Upper airway swelling is a very dangerous sequela
of inhalation injury. Swelling begins within hours after
injury and persists for 2 to 4 days until tissue edema
wanes.8 As with the patient described in this report, every
unsuccessful attempt to insert an artificial airway device
may worsen the patency of the natural airway. The indications
for endotracheal intubation of burned patients
include decreased mental status resulting from inhalation
of metabolic asphyxiants such as carbon monoxide or hydrogen
cyanide, airway obstruction caused by edema and
debris, and respiratory failure due to pulmonary edema.13
If orotracheal intubation is not possible, cricothyrotomy
should be performed.
Patients with soot in the oral cavity, facial burns,
and/or body burns are more likely to experience laryngeal
edema and to require intubation. Edema of the true
or false vocal cords detected by fiberoptic laryngoscopic
examination also is predictive of the need for intubation.
14 The absence of classic signs of inhalation injury