title: Tracheal intubation difficulties in the setting of face and neck burns: myth or reality?
abstract: BACKGROUND
  Face and/or neck burn (FNB) exposes patients to the double respiratory risk of obstruction and hypoxia, and these risks may require a tracheal intubation. This study aims to describe the incidence and the characteristics of difficult intubation in FNB patients.
  
  
  METHODS
  We conducted a 5-year retrospective, single-center study including all patients meeting the following criteria: 18 years of age or older, an FNB at least 1% of burned surface area with a severity equal to or greater than the superficial second degree, and intubation and a burn center admission within the first 24 hours after the burn. Patients were compared according to the difficulty of their intubation.
  
  
  RESULTS
  Between January 2007 and December 2011, we included 134 patients. The incidence of difficult intubation was 11.2% but was greater in the burn center than in the pre-burn center: 16.9% vs 3.5% (P = .02). The most important difference between patients with or without difficult intubation was the time between the burn injury and the intubation: 210 (105-290) vs 120 (60-180) minutes (P = .047). After multivariate analysis, an intubation performed at a burn center was independently associated with difficult intubation: odds ratio = 3.2; 95% confidence interval, 1.1-528.
  
  
  CONCLUSIONS
  This study underlines the high incidence of difficult intubation in FNB patients, greater than 11.2%, and demonstrates that intubation is more difficult when realized at a burn center, probably because it is performed later, allowing for development of cervical and laryngeal edema.
authors.affiliation: Burn Intensive Care Unit, Sainte Anne Military Teaching Hospital, Toulon, France. Electronic address: pierre.esnault@gmail.com.
authors.forename: Pierre
authors.initials: P
authors.lastname: Esnault
authors.affiliation: Burn Intensive Care Unit, Sainte Anne Military Teaching Hospital, Toulon, France.
authors.forename: Bertrand
authors.initials: B
authors.lastname: Prunet
authors.affiliation: Burn Intensive Care Unit, Sainte Anne Military Teaching Hospital, Toulon, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Cotte
authors.affiliation: Department of Emergency Medicine, Sainte Anne Military Teaching Hospital, Toulon, France.
authors.forename: Hélène
authors.initials: H
authors.lastname: Marsaa
authors.affiliation: Battlefield Health and Trauma Research Institute, Fort Sam Houston, TX, USA.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Prat
authors.affiliation: Burn Intensive Care Unit, Sainte Anne Military Teaching Hospital, Toulon, France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Lacroix
authors.affiliation: Burn Intensive Care Unit, Sainte Anne Military Teaching Hospital, Toulon, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Goutorbe
authors.affiliation: Burn Intensive Care Unit, Sainte Anne Military Teaching Hospital, Toulon, France.
authors.forename: Ambroise
authors.initials: A
authors.lastname: Montcriol
authors.affiliation: Burn Intensive Care Unit, Sainte Anne Military Teaching Hospital, Toulon, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Dantzer
authors.affiliation: Burn Intensive Care Unit, Sainte Anne Military Teaching Hospital, Toulon, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Meaudre
mesh_terms: D000328:Adult; D000402:Airway Obstruction / Q000209:etiology / Q000628:therapy*; D002053:Burn Units / Q000706:statistics & numerical data*; D002056:Burns / Q000150:complications / Q000628:therapy*; D015331:Cohort Studies; D005151:Facial Injuries / Q000150:complications / Q000628:therapy*; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000706:statistics & numerical data*; D007819:Laryngeal Edema / Q000209:etiology; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D019838:Neck Injuries / Q000150:complications / Q000628:therapy*; D016017:Odds Ratio; D012131:Respiratory Insufficiency / Q000628:therapy*; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D061665:Time-to-Treatment