Airway

The airway is at risk by three major mechanisms:

• Generalised oedema as a systemic response from an increasing burn size and depth can cause swelling of the airway and compromise airflow^{9, 10.}
• Localised oedema as a result or direct thermal damage to the airway can obstruct airflow⁹
• Inhalation injury as a result of heat, smoke or toxic chemicals can cause damage to the airway.⁹

Assessment

Factors that increase the suspicion of airway obstruction or inhalation injury include: ¹⁰

Figure 9

Airway compromise can develop over a matter of hours and may only come to light when the patient is in crisis⁹. Figure 10 shows airway change over a period of 1 hour.

adapted from Airway swelling after laryngeal burn induced by swallowing hot food: Korean J Otorhinolaryngol-Head Neck Surg. 2015 Sep;58(9):634-636.

https://synapse.koreamed.org/ViewImage.php?Type=F&aid=507327&id=F1&afn=38_KJORL-HN_58_9_634&fn=kjorl-hns-58-634-g001_0038KJORL-HN

Management

1. Sit patient upright⁹
2. Any suspected airway injury necessitates senior anaesthetic review to identify and predict deterioration⁹.
3. If indicated, early intubation with an uncut tube⁹ prevents the tube moving in the event of further swelling¹⁰

Common pitfalls

• Failure to recognise or predict the deteriorating airway.