Dr Yue Zhen1-4, Dylan Misso5, Suzanne Rea1-3, Shyan Vijayasekaran3,4, Mark Fear6,7, Fiona Wood1-3,6,7
1Department of Burns, Perth Children’s Hospital, Nedlands, Australia, 2Department of Burns, Fiona Stanley Hospital, Murdoch, Australia, 3Division of Surgery, University of Western Australia, Australia, 4Department of Otolaryngology, Head and Neck Surgery, Perth Children’s Hospital, Australia, 5Department of Orthopaedic surgery, Perth Children’s Hospital, Nedlands, , Australia, 6Burn injury research unit, School of Biomedical Sciences, University of Western Australia, Australia, 7Fiona Wood Foundation, Fiona Stanley Hospital, Murdoch, Australia
Objectives: Long-term laryngotracheal complications (LTLC) after inhalation injury (II) are an under-recognised condition in patients with burns. The purpose of this study was to systematically review all available evidence on LTLC after II and identify gaps in knowledge to guide the direction of future research.
Methods: A scoping review was performed to synthesize all available evidence on LTLC after II, as guided by the question, “What are the LTLC after II, in patients with or without a history of translaryngeal intubation and/or tracheostomy?”. MEDLINE, Web of Science, Ovid Embase, Cochrane Library and Google Scholar were searched for publications on this topic. Publications in any language, any year of publication and involving all ages of patients were preliminarily screened. Case reports, peer-reviewed conference proceedings, animal and experimental studies were also screened. Studies involving airway injury due to ingestion of caustic substances, foreign bodies, or iatrogenic fires, as well as opinion pieces and letters to editors were excluded from the preliminary screening.
Results: Of the 3567 citations screened, a total of 153 full text articles were assessed for eligibility and 49 were included in the scoping review. The overall level of evidence was low, with case reports constituting 46.7% of all included human studies. The review identified 361 patients with LTLC, who had 531 discrete laryngotracheal lesions. The lesions were most frequently in the trachea (36.9%), followed by the glottis (34.7%) and subglottis (19.0%).
Conclusions: LTLC occur in 4.8-6.5% of patients after II and these complications are under-recognised in burns patients. The risk factors for LTLC include high-grade II, elevated initial inflammatory responses, prolonged translaryngeal intubation and a history of tracheostomy. The goal of management is to restore airway patency, preserve voice quality and restore normal diet and swallow function. There is limited high level evidence on LTLC, particularly with regards to long-term functional morbidity in voice and swallow. Large, prospective studies are required to address this gap in knowledge.
Emily is a service registrar working at the FSH State Burns Unit. She is currently enrolled in a Master of Philosophy at the University of Western Australia for her research with the Burns Unit.