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Case Reports
. 2020 Jan;61(1):46-53.
doi: 10.11622/smedj.2019048. Epub 2019 Jun 14.

Airway management in inhalation injury: a case series

Suneel Ramesh Desai  1   2 , Delong Zeng  3 , Si Jack Chong  3
Affiliations
Case Reports

Airway management in inhalation injury: a case series

Suneel Ramesh Desai et al. Singapore Med J. 2020 Jan.

Abstract

Inhalation injury is a serious consequence of a fire or an explosion, with potential airway compromise and respiratory complications. We present a case series of five patients with inhalational burns who presented to Singapore General Hospital and discuss our approach to their early management, including early evaluation and planning for the upper and lower airway, coexisting cutaneous burns, and monitoring their ICU (intensive care unit) severity of illness, sepsis and acute respiratory distress syndrome. All five patients suffered various grades of inhalation injury. The patients were initially assessed by nasolaryngoscopy, and three patients were prophylactically intubated before being sent to the emergency operating theatre for definitive airway and burns management with fibreoptic bronchoscopy. All patients were successfully extubated and discharged stable. Various complications can arise as a result of an inhalation injury. Based on our cases and literature review, we propose a standardised workflow for patients with inhalation injury.

Keywords: airway management; bronchoscopy; burns; inhalation injury; ventilation.

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Figures

Box 1
Box 1
Ikonomidis et al’s(11) classification of endoscopic grade in inhalation injury:
Fig. 1
Fig. 1
Flowchart shows our institution’s protocol on intubating a patient with suspected inhalation injury. A&E: accident and emergency department; ABG: arterial blood gas; COHb: carboxyhaemoglobin; CXR: chest radiography; EOT: emergency operating theatre; ICU: intensive care unit
Fig. 2
Fig. 2
Flowchart shows the decision-making process for upper airway management in inhalation injury. ETT: endotracheal tube; LMA: laryngeal mask airway; SV: spontaneous ventilation
Fig. 3
Fig. 3
Images of Patient 1 collected during his acute respiratory distress syndrome (ARDS) phase while in the BICU. Bronchoscopic images show (a) bronchorrhoea; and (b) bronchial mucosal erythema and bleeding. (c) Chest radiograph shows ARDS. (d) Photograph shows carbonaceous deposits extracted from bronchoalveolar lavage.
Box 2
Box 2
Guidelines based on abbreviated injury score (AIS):
Fig. 4
Fig. 4
Flowchart shows our recommended standardised workflow for patients with inhalation injury.
See this image and copyright information in PMC

References

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