Airway Management in Burn Patients with Inhalation Injury

Park, Il Seok; Chang, Jai Hyuk; Kim, Beom Gyu; Kim, Yong Bok; Rho, Young Soo; Ahn, Hwoe Young; Kim, Jong Hyun

Abstract

BACKGROUND AND OBJECTIVES
Respiratory failure remains one of the leading causes of death in burn patients with inhalation injury. Obtaining and maintaining a secure airway are both essential and challenging. Although different airway managements are performed in burn patients with inhalation injury, its exact indications and timing remain controversial. The purpose of this study is to define the principle of airway management in burn patients with inhalation injury.
SUBJECTS AND METHOD
A retrospective study was performed on 177 burn patients with inhalation injury who were admitted to Hangang Sacred Heart Hospital at Hallym University Medical Center from July 2002 to June 2005.
RESULTS
Severty-seven patients underwent mask O2 supply for initial airway management. A total of 77 patients survived. One hundred patients underwent endotracheal intubation for initial airway management. Of these, 42 patients underwent tracheotomy after endotracheal intubation. A total of 42 patients reported abnormal chest X-ray findings. Of these, 10 patients survived and had significant improvement in PaO2/FiO2 ratios within 3 days following tracheotomy.
CONCLUSION
In most cases, laryngotracheal edema subsides within 72 hours, permitting short periods of airway management. Deterioration of respiratory function permits prolonged intubation and ventilator support. Although tracheotomy does not improve general condition, it offers some advantages in terms of pulmonary toilet, patient comfort and airway security. If patients show deterioration of respiratory function, tracheotomy should be performed earlier.