Laryngeal inhalational injuries: A systematic review

• Published in: Burns 2022-02, Vol.48 (1), p.23-33
• Main Authors: Tang, Jessica A., Amadio, Grace, Nagappan, Lavanya, Schmalbach, Cecelia E., Dion, Gregory R.
• Format: Article
• Language: English
• Subjects: Burns - complications; Humans; Intubation, Intratracheal; Laryngeal Diseases - complications; Laryngeal inhalational injuries; Laryngostenosis - etiology; Larynx - injuries; Posterior glottic stenosis; Retrospective Studies; Subglottic stenosis; Upper airway
• ISSN: 0305-4179; 1879-1409
• DOI: 10.1016/j.burns.2021.02.006

•Enclosed space fires may increase the risk of smoke inhalational injury.•Cough and dysphonia were frequently observed in laryngeal inhalational injury.•Laryngeal exam should be performed whenever possible prior to intubation. Laryngeal inhalation injury carries a significant increase in mortality rate and often indicates immediate airway evaluation. This may be difficult in the setting of clinical deterioration necessitating immediate intubation, which itself can synergistically cause mucosal damage. Prior studies do not encompass predictive factors or long-term outcomes for the laryngotracheal complex. This systemic review of PubMed, Embase, and Cochrane identified studies investigating inhalational injuries of the upper airway. Demographic data as well as presentation, physical findings, and delayed sequelae were documented. Laryngotracheal burn patients were divided into two cohorts based on timing of laryngeal injury diagnosis (before- versus after-airway intervention). 1051 papers met initial search criteria and 43 studies were ultimately included. Airway stenosis was more common in patients that were intubated immediately (50.0%, n = 18 versus 5.2%, n = 13; p = 0.57). Posterior glottic involvement was only identified in patients intubated prior to airway evaluation (71.4%, n = 15). All studies reported a closed space setting for those patients in whom airway intervention preceded laryngeal evaluation. Laryngeal inhalational injuries are a distinct subset that can have a variety of minor to severe laryngotracheal delayed sequelae, particularly for thermal injuries occurring within enclosed spaces. Given these findings, early otolaryngology referral may mitigate or treat these effects.