Positive signs on physical examination are not always indications for endotracheal tube intubation in patients with facial burn
Dublin Core
Title
Positive signs on physical examination are not always indications for endotracheal tube intubation in patients with facial burn
Subject
Endotracheal tube, Facial burn, TBSA, Short of breath
Description
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 confrmed inhalation injuries were com‑
pared. 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 confrmed 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 fndings 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.
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 confrmed inhalation injuries were com‑
pared. 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 confrmed 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 fndings 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.
Creator
Ruo‑Yi Huang, Szu‑Jen Chen, Yen‑Chang Hsiao, Ling‑Wei Kuo, Chien‑Hung Liao, Chi‑Hsun Hsieh, Francesco Bajani and Chih‑Yuan Fu
Publisher
BMC Emergency Medicine
Date
(2022) 22:36
Contributor
Fajar bagus W
Format
PDF
Language
English
Type
Text
Files
Collection
Citation
Ruo‑Yi Huang, Szu‑Jen Chen, Yen‑Chang Hsiao, Ling‑Wei Kuo, Chien‑Hung Liao, Chi‑Hsun Hsieh, Francesco Bajani and Chih‑Yuan Fu, “Positive signs on physical examination are not always indications for endotracheal tube intubation in patients with facial burn,” Repository Horizon University Indonesia, accessed April 4, 2025, https://repository.horizon.ac.id/items/show/4046.