A Case Report of Emergency Cricothyroidotomy Due to Tracheal Intubation Failure in the Patient with Posterior Glottic Stenosis Due to Inhalation Burn / 계명의대학술지

Injuries of the larynx are common in patients with a history of inhalation burns. When anesthesia is performed in such patients, the possibility of tracheal intubation should be thoroughly checked in advance, and preparation should be made in case of possible failure. 73-year-old woman who underwent laser cordotomy due to posterior glottic stenosis due to inhalation burn. Her height and weight were 140 cm and 58.9 kg. We proceeded anesthesia, because preoperative fiberoptic laryngoscopy and otolaryngology consultation showed that tracheal intubation was possible. However, the intubation failed and the manual ventilation was not performed afterwards, so the cricothyroidotomy was performed as an emergency. Anesthesia in patients with posterior glottic stenosis due to inhalation burns requires a great deal of attention and, above all, thorough evaluation in order to confirm the possibility of tracheal intubation. If this is not possible, you should look for alternatives and be prepared, and even if you think it's possible, try anesthesia with thorough preparation for the possible failure.

Anesthetic management with extracorporeal membrane oxygenation in a patient with acute airway obstruction after inhalation burn injury: A case report

A 36-year-old woman was admitted to the intensive care unit because of an inhalation burn injury. Five days after admission, she developed dyspnea and hypercarbia. Therefore, fiberoptic bronchoscopy was performed through the endotracheal tube, which revealed foreign bodies in the tube. Tracheostomy was performed to remove, albeit incompletely, the foreign bodies (endotracheal debris). As sudden movement of the patient or airway reaction could cause the foreign bodies to move deeper into the bronchus during manipulation of the rigid bronchoscope, general anesthesia was induced and maintained by using total intravenous anesthesia with extracorporeal membrane oxygenation (ECMO). The foreign bodies were successfully removed without any other complications. This case showed that sloughed endobronchial debris after an inhalation burn injury caused acute airway obstruction. In such cases, alternative ventilation methods such as tracheostomy and ECMO may have to be applied, which can support a surgeon to focus on the procedure regardless of prolonged procedural time.

A Case of Inhalation Burn-Induced Extensive Tracheal Inflammatory Crust Removed by Ventilating Bronchoscopy under Tracheostomy and Extracorporeal Membrane Oxygenation / 대한이비인후과학회지

Foreign body impaction in airway is life-threatening as it can cause total airway obstruction. Such foreign bodies are removed under bronchoscopy in most patients. In some patients, however, the cardiopulmonary condition becomes unstable to undergo ventilating bronchoscopy under general anesthesia to remove the foreign body. In these conditions, extracorporeal membrane oxygenation (ECMO) can be adopted for cardiopulmonary support to stabilize the patient while removing the foreign body. ECMO supports tissue oxygenation and has been shown to improve survival of patients with adult respiratory distress syndrome. ECMO allows lungs to reserve their functions and decreases further lung injuries. The authors report one case of extensive tracheal inflammatory crust removed by ventilating bronchoscopy under tracheostomy and ECMO.

Successful Treatment of Tracheal Stenosis with Slide Tracheoplasty after the Failure of Resection with End-to-End Anastomosis

The combined effects of inhaled irritant gases and heat in burn patients can result in the development of laryngotracheal strictures. Several factors could adversely affect the development of tracheal stenosis and cause the growth of granulation tissue. Yet the current treatment options for this condition are limited because of the paucity of case reports. We report here on a case of a patient who experienced recurrent upper tracheal stenosis after an inhalation injury. She displayed repetitive symptoms of stenosis even after several laryngomicrosurgeries and resection with end-to-end anastomosis. Finally, 5 yr after the burn injury, slide tracheoplasty was successfully performed and the postoperative check-up findings and the increased airway volume seen on imaging were all satisfactory.

Laryngotracheal Stenosis in Burned Patients with Inhalation Injury: Analysis of Risk Factors / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Laryngotracheal stenosis (LTS) in burned patients with inhalation injury have features distinct from other stenosis after intubation or tracheotomy. However, the risk factors for LTS in burned patients with inhalation injury have not been thoroughly assessed. The aim of this study is to identify the risk factors for and evaluate the pattern of LTS in burned patients with inhalation injury. SUBJECTS AND METHOD: From May 2005 to April 2007, 227 burned patients with inhalation injury treated at the Hangang Sacred Heart Hospital, Hallym University Medical Center were investigated retrospectively. The risk factors analyzed for LTS in burned patients with inhalation injury were gender, age, duration of intubation, size of the endotracheal tube, previous tracheotomy, number of intubations, severity of inhalation injury. RESULTS: Among 81 patients who survived and could be followed up until the study period, 10 (12%) patients developed LTS. The stenosis involved the subglottis.cervical trachea (5), subglottis.cervical tracheal and glottis (1), glottis (4). According to Myer-Cotton classification, there were 6 (60%) patients with grade III, IV stenoses on subglottis.cervical trachea. The number of intubations and previous tracheotomy were found to be risk factors for the development of LTS in burned patients with inhalation injury. CONCLUSION: LTS by inhalation injury is usually shown on web at the anterior and posterior glottic areas or circumferential narrowing of the subglottis. Repeated endotracheal intubations and previous tracheotomy in patients with inhalation injury may increase the prevalence of LTS.

Histopathologic Changes of Tracheal Mucosa in Burned Patients with Inhalation Injury / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Inhalation injuries can produce a wide spectrum of negative clinical effects. Respiratory failure remains one of the leading causes of death in burned patients with inhalation injury. Despite advances in understanding of inhalation injury, few studies have focused on histopathologic findings of tracheal mucosa. The purpose of this study is to investigate histopathologic changes of tracheal mucosa in burned patients with inhalation injury. SUBJECTS AND METHOD: Tracheotomy was performed on 31 patients who was admitted to the Hospital center from May 2005 to March 2006. Thirty-one patients were divided into two groups : patients with inhalation injury (group I)(n=16), patients without inhalation injury (group II)(n=15). Tracheal mucosa were taken out during the tracheotomy. The tracheal mucosa were read blindly by one pathologist. RESULTS: Histopathologic examination showed the following finding in the tracheal mucosa of all patients in the group I : epithelial ulceration. Different findings were observed in the group I as time passed by after inhalation injury, such as interstitial edema, inflammatory cell infiltration, capillary dilatation, and increased fibrosis. No abnormal findings were observed in the tracheal mucosa in the group II. CONCLUSION: Inhalation injuries cause histopathologic damages to tracheal mucosa. The different histopathologic findings of tracheal mucosa that take place in time following inhalation injuries suggest to process an inflammatory reaction. The study in related to clinical features should be needed due to tracheal mucosa injury may produce respiratory complications.

Airway Management in Burn Patients with Inhalation Injury / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Respiratory failure remains one of the leading causes of death in burn patients with inhalation injury. Obtaining and maintaining a secure airway are both essential and challenging. Although different airway managements are performed in burn patients with inhalation injury, its exact indications and timing remain controversial. The purpose of this study is to define the principle of airway management in burn patients with inhalation injury. SUBJECTS AND METHOD: A retrospective study was performed on 177 burn patients with inhalation injury who were admitted to Hangang Sacred Heart Hospital at Hallym University Medical Center from July 2002 to June 2005. RESULTS: Severty-seven patients underwent mask O2 supply for initial airway management. A total of 77 patients survived. One hundred patients underwent endotracheal intubation for initial airway management. Of these, 42 patients underwent tracheotomy after endotracheal intubation. A total of 42 patients reported abnormal chest X-ray findings. Of these, 10 patients survived and had significant improvement in PaO2/FiO2 ratios within 3 days following tracheotomy. CONCLUSION: In most cases, laryngotracheal edema subsides within 72 hours, permitting short periods of airway management. Deterioration of respiratory function permits prolonged intubation and ventilator support. Although tracheotomy does not improve general condition, it offers some advantages in terms of pulmonary toilet, patient comfort and airway security. If patients show deterioration of respiratory function, tracheotomy should be performed earlier.

Clinical Analysis of Inhalation Burn

PURPOSE: The mortality rate of burn patients dying from burn shock or sepsis is declining owing to improved treatment methods such as advances in fluid therapy and antibiotic application. Over the past 10 years, however, damage to the trachea and the lungs caused by inhalation of poisonous gases in closed spaces and the resulting complications have become the primary causes of death for burn patients. The purpose of this study is to appraise the clinical significance of inhalation burn by focusing the analysis on the mass- produced burn patients from a recent short period. METHODS: This study involved 23 patients who were admitted to the Department of General Surgery from the Emergency Room at the Inha University Hospital after suffering burns in a fire that broke out at a pub in Inchon, Korea, on 30 October 1999. RESULTS: The average age was 16.6 and most of the patients were adolescents. The average of the total burn surface was 7%, with 17 patients (73.9%) having less than 5%. A bronchoscopy was applied to all the patients. A total of 13 patients (56.5%) had intubation. Of these, 4 had a tracheostomy three days after hospitalization. Of the 23 patients who were the subjects of this clinical study, 12 patients, accounting for 52.2% of the total, developed pneumonia. Two people also developed tracheal stenosis and both of them underwent a tracheal resection and anastomosis. Four patients had to receive psychiatric treatment due to post traumatic stresss disorder. None of the 23 patients died. CONCLUSION: In the case of burns suffered in confined areas, an inhalation burn, rather than the mere size of the burn, will have a greater bearing on fatality and the occurrence of pulmonary complications. For this reason, one cannot overemphasize the importance of preventing fire by taking appropriate safety precautions and keeping the surroundings clear of inflammable materials. However, once burn injury occurs, every effort should be made to ensure that there will be minimum after effects and scars through earliest possible intervention.