Pre-burn centre management of the airway in patients with face burns

Face burns expose patients to a higher respiratory risk, and early prophylactic intubation before they enter the burn unit might be life-saving. However, unnecessary intubation may compromise their clinical evolution. Hence, the decision to perform pre-burn centre endotracheal intubation remains a clinical challenge. A retrospective study was developed to characterize the experience of the tertiary burn unit of the Hospital da Prelada with face burn patients arriving endotracheally-intubated between January 2009 and September 2013. Specific goals included assessment of whether these intubations were clinically appropriate and if these procedures determined significant changes in clinical course and outcome. A total of 136 patients were admitted to our burn centre with facial burns. 38.2% (n=52) of them arrived endotracheally-intubated, with 75% (n=39) intubated at the scene of the burn injury and 25% (n=13) in the emergency room because of the suspicion of smoke inhalation injury. In only 23% of the cases (n=12) was the lesion confirmed by bronchoscopy. The overall mortality rate was 12.5% (n=17): 3.6% (n=3) were patients who had not been subjected to pre-burn centre intubation, and 27% (n=14) were in the group of patients arriving intubated. A face burn is a warning sign of a possible upper airway injury, and pre-burn centre prophylactic intubation might be life-saving. However, unnecessary intubation may impair clinical evolution. Therefore, it is imperative that updated practice guidelines for pre-burn centre airway management are adhered to, and that these guidelines are subject to revision in order to improve airway management in burn patients.