Airway burn or inhalation injury: should all patients be intubated?
Keywords:
Burns, Intubation Burns, Inhalation, Airway Man agement, Laryngoscopy
Abstract
Introduction:
Burns are the fourth cause of trauma worldwide with 90% occurring in developing countries. It has been common practice for a patient with airway burn and/or inhalation injury to be intubated early due to the risk of loss of airway patency. However, the question is: should this continue to be the best practice? Are there any studies showing that not every patient should be intubated?
Objective:
To check whether patients with airway burn and/or inhalation injury should be prophylactically intubated.
Methods:
A non-systematic review of the literature in PubMed, Medline, and LILACS databases was completed.
Results:
A total of 30% to 40% of all patients intubated due to a history of airway burn and/or inhalation injury are extubated early, with evidence of unnecessary intubations that increase the risk of complications. The 2016 International Society for Burn Injury clinical guidelines for the care of the burn patient recommend intubation or tracheostomy, only as an indication if the airway patency is jeopardized, whereas observation and monitoring are the recommended treatment for secondary upper airway burns due to inhalation.
References
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2. World Health Organization. Burns. 2016; [Cited 17 Apr 17]. Available from: http://www.who.int/mediacentre/factsheets/fs365/en/.
3. Bolívar NG. Lesiones por artefactos explosivos periodo II de 2017. pdf. Instituto Nacional de Salud; periodo epidemiológico II, Colombia 2017.
4. Phillips AW, Cope O. Burn therapy: III. Beware the facial burn. Ann Surg 1962;156:759-766.
5. Venus B, Matsuda T, Copiozo JB, Mathru M. Prophylactic intubation and continuous positive airway pressure in the management of inhalation injury in burn victims. Crit Care Med 1981;9:519-523.
6. Bartlett RH, Niccole M, Tavis MJ, Allyn PA, Furnas DW. Acute Management of the Upper Airway in Facial Burns and Smoke Inhalation. Arch Surg 1976;111:744-749.
7. Goodwin C. Advanced Burn Life Support Course. Advisory Committee, Chicago:2011.
8. Toussaint J, Singer AJ. The evaluation and management of thermal injuries: 2014 update. Clin Exp Emerg Med 2014;1:8-18.
9. Moore KL, Dalley AF. Anatomía con orientación clínica. Ed. Médica Panamericana; 2009. 1205 p.
10. Enkhbaatar P, Pruitt BAJr, Suman O, Mlcak R, Wolf SE, Sakurai H, et al. Pathophysiology, research challenges, and clinical management of smoke inhalation injury. Lancet 2016;388:1437-1446.
11. Mlcak RP. Inhalation injury from heat, smoke, or chemical irritants. UpToDate. [Cited 10 Apr 17]. Available at: https://www.uptodate.com/contents/inhalation-injury-from-heat-smoke-orchemical-irritants.
12. Palmieri TL. Inhalation injury: research progress and needs. J Burn Care Res 2007;28:549-554.
13. Cioffi WGJr, Rue LW 3rd. Diagnosis and treatment of inhalation injuries. Crit Care Nurs Clin North Am 1991;3:191-198.
14. Oscier C, Emerson B, Handy JM. New perspectives on airway management in acutely burned patients. Anaesthesia 2014;69:105-110.
15. Rice PL, Orgill DP. Emergency care of moderate and severe thermal burns in adults. UpToDate. 2017. [Cited 14 Apr 17]. Available at: https://www.uptodate.com/contents/emergency-care-of-moderate-and-severe-thermal-burns-in-adults.
16. Contreras Zúñiga E, Domínguez Villegas MC. Quemadura de vía aerea. Rev Am Med Respir 2009;9:54-60.
17. Toon MH, Maybauer MO, Greenwood JE, Maybauer DM, Fraser JF. Management of acute smoke inhalation injury. Crit Care Resusc 2010;12:53-61.
18. Sheridan RL. Fire-Related Inhalation Injury. N Engl J Med 2016;375:464-469.
19. Rehberg S, Maybauer MO, Enkhbaatar P, Maybauer DM, Yamamoto Y, Traber DL. Pathophysiology, management and treatment of smoke inhalation injury. Expert Rev Respir Med 2009;3:283-297.
20. Huzar TF, George T, Cross JM. Carbon monoxide and cyanide toxicity: etiology, pathophysiology and treatment in inhalation injury. Expert Rev Respir Med 2013;7:159-170.
21. Burillo-Putze G, Nogué-Xarau S, Pérez-Castrillón JL, Dueñas-Laita A. [Cyanide and carbon monoxide in intoxication by smoke in a fire]. Rev Neurol 2009;48:335-336.
22. Anseeuw K, Delvau N, Burillo-Putze G, De Iaco F, Geldner G, Holmström P, et al. Cyanide poisoning by fire smoke inhalation: a European expert consensus. Eur J Emerg Med 2013;20:2-9.
23. Dries DJ, Endorf FW. Inhalation injury: epidemiology, pathology, treatment strategies. Scand J Trauma Resusc Emerg Med 2013;21:31.
24. Latenser BA. Critical care of the burn patient: the first 48hours. Crit Care Med 2009;37:2819-2826.
25. Palmieri TL. Inhalation injury consensus conference: conclusions. J Burn Care Res 2009;30:209-210.
26. Mlcak RP, Suman OE, Herndon DN. Respiratory management of inhalation injury. Burns 2007;33:2-13.
27. Colohan SM. Predicting prognosis in thermal burns with associated inhalational injury: a systematic review of prognostic factors in adult burn victims. J Burn Care Res 2010;31:529-539.
28. Mackie DP, van Dehn F, Knape P, et al. Increase in early mechanical ventilation of burn patients: an effect of current emergency trauma management? J Trauma 2011;70:611-615.
29. Walker PF, Buehner MF, Wood LA, et al. Diagnosis and management of inhalation injury: an updated review. Crit Care 2015;19:351.
30. Bittner EA, Shank E, Woodson L, et al. Acute and perioperative care of the burn-injured patient. Anesthesiology 2015;122:448-464.
31. Romanowski KS, Palmieri TL, Sen S, et al. More than one third of intubations in patients transferred to burn centers are unnecessary: proposed guidelines for appropriate intubation of the burn patient. J Burn Care Res 2016;37:e409-e414.
32. Eastman AL, Arnoldo BA, Hunt JL, et al. Pre-burn center management of the burned airway: do we know enough? J Burn Care Res 2010;31:701.
33. Costa Santos D, Barros F, Frazão M, et al. Pre-burn centre management of the airway in patients with face burns. Ann Burns Fire Disasters 2015;28:259-263.
34. Priyambada Behera GS. Fatal laryngeal oedema in burns. Trauma Treat 2014;04:01.
35. Greathouse JS, Stuart JL, White WAJr. Difficult airway management following severe gasoline burn injury: a case report. AANA J 2012;80:268-272.
36. Steering Subcommittee, Advisory Subcommittee ISBI practice guidelines for burn care. Burns 2016;42:953-1021.
37. Practice Guidelines Committee; Steering Subcommittee; Advisory Subcommittee ISBI practice guidelines for burn care. Burns 2016;42:953-1021.
38. Kearns RD, Hubble MW, Holmes JH IV, et al. Advanced burn life support for day-to-day burn injury management and disaster preparedness: stakeholder experiences and student perceptions following 56 advanced burn life support courses. J Burn Care Res 2015;36:455-464.
39. Vivó C, Galeiras R, del Caz MDP. Initial evaluation and management of the critical burn patient. Med Intensiva 2016; 40:49-59.
40. Cochran A. Inhalation injury and endotracheal intubation. J Burn Care Res 2009;30:190-191.
41. Larrea B. Airway management in critical burned patients. Rev Chil Anest 2010;39:137-140.
42. Antonio ACP, Castro PS, Freire LO. Smoke inhalation injury during enclosed-space fires: an update. J Bras Pneumol 2013;39:373-381.
43. Ribeiro C, Guimarães M, AntunesA, et al. "Theblack bronchoscopy": a case of airway soot deposition. J Bronchology Interv Pulmonol 2013;20:271.
44. Madnani DD, Steele NP, de Vries E. Factors that predict the need for intubation in patients with smoke inhalation injury. Ear Nose Throat J 2006;85:278-280.
45. Ikonomidis C, Lang F, Radu A, et al. Standardizing the diagnosis of inhalation injury using a descriptive score based on mucosal injury criteria. Burns 2012;38:513-519.
46. Spano S, Hanna S, Li Z, et al. Does bronchoscopic evaluation of inhalation injury severity predict outcome? J Burn Care Res 2016;37:1-11.
47. You K, Yang H-T, Kym D, et al. Inhalation injury in burn patients: establishing the link between diagnosis and prognosis. Burns 2014;40:1470-1475.
48. Mosier MJ, Pham TN, Park DR, et al. Predictive value of bronchoscopy in assessing the severity of inhalation injury. J Burn Care Res 2012;33:65-73.
49. Foster K, Holmes JH4th. Inhalation injury: state of the science 2016. J Burn Care Res 2017;38:137-141.
50. KamedaT, FujitaM. Point-of-careultrasounddetection of tracheal wall thickening caused by smoke inhalation. Crit Ultrasound J 2014;6:11.
2. World Health Organization. Burns. 2016; [Cited 17 Apr 17]. Available from: http://www.who.int/mediacentre/factsheets/fs365/en/.
3. Bolívar NG. Lesiones por artefactos explosivos periodo II de 2017. pdf. Instituto Nacional de Salud; periodo epidemiológico II, Colombia 2017.
4. Phillips AW, Cope O. Burn therapy: III. Beware the facial burn. Ann Surg 1962;156:759-766.
5. Venus B, Matsuda T, Copiozo JB, Mathru M. Prophylactic intubation and continuous positive airway pressure in the management of inhalation injury in burn victims. Crit Care Med 1981;9:519-523.
6. Bartlett RH, Niccole M, Tavis MJ, Allyn PA, Furnas DW. Acute Management of the Upper Airway in Facial Burns and Smoke Inhalation. Arch Surg 1976;111:744-749.
7. Goodwin C. Advanced Burn Life Support Course. Advisory Committee, Chicago:2011.
8. Toussaint J, Singer AJ. The evaluation and management of thermal injuries: 2014 update. Clin Exp Emerg Med 2014;1:8-18.
9. Moore KL, Dalley AF. Anatomía con orientación clínica. Ed. Médica Panamericana; 2009. 1205 p.
10. Enkhbaatar P, Pruitt BAJr, Suman O, Mlcak R, Wolf SE, Sakurai H, et al. Pathophysiology, research challenges, and clinical management of smoke inhalation injury. Lancet 2016;388:1437-1446.
11. Mlcak RP. Inhalation injury from heat, smoke, or chemical irritants. UpToDate. [Cited 10 Apr 17]. Available at: https://www.uptodate.com/contents/inhalation-injury-from-heat-smoke-orchemical-irritants.
12. Palmieri TL. Inhalation injury: research progress and needs. J Burn Care Res 2007;28:549-554.
13. Cioffi WGJr, Rue LW 3rd. Diagnosis and treatment of inhalation injuries. Crit Care Nurs Clin North Am 1991;3:191-198.
14. Oscier C, Emerson B, Handy JM. New perspectives on airway management in acutely burned patients. Anaesthesia 2014;69:105-110.
15. Rice PL, Orgill DP. Emergency care of moderate and severe thermal burns in adults. UpToDate. 2017. [Cited 14 Apr 17]. Available at: https://www.uptodate.com/contents/emergency-care-of-moderate-and-severe-thermal-burns-in-adults.
16. Contreras Zúñiga E, Domínguez Villegas MC. Quemadura de vía aerea. Rev Am Med Respir 2009;9:54-60.
17. Toon MH, Maybauer MO, Greenwood JE, Maybauer DM, Fraser JF. Management of acute smoke inhalation injury. Crit Care Resusc 2010;12:53-61.
18. Sheridan RL. Fire-Related Inhalation Injury. N Engl J Med 2016;375:464-469.
19. Rehberg S, Maybauer MO, Enkhbaatar P, Maybauer DM, Yamamoto Y, Traber DL. Pathophysiology, management and treatment of smoke inhalation injury. Expert Rev Respir Med 2009;3:283-297.
20. Huzar TF, George T, Cross JM. Carbon monoxide and cyanide toxicity: etiology, pathophysiology and treatment in inhalation injury. Expert Rev Respir Med 2013;7:159-170.
21. Burillo-Putze G, Nogué-Xarau S, Pérez-Castrillón JL, Dueñas-Laita A. [Cyanide and carbon monoxide in intoxication by smoke in a fire]. Rev Neurol 2009;48:335-336.
22. Anseeuw K, Delvau N, Burillo-Putze G, De Iaco F, Geldner G, Holmström P, et al. Cyanide poisoning by fire smoke inhalation: a European expert consensus. Eur J Emerg Med 2013;20:2-9.
23. Dries DJ, Endorf FW. Inhalation injury: epidemiology, pathology, treatment strategies. Scand J Trauma Resusc Emerg Med 2013;21:31.
24. Latenser BA. Critical care of the burn patient: the first 48hours. Crit Care Med 2009;37:2819-2826.
25. Palmieri TL. Inhalation injury consensus conference: conclusions. J Burn Care Res 2009;30:209-210.
26. Mlcak RP, Suman OE, Herndon DN. Respiratory management of inhalation injury. Burns 2007;33:2-13.
27. Colohan SM. Predicting prognosis in thermal burns with associated inhalational injury: a systematic review of prognostic factors in adult burn victims. J Burn Care Res 2010;31:529-539.
28. Mackie DP, van Dehn F, Knape P, et al. Increase in early mechanical ventilation of burn patients: an effect of current emergency trauma management? J Trauma 2011;70:611-615.
29. Walker PF, Buehner MF, Wood LA, et al. Diagnosis and management of inhalation injury: an updated review. Crit Care 2015;19:351.
30. Bittner EA, Shank E, Woodson L, et al. Acute and perioperative care of the burn-injured patient. Anesthesiology 2015;122:448-464.
31. Romanowski KS, Palmieri TL, Sen S, et al. More than one third of intubations in patients transferred to burn centers are unnecessary: proposed guidelines for appropriate intubation of the burn patient. J Burn Care Res 2016;37:e409-e414.
32. Eastman AL, Arnoldo BA, Hunt JL, et al. Pre-burn center management of the burned airway: do we know enough? J Burn Care Res 2010;31:701.
33. Costa Santos D, Barros F, Frazão M, et al. Pre-burn centre management of the airway in patients with face burns. Ann Burns Fire Disasters 2015;28:259-263.
34. Priyambada Behera GS. Fatal laryngeal oedema in burns. Trauma Treat 2014;04:01.
35. Greathouse JS, Stuart JL, White WAJr. Difficult airway management following severe gasoline burn injury: a case report. AANA J 2012;80:268-272.
36. Steering Subcommittee, Advisory Subcommittee ISBI practice guidelines for burn care. Burns 2016;42:953-1021.
37. Practice Guidelines Committee; Steering Subcommittee; Advisory Subcommittee ISBI practice guidelines for burn care. Burns 2016;42:953-1021.
38. Kearns RD, Hubble MW, Holmes JH IV, et al. Advanced burn life support for day-to-day burn injury management and disaster preparedness: stakeholder experiences and student perceptions following 56 advanced burn life support courses. J Burn Care Res 2015;36:455-464.
39. Vivó C, Galeiras R, del Caz MDP. Initial evaluation and management of the critical burn patient. Med Intensiva 2016; 40:49-59.
40. Cochran A. Inhalation injury and endotracheal intubation. J Burn Care Res 2009;30:190-191.
41. Larrea B. Airway management in critical burned patients. Rev Chil Anest 2010;39:137-140.
42. Antonio ACP, Castro PS, Freire LO. Smoke inhalation injury during enclosed-space fires: an update. J Bras Pneumol 2013;39:373-381.
43. Ribeiro C, Guimarães M, AntunesA, et al. "Theblack bronchoscopy": a case of airway soot deposition. J Bronchology Interv Pulmonol 2013;20:271.
44. Madnani DD, Steele NP, de Vries E. Factors that predict the need for intubation in patients with smoke inhalation injury. Ear Nose Throat J 2006;85:278-280.
45. Ikonomidis C, Lang F, Radu A, et al. Standardizing the diagnosis of inhalation injury using a descriptive score based on mucosal injury criteria. Burns 2012;38:513-519.
46. Spano S, Hanna S, Li Z, et al. Does bronchoscopic evaluation of inhalation injury severity predict outcome? J Burn Care Res 2016;37:1-11.
47. You K, Yang H-T, Kym D, et al. Inhalation injury in burn patients: establishing the link between diagnosis and prognosis. Burns 2014;40:1470-1475.
48. Mosier MJ, Pham TN, Park DR, et al. Predictive value of bronchoscopy in assessing the severity of inhalation injury. J Burn Care Res 2012;33:65-73.
49. Foster K, Holmes JH4th. Inhalation injury: state of the science 2016. J Burn Care Res 2017;38:137-141.
50. KamedaT, FujitaM. Point-of-careultrasounddetection of tracheal wall thickening caused by smoke inhalation. Crit Ultrasound J 2014;6:11.
How to Cite
1.
Orozco-Peláez YA. Airway burn or inhalation injury: should all patients be intubated?. Colomb. J. Anesthesiol. [Internet]. 2018 Dec. 1 [cited 2024 Apr. 23];46(Supplement):26-31. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/128
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Published
2018-12-01
How to Cite
1.
Orozco-Peláez YA. Airway burn or inhalation injury: should all patients be intubated?. Colomb. J. Anesthesiol. [Internet]. 2018 Dec. 1 [cited 2024 Apr. 23];46(Supplement):26-31. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/128
Section
Narrative review
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