TITLE: Algorithm for airway management in critically ill burn patients with smoke inhalation injury at emergency room.
AUTHORS: A Rey, L Lagunes, J Baena, S Marquina, L Perez, L Dominguez, R Monforte, M Riveiro, A Robles, JP Barret, M Baguena
AFFILIATION: Vall d’Hebron University Hospital, Barcelona, Spain
WORDS: 296

INTRODUCTION
Mortality related to smoke inhalation injury (SII) remains high despite medical advances mostly due to respiratory complications. (1) Airway management (AM) in these patients is a matter of current debate going from observation to prophylactic tracheal intubation (2,3) To date, no such algorithm for identifying SII patients at risk for respiratory complications has been described. 

OBJECTIVE:
To describe a bedside clinical algorithm for AM in critically ill burn patients with SII at Vall d’Hebron University Hospital Burn Unit.

METHODS:
Review of existing AM approach in these population was performed on principal electronic medical databases (PubMed, EMBASE and Medline). Development of clinical algorithm with fast and bedside approach was intended, consensus on medical staff was achieved. 

RESULTS: 
Immediate intubation is indicated if upper airway is threatened, gas exchange mandate mechanical ventilatory support or mental status is inadequate for airway protection. Early elective intubation is performed in case of extensive and deep facial burn with nasogenic affectation and circular neck burn, total body surface affectation >50% or when SII is highly suspected with thermal damage of upper airway (intraoral burn or soot in oral cavity or sputum). However, if low suspicion of SII, thermal damage or face or neck burns are not severe, a direct laryngoscopic evaluation is advised. In case of glotic or supraglotic involvement immediate intubation is indicated, if not present usual A,B,C,D,E approach is advised.
 
CONCLUSION:   
Early identification of SII patients who will require intubation is crucial. Challenge relies in predicting which patients requires intubation. With this bedside algorithm, we aim to unify intubation criteria and approach to the airway management of burned patient in the safest way.

REFERENCES: 
1. Walker et al. Critical Care, 2015; 19:351.
2. Madnani DD et al. Ear Nose Throat J. 2006;85(4):278-80.
3. Cancio CL. Clin Plast Surg. 2009;36(4):555-67