Airway burn or inhalation injury: should all patients be intubated?

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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.

Conclusion:

There is no conclusive clinical evidence to justify routine prophylactic intubation. In case of suspected airway burn and/or injury by inhalation, the recommendation is to complement the medical evaluation with an examination of the oropharynx via fiberoptic bronchoscopy or laryngoscopy (direct or indirect) to identify airway edema, its evolution, and then decide whether intubation is appropriate.

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