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Am J Emerg Med. 2014 Oct;32(10):1174-8. doi: 10.1016/j.ajem.2014.07.014. Epub 2014 Jul 30.

Tracheal intubation difficulties in the setting of face and neck burns: myth or reality?

Author information

1
Burn Intensive Care Unit, Sainte Anne Military Teaching Hospital, Toulon, France. Electronic address: pierre.esnault@gmail.com.
2
Burn Intensive Care Unit, Sainte Anne Military Teaching Hospital, Toulon, France.
3
Department of Emergency Medicine, Sainte Anne Military Teaching Hospital, Toulon, France.
4
Battlefield Health and Trauma Research Institute, Fort Sam Houston, TX, USA.

Abstract

INTRODUCTION:

Face and/or neck burn (FNB) exposes patients to the double respiratory risk of obstruction and hypoxia, and these risks may require a tracheal intubation. This study aims to describe the incidence and the characteristics of difficult intubation in FNB patients.

METHODS:

We conducted a 5-year retrospective, single-center study including all patients meeting the following criteria: 18 years of age or older, an FNB at least 1% of burned surface area with a severity equal to or greater than the superficial second degree, and intubation and a burn center admission within the first 24 hours after the burn. Patients were compared according to the difficulty of their intubation.

RESULTS:

Between January 2007 and December 2011, we included 134 patients. The incidence of difficult intubation was 11.2% but was greater in the burn center than in the pre-burn center: 16.9% vs 3.5% (P = .02). The most important difference between patients with or without difficult intubation was the time between the burn injury and the intubation: 210 (105-290) vs 120 (60-180) minutes (P = .047). After multivariate analysis, an intubation performed at a burn center was independently associated with difficult intubation: odds ratio = 3.2; 95% confidence interval, 1.1-528.

CONCLUSIONS:

This study underlines the high incidence of difficult intubation in FNB patients, greater than 11.2%, and demonstrates that intubation is more difficult when realized at a burn center, probably because it is performed later, allowing for development of cervical and laryngeal edema.

PMID:
25151328
DOI:
10.1016/j.ajem.2014.07.014
[Indexed for MEDLINE]

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