Lowery Anne Sun, Dion Greg, Thompson Callie, Weavind Liza, Shinn Justin, McGrane Stuart, Summitt Blair, Gelbard Alexander
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.
J Burn Care Res. 2019 Oct 16;40(6):961-965. doi: 10.1093/jbcr/irz133.
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.
吸入性损伤与烧伤死亡率独立相关，但关于气道热损伤的发生率、危险因素或功能结局的信息却很少。在热吸入性损伤患者中，我们试图确定喉气管狭窄（LTS）的发生率，描绘与LTS发生相关的危险因素，并评估长期气管切开依赖情况作为喉功能的替代指标。对2012年至2017年在单一机构烧伤重症监护病房接受热吸入性损伤治疗的成年患者进行回顾性队列研究。评估符合条件患者的记录以确定是否存在LTS（喉部、声门下或气管狭窄）。评估患者特征、烧伤损伤特征和特定治疗协变量。采用描述性统计、曼-惠特尼U检验、比值比和卡方检验比较LTS组与非LTS组。在研究期间的129例热吸入性损伤患者中，8例（6.2%）发生了LTS。与非LTS组相比，LTS患者的平均烧伤总面积更大（平均30.3，四分位间距7 - 57.5对10.5，四分位间距0 - 15.12，P = 0.01），吸入性损伤程度更高（平均2.63对1.80，P = 0.05），插管时间更长（12.63对5.44；P < 0.001），炎症反应更强烈（入院时平均白细胞计数25.8对14.9，P = 0.02，入院时平均血糖水平176.4对136.9，P = 0.01）。在最后一次随访时，LTS患者的气管切开依赖率显著更高（50%对1.7%，P < 0.001）。6%的热吸入性损伤患者发生LTS。LTS与更严重的热气道损伤、更长的插管时间以及更严重的初始宿主炎症相关。吸入性损伤且发生LTS的患者气管切开依赖风险高。在热吸入性损伤的烧伤患者中，应尽早将喉部评估和针对性治疗纳入多专科护理路径。
