EFFICACY OF FIBEROPTIC LARYNGOSCOPY IN THE DIAGNOSIS OF INHALATION INJURIES

Background: A significant proportion of burn patients with inhalation injuries incur difficulties with airway protection, dysphagia, and asp iration. In assessing the need for intubation in burn patients, the ef ficacy of fiberoptic laryngoscopy was compared with clinical findings and the findings of diagnostic tests, such as arterial blood gas analy sis, measurement of carboxyhemoglobin levels, pulmonary function tests , and radiography of the lateral aspect of the neck. Objective: To det ermine if these patients were at risk for aspiration or dysphagia, bar ium-enhanced fluoroscopic swallowing studies were performed. Design: P rospective study. Settings: Burn intensive care unit in an academic te rtiary referral center. Main Outcome Measures: Need for endotracheal i ntubation and potential for aspiration. Results: Six (55%) of 11 patie nts had clinical findings and symptoms that indicated, under tradition al criteria, endotracheal intubation for airway protection. Visualizat ion of the upper airway with fiberoptic laryngoscopy obviated the need for endotracheal intubation in all 11 patients. These patients also f ailed to evidence an increased risk of aspiration or other swallowing dysfunction. Conclusions: In comparison with other diagnostic criteria , fiberoptic laryngoscopy allows differentiation of those patients wit h inhalation injuries who, while at risk for upper airway obstruction, do not require intubation. These patients may be safely observed in a monitored setting with serial fiberoptic examinations, thus avoiding the possible complications associated with intubation of an airway wit h a compromised mucosalized surface. In these patients, swallowing abn ormalities do not manifest.