Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Mar 8;22(1):36.
doi: 10.1186/s12873-022-00594-9.

Positive signs on physical examination are not always indications for endotracheal tube intubation in patients with facial burn

Ruo-Yi Huang  1 , Szu-Jen Chen  1 , Yen-Chang Hsiao  2 , Ling-Wei Kuo  1 , Chien-Hung Liao  1 , Chi-Hsun Hsieh  1 , Francesco Bajani  1 , Chih-Yuan Fu  3
Affiliations

Positive signs on physical examination are not always indications for endotracheal tube intubation in patients with facial burn

Ruo-Yi Huang et al. BMC Emerg Med. .

Abstract

Background: After clinical evaluation in the emergency department (ED), facial burn patients are usually intubated to protect their airways. However, the possibility of unnecessary intubation or delayed intubation after admission exists. Objective criteria for the evaluation of inhalation injury and the need for airway protection in facial burn patients are needed.

Methods: Facial burn patients between January 2013 and May 2016 were reviewed. Patients who were and were not intubated in the ED were compared. All the intubated patients received routine bronchoscopy and laboratory tests to evaluate whether they had inhalation injuries. The patients with and without confirmed inhalation injuries were compared. Multivariate logistic regression analysis was used to identify the independent risk factors for inhalation injuries in the facial burn patients. The reasons for intubation in the patients without inhalation injuries were also investigated.

Results: During the study period, 121 patients were intubated in the ED among a total of 335 facial burn patients. Only 73 (60.3%) patients were later confirmed to have inhalation injuries on bronchoscopy. The comparison between the patients with and without inhalation injuries showed that shortness of breath (odds ratio = 3.376, p = 0.027) and high total body surface area (TBSA) (odds ratio = 1.038, p = 0.001) were independent risk factors for inhalation injury. Other physical signs (e.g., hoarseness, burned nostril hair, etc.), laboratory examinations and chest X-ray findings were not predictive of inhalation injury in facial burn patients. All the patients with a TBSA over 60% were intubated in the ED even if they did not have inhalation injuries.

Conclusions: In the management of facial burn patients, positive signs on conventional physical examinations may not always be predictive of inhalation injury and the need for endotracheal tube intubation in the ED. More attention should be given to facial burn patients with shortness of breath and a high TBSA. Airway protection is needed in facial burn patients without inhalation injuries because of their associated injuries and treatments.

Keywords: Endotracheal tube; Facial burn; Short of breath; TBSA.

PubMed Disclaimer

Conflict of interest statement

No competing interests.

Figures

Fig. 1
Fig. 1
Study population, protocol and key numbers in the current study
Fig. 2
Fig. 2
The relationship between the TBSA and proportion of patients who truly needed intubations and the relationship between the TBSA and the proportion of patients who were intubated in the ED
See this image and copyright information in PMC

References

    1. Rue LW, Cioffi WG, Mason A, McManus W, Pruitt BA. The risk of pneumonia in thermally injured patients requiring ventilatory support. J Burn Care Res. 1995;16:262–268. doi: 10.1097/00004630-199505000-00008. - DOI - PubMed
    1. Mock C, Peck M, Peden M, Krug E, editors. A WHO plan for burn prevention and care. Geneva: World Health Organisation; 2008.
    1. Traber DL, Hawkins HK, Enkhbaatar P, Cox RA, Schmalstieg FC, Zwischenberger JB, et al. The role of the bronchial circulation in the acute lung injury resulting from burn and smoke inhalation. Pulm Pharmacol Ther. 2007;20:163–166. doi: 10.1016/j.pupt.2005.12.006. - DOI - PubMed
    1. Clark WR. Smoke inhalation: diagnosis and treatment. World J Surg. 1992;16:24–29. doi: 10.1007/BF02067110. - DOI - PubMed
    1. Cancio LC. Airway management and smoke inhalation injury in the burn patient. Clin Plast Surg. 2009;36:555–567. doi: 10.1016/j.cps.2009.05.013. - DOI - PubMed