Abstract
We observed the larynx in inhalation injury by serial fiberoptic bronchoscopy (FOB) to establish intubation criteria based on laryngeal edema. Between November 1991 and April 1997, 156 patients were admitted to our hospital due to burn and or inhalation injury. Sixty-eight patients who underwent FOB within 24 hours after injury had evidence of laryngeal injury. Endotracheal intubation was performed according to pre-determined criteria. Patients with laryngeal injury were assigned to one of five groups based on whether they were intubated or not, the timing of intubation, and the reason for intubation. Group I (n=14) patients had marked laryngeal edema and were intubated after initial FOB according to the criteria. Group II (n=14) patients did not have severe laryngeal edema but were intubated after initial FOB according to the criteria. Group III (n=4) patients were not intubated after initial FOB but were intubated after follow up FOB according to the criteria. Group IV (n=33) patients were never intubated according to the criteria. Group V (n=3) patients were intubated after initial FOB based on the attending physician's decision. Pre-established intubation criteria were not met in this group. 1) We examined the relationship between laryngeal edema and post injury interval in group I, III, and IV. 2) We examined the relationship between groups I, II, III, and IV and age, total burn surface area, burn index, prognostic burn index, presence of facial burn, and presence of cervical burn. 3) We examined the relationship between group III, IV and serum total protein level and treatments that might influence laryngeal edema. Results; 1) Using our intubation criteria, enodtracheal intubation was not required in 48.5% of patients. Our intubation criteria provide an evidenced based strategy for preventive intubation. 2) Biphasic peaks of laryngeal edema were recognized within 24 ours after injury. 3) In addition to direct injury, body burn is a significant factor for progressive laryngeal edema.
