Preventing unnecessary intubations

A 5-year regional burn center experience using flexible fiberoptic laryngoscopy for airway evaluation in patients with suspected inhalation or airway injury

Shawn Moshrefi, Clifford C. Sheckter, Kimberly Shepard, Clifford Pereira, Drew J. Davis, Yvonne Karanas, Danielle H. Rochlin

Research output: Contribution to journalArticle

Abstract

The decision to intubate acute burn patients is often based on the presence of classic clinical exam findings. However, these findings may have poor correlation with airway injury and result in unnecessary intubation. We investigated flexible fiberoptic laryngoscopy (FFL) as a means to diagnose upper airway thermal and inhalation injury and guide airway management. A retrospective chart review of all burn patients who underwent FFL from 2013 to 2017 was performed. Their charts were reviewed to determine the indications for FFL including the historical data and physical exam findings that indicated airway injury as well as patient age, TBSA, type and depth of burn injury, carboxyhemoglobin level, and clinical course. Fifty-one patients underwent FFL, with an average TBSA of 6.5% (range 0.5-38.0%) and carboxyhemoglobin level of 3.5%. Burn mechanism was flame (35.3%) or flash (51.0%), with 50% occurring in enclosed spaces. In all cases, the decision to perform FFL was based on physical exam findings meeting criteria for intubation, including facial burns, singed nasal hairs, nasal soot, voice change, throat pain or abnormal sensation, shortness of breath, carbonaceous sputum, wheezing, or stridor. Based on FFL, 9 patients (17.7%) were treated with steroids, 28 patients (54.9%) received supportive care, and 6 patients (11.8%) had repeat FFL for monitoring. One patient was intubated after repeat FFL examination. All patients who underwent FFL met traditional criteria for intubation based on exam, however 98% were monitored without issues based on FFL findings. FFL is a valuable tool that can lead to fewer intubations in acute burn patients with a stable respiratory status for whom history and physical exam suggest upper airway injury.

Original languageEnglish (US)
Pages (from-to)341-346
Number of pages6
JournalJournal of Burn Care and Research
Volume40
Issue number3
DOIs
StatePublished - Jan 1 2019
Externally publishedYes

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Burn Units
Laryngoscopy
Intubation
Inhalation
Wounds and Injuries
Carboxyhemoglobin
Respiratory Sounds
Nose
Soot
Airway Management
Pharynx
Sputum
Burns
Dyspnea
Hair
Patient Care
Hot Temperature
History
Steroids

ASJC Scopus subject areas

  • Surgery
  • Emergency Medicine
  • Rehabilitation

Cite this

Preventing unnecessary intubations : A 5-year regional burn center experience using flexible fiberoptic laryngoscopy for airway evaluation in patients with suspected inhalation or airway injury. / Moshrefi, Shawn; Sheckter, Clifford C.; Shepard, Kimberly; Pereira, Clifford; Davis, Drew J.; Karanas, Yvonne; Rochlin, Danielle H.

In: Journal of Burn Care and Research, Vol. 40, No. 3, 01.01.2019, p. 341-346.

Research output: Contribution to journalArticle

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