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Patient Safety and Quality Improvement

Optimizing Pediatric Airway Management for Burns in a Resource-constrained Setting

Monday, October 2, 2023
4:15 PM - 4:21 PM East Coast USA Time
Location: 202A

    Presenting Author(s)

  • Kelly E. Daniels, MD

    Resident
    University of Pittsburgh Medical Center
    Pittsburgh, PA, United States

    • Co-Author(s)

  • Hl

    Hettie le Roux, MD

    Red Cross War Memorial Children's Hospital, University of Cape Town, USA

  • SS

    Shamiel Salie, MD

    Red Cross War Memorial Children's Hospital, University of Cape Town, USA

    • Senior Author(s)

  • SP

    Shazia Peer, MD

    Professor
    Red Cross War Memorial Children's Hospital, University of Cape Town
    Cape Town, ZAF

Introduction: Pediatric burn injuries occur with increased incidence in resource-constrained countries due to reliance on open flame in the setting of frequent power outages or limited access to electricity. The purpose of this study was to review outcomes of children admitted to the PICU with inhalational burns and to propose a standardized algorithm for airway management and early otolaryngologic (ENT) referral, with the goal of minimizing acute decompensations and long-term complications.

Methods: Retrospective chart review was performed on all pediatric patients without pre-existing laryngeal pathology with inhalational burn injuries requiring intubation that were admitted to the ICU at a tertiary care children’s hospital in a resource-constrained country from 2015-2020. Patient demographics, details of burn injury complex, airway symptoms, duration of intubation, and disposition were reviewed and analyzed.

Results: N=74 patients, median age 5.0 years, were identified with inhalational injuries. Majority of burns were from open flames (86.5%, n=64), followed by hot water (n=5), electrical burns (n=3), hot oil (n=1), and firecracker (n=1). There were 13 mortalities (17.5%). ENT was consulted for 9 of 74 patients (12.2%) a median of 12 days (range 0-52 days) after initial presentation. 39% (n=29 patients) had a documented airway exam at time of initial intubation. 83% (n=24) of these patients had documented abnormal airway findings at initial intubation. ENT was consulted within 24 hours for 2 of 24 patients. Long-term laryngeal sequelae was found to include vocal fold granuloma, anterior glottic web, intubation injury, nasopharyngeal stenosis, subglottic stenosis, and need for tracheostomy.

Conclusions: Our study highlighted a deficiency in standardized airway evaluations and timely referrals to otolaryngology for patients with inhalational burns. In order to improve patient outcomes, we propose a standardized airway evaluation with referral algorithm for adaptation in resource-constrained environments where immediate evaluation by specialists is limited.