) without facial burns developed pneumonia (p < 0.005). Of the 12 patients with pneumonia, 7 required ventilatory assistance and 6 of the 7 died in the MICU. The authors conclude that the presence of facial burns is associated with the later development of pneumonia in a high percentage of cases. Pneumonia contributes significantly to the high mortality rate. The need for ventilatory assistance in smoke inhalation patients is associated with a poor prognosis.