title: Factors that predict the need for intubation in patients with smoke inhalation injury.
abstract: Early identification of smoke inhalation patients who will require intubation is crucial. We conducted a retrospective chart review to identify predictors of respiratory distress in patients who present with smoke inhalation injury. Our study involved 41 patients who had been treated in the emergency room at a regional burn center. Eight of these patients required intubation. Intubation was positively correlated with physical examination findings of soot in the oral cavity (p < 0.001), facial burns (p = 0.025), and body burns (p = 0.025). The need for intubation was also predicted by fiberoptic laryngoscopic findings of edema of either the true vocal folds (p < 0.001) or the false vocal folds (p < 0.01). No statistically significant correlation was found between intubation and any of the classic symptoms of smoke inhalation: stridor, hoarseness, drooling, and dysphagia (all p = 1.0). Also, multivariate analysis revealed that facial burns correlated significantly with edema of the true vocal folds (p = 0.01) and body burns correlated significantly with edema of both the true (p = 0.047) and false (p = 0.003) vocal folds. We conclude that patients with soot in the oral cavity, facial burns, and/or body burns should be monitored closely because these findings indicate a higher likelihood of laryngeal edema and the need for intubation.
authors.affiliation: Department of Otolaryngology, Jacobi Medical Center, Albert Einstein College of Medicine, New York City, USA.
authors.forename: Dilip D
authors.initials: DD
authors.lastname: Madnani
authors.forename: Natalie P
authors.initials: NP
authors.lastname: Steele
authors.forename: Egbert
authors.initials: E
authors.lastname: de Vries
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002244:Carbon; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal; D007819:Laryngeal Edema / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D015208:Smoke Inhalation Injury / Q000150:complications* / Q000628:therapy*; D014827:Vocal Cords / Q000473:pathology
chemical_list: D002244:Carbon