Hyland Ela J, Harvey John G, Martin Andrew J P, Holland Andrew J A
The Children's Hospital's Burns Research Institute and the Department of Anaesthesia, The Children's Hospital at Westmead, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.
J Paediatr Child Health. 2015 Oct;51(10):976-81. doi: 10.1111/jpc.12912. Epub 2015 May 4.
The aim of the study was to describe characteristics of children with anterior neck burns admitted to our Paediatric Intensive Care Unit (PICU) and to highlight potential airway complications associated with these injuries, especially in children with scalds.
Retrospective review of children with anterior neck burns requiring admission to PICU January 2004-December 2013.
Fifty-two children with anterior neck burns were admitted; average age 6.6 years. Thirty sustained flame/explosion injuries; 22 scalds. Seventy-nine per cent were male. Mean total body surface area (TBSA) burn 21%. Forty-seven were intubated. Some primary reasons for intubation included unconsciousness, inhalational/ingestion/direct airway injury and large TBSA. Majority, however, required intubation for airway complications secondary to subcutaneous/soft tissue anterior neck oedema not associated with airway injury/ingestion/inhalational burns. The scalds subgroup mean age was 2.3 years. Eighty-two per cent were male. Mean TBSA 18%. There were no inhalational/ingestion/airway injuries. Nineteen children were intubated; average 9.3 h post-injury. Majority (63%) were intubated post-arrival in the Burn Unit, compared with flame/explosion group (32%). Primary reasons for intubation included large burns, although majority (74%) required intubation for airway complications secondary to subcutaneous and soft tissue anterior neck oedema. For the flame/explosion group this was the case in only 46%, with other primary reasons such as unconsciousness or inhalational injury being the immediate precedent.
These results demonstrate that subcutaneous and soft tissue oedema secondary to anterior neck burns may contribute to airway narrowing and compromise requiring intubation. When assessing children's airways, evolving oedema should be recognised and higher observation or early intubation considered regardless of the mechanism of injury.
本研究旨在描述入住我院儿科重症监护病房（PICU）的前颈部烧伤儿童的特征，并强调与这些损伤相关的潜在气道并发症，尤其是烫伤儿童。
回顾性分析2004年1月至2013年12月入住PICU的前颈部烧伤儿童。
52例前颈部烧伤儿童入院；平均年龄6.6岁。30例为火焰/爆炸伤；22例为烫伤。79%为男性。平均烧伤总面积（TBSA）为21%。47例进行了气管插管。一些插管的主要原因包括意识丧失、吸入/摄入/直接气道损伤和大面积TBSA。然而，大多数需要插管是由于前颈部皮下/软组织水肿继发的气道并发症，与气道损伤/摄入/吸入性烧伤无关。烫伤亚组平均年龄为2.3岁。82%为男性。平均TBSA为18%。无吸入/摄入/气道损伤。19例儿童进行了气管插管；受伤后平均9.3小时。大多数（63%）在烧伤病房到达后进行插管，而火焰/爆炸组为32%。插管的主要原因包括大面积烧伤，尽管大多数（74%）需要插管是由于前颈部皮下和软组织水肿继发的气道并发症。对于火焰/爆炸组，只有46%是这种情况，其他主要原因如意识丧失或吸入性损伤是直接原因。
这些结果表明，前颈部烧伤继发的皮下和软组织水肿可能导致气道狭窄并需要插管。在评估儿童气道时，应认识到不断发展的水肿，无论损伤机制如何，都应考虑加强观察或早期插管。
