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Airway compromise in children with anterior neck burns: Beware the scalded child
Author(s) -
Hyland Ela J,
Harvey John G,
Martin Andrew JP,
Holland Andrew JA
Publication year - 2015
Publication title -
journal of paediatrics and child health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.631
H-Index - 76
eISSN - 1440-1754
pISSN - 1034-4810
DOI - 10.1111/jpc.12912
Subject(s) - medicine , airway , total body surface area , intubation , anesthesia , unconsciousness , surgery , airway obstruction , poison control , emergency medicine
Aim 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. Methods Retrospective review of children with anterior neck burns requiring admission to PICU J anuary 2004– D ecember 2013. Results 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. Conclusion 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.