TY - JOUR
T1 - Incidence of Laryngotracheal Stenosis after Thermal Inhalation Airway Injury
AU - Lowery, Anne Sun
AU - Dion, Greg
AU - Thompson, Callie
AU - Weavind, Liza
AU - Shinn, Justin
AU - McGrane, Stuart
AU - Summitt, Blair
AU - Gelbard, Alexander
N1 - Funding Information:
*Department of Otolaryngology, Vanderbilt University School of Medicine, Nashville, Tennessee; †Department of Otolaryngology and Head and Neck Surgery, Brooke Army Medical Center, Fort Sam Houston, Houston, Texas; ‡Division of Trauma and Surgical Critical Care, Vanderbilt University Medical Center; ||Division of Anesthesiology Critical Care Medicine, Vanderbilt University Medical Center; $Department of Otolaryngology and Head and Neck Surgery, Vanderbilt University Medical Center; ¶Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee Funding: The authors received no financial support for research, authorship, and/ or publication of this article.
Publisher Copyright:
© 2019 American Burn Association 2019. All rights reserved.
PY - 2019/10/16
Y1 - 2019/10/16
N2 - Inhalation injury is independently associated with burn mortality, yet little information is available on the incidence, risk factors, or functional outcomes of thermal injury to the airway. In patients with thermal inhalation injury, we sought to define the incidence of laryngotracheal stenosis (LTS), delineate risk factors associated with LTS development, and assess long-term tracheostomy dependence as a proxy for laryngeal function. Retrospective cohort study of adult patients treated for thermal inhalation injury at a single institution burn critical care unit from 2012 to 2017. Eligible patients' records were assessed for LTS (laryngeal, subglottic, or tracheal stenosis). Patient characteristics, burn injury characteristics, and treatment-specific covariates were assessed. Descriptive statistics, Mann-Whitney U-tests, odds ratio, and chi-square tests compared LTS versus non-LTS groups. Of 129 patients with thermal inhalation injury during the study period, 8 (6.2%) developed LTS. When compared with the non-LTS group, patients with LTS had greater mean TBSA (mean 30.3, Interquartile Range 7-57.5 vs 10.5, Interquartile Range 0-15.12, P =. 01), higher grade of inhalation injury (mean 2.63 vs 1.80, P =. 05), longer duration of intubation (12.63 vs 5.44; P <. 001), and greater inflammatory response (mean white blood cell count on presentation 25.8 vs 14.9, P =. 02, mean hyperglycemia on presentation 176.4 vs 136.9, P =. 01). LTS patients had a significantly higher rate of tracheostomy dependence at last follow-up (50 vs 1.7%, P <. 001). Six percent of patients with thermal inhalation injury develop LTS. LTS was associated with more severe thermal airway injury, longer duration of intubation, and more severe initial host inflammation. Patients with inhalation injury and LTS are at high risk for tracheostomy dependence. In burn patients with thermal inhalation injury, laryngeal evaluation and directed therapy should be incorporated early into multispecialty pathways of care.
AB - Inhalation injury is independently associated with burn mortality, yet little information is available on the incidence, risk factors, or functional outcomes of thermal injury to the airway. In patients with thermal inhalation injury, we sought to define the incidence of laryngotracheal stenosis (LTS), delineate risk factors associated with LTS development, and assess long-term tracheostomy dependence as a proxy for laryngeal function. Retrospective cohort study of adult patients treated for thermal inhalation injury at a single institution burn critical care unit from 2012 to 2017. Eligible patients' records were assessed for LTS (laryngeal, subglottic, or tracheal stenosis). Patient characteristics, burn injury characteristics, and treatment-specific covariates were assessed. Descriptive statistics, Mann-Whitney U-tests, odds ratio, and chi-square tests compared LTS versus non-LTS groups. Of 129 patients with thermal inhalation injury during the study period, 8 (6.2%) developed LTS. When compared with the non-LTS group, patients with LTS had greater mean TBSA (mean 30.3, Interquartile Range 7-57.5 vs 10.5, Interquartile Range 0-15.12, P =. 01), higher grade of inhalation injury (mean 2.63 vs 1.80, P =. 05), longer duration of intubation (12.63 vs 5.44; P <. 001), and greater inflammatory response (mean white blood cell count on presentation 25.8 vs 14.9, P =. 02, mean hyperglycemia on presentation 176.4 vs 136.9, P =. 01). LTS patients had a significantly higher rate of tracheostomy dependence at last follow-up (50 vs 1.7%, P <. 001). Six percent of patients with thermal inhalation injury develop LTS. LTS was associated with more severe thermal airway injury, longer duration of intubation, and more severe initial host inflammation. Patients with inhalation injury and LTS are at high risk for tracheostomy dependence. In burn patients with thermal inhalation injury, laryngeal evaluation and directed therapy should be incorporated early into multispecialty pathways of care.
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U2 - 10.1093/jbcr/irz133
DO - 10.1093/jbcr/irz133
M3 - Article
C2 - 31332446
AN - SCOPUS:85073580826
SN - 1559-047X
VL - 40
SP - 961
EP - 965
JO - Journal of Burn Care and Research
JF - Journal of Burn Care and Research
IS - 6
ER -