Airway Management for Acute and Reconstructive Burns: Our 30-year Experience

Area of Science:

• Burns and Trauma
• Airway Management
• Surgical Procedures

Background:

• Burn injuries significantly alter airway anatomy, complicating evaluation and intubation.
• Laryngeal and supraglottic edema and scarring present unique challenges in burn patients.
• Standard laryngoscopy is often insufficient for securing airways in this population.

Purpose of the Study:

• To outline a safe and effective approach to airway management in acute and reconstructive burn patients.
• To share lessons learned over 30 years of managing burn patient airways.
• To highlight the need for flexible and creative airway management strategies.

Main Methods:

• Review of airway management techniques employed over 30 years in a large burn center.
• Focus on fiberoptic bronchoscopy and various airway manipulation techniques.
• Discussion of criteria for tracheostomy in severe burn cases.

Main Results:

• Standard laryngoscopy is frequently inadequate for burn patients.
• Fiberoptic bronchoscopy and specialized techniques are often necessary.
• Tracheostomy is reserved for specific indications like ventilatory failure or severe burns.

Conclusions:

• Safe airway management in burn patients requires specialized, non-standard approaches.
• Multidisciplinary expertise is crucial for successful airway acquisition and maintenance.
• This review provides a practical guide to current best practices in burn airway management.