title: Indications for intubation and early tracheostomy in patients with Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis.
abstract: BACKGROUND
  Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) result in epidermal sloughing and mucositis. There are no published guidelines for intubation and early tracheostomy in this patient population.
  
  
  METHODS
  A retrospective chart review of 40 patients admitted from 2010 to 2015 with SJS and TEN was conducted. Descriptive statistics and significance were calculated.
  
  
  RESULTS
  Of the 43% of patients who underwent early tracheostomy, 100% had oral involvement while the initial total body surface area (TBSA) was 70% or more in 41% of patients (P < .05). TBSA progressed 15% or more in 53% of patients with 6% having airway involvement and a neurologic diagnosis mandating intubation. Mortality was 17%.
  
  
  CONCLUSIONS
  Indications for intubation and early tracheostomy for SJS and TEN are documented oral involvement plus one of the following: initial TBSA 70% or more; progression of TBSA involved from hospital day 1 to hospital day 3, 15% TBSA or more; underlying neurologic diagnosis preventing airway protection; and documented airway involvement on direct laryngoscopy.
authors: Emory University School of Medicine and Grady Health System, 69 Jesse Hill Jr. Drive, SE, Atlanta, GA, 30303, USA. Electronic address: rachel.y.williams@emory.edu.
authors: Rachael
authors: R
authors: Williams
authors: Emory University School of Medicine and Grady Health System, 69 Jesse Hill Jr. Drive, SE, Atlanta, GA, 30303, USA.
authors: Juvonda
authors: J
authors: Hodge
authors: Emory University School of Medicine and Grady Health System, 69 Jesse Hill Jr. Drive, SE, Atlanta, GA, 30303, USA.
authors: Walter
authors: W
authors: Ingram
mesh_terms: D000328:Adult; D001706:Biopsy; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013262:Stevens-Johnson Syndrome / Q000473:pathology / Q000628:therapy*; D014139:Tracheostomy
keywords: Early tracheostomy; Intubation; Stevens–Johnson syndrome; Toxic epidermal necrolysis