title: Airway management of recovered pediatric patients with severe head and neck burns: a review.
abstract: There are approximately 10,000 pediatric burn survivors in the United States each year, many of whom will present for reconstructive surgery after severe burns in the head and neck (1). These recovered burn victims, who are beyond the acute phase of injury, often have significant scarring and contractures in the face, mouth, nares, neck, and chest, which can make airway management challenging and potentially lead to a 'cannot intubate, cannot ventilate' scenario (2). Although numerous cases have been presented in the literature on this topic (3-17), there are no comprehensive review articles on the unique challenges of airway management in the recovered pediatric burn patient with distorted airway anatomy. This article aims to provide a comprehensive review of airway management in such patients, focusing on challenges encountered during mask ventilation and tracheal intubation, as well as the role of surgical release of neck contractures to facilitate tracheal intubation. Lessons learned from all reported cases identified in a thorough literature search are incorporated into this review.
authors.affiliation: Department of Anesthesia, Critical Care, and Pain Medicine, Shriners Hospital for Children, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA. tjcaruso@partners.org
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Caruso
authors.forename: Luke S
authors.initials: LS
authors.lastname: Janik
authors.forename: Gennadiy
authors.initials: G
authors.lastname: Fuzaylov
mesh_terms: D000293:Adolescent; D058109:Airway Management / Q000379:methods*; D002056:Burns / Q000473:pathology / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D003286:Contracture / Q000601:surgery; D006259:Craniocerebral Trauma / Q000473:pathology / Q000628:therapy*; D005260:Female; D006801:Humans; D007223:Infant; D007442:Intubation, Intratracheal; D017214:Laryngeal Masks; D008297:Male; D019838:Neck Injuries / Q000473:pathology / Q000628:therapy*; D012121:Respiration, Artificial; D012189:Retrospective Studies