Ikonomidis et al reported criteria to standardize the diagnosis of burn-associated inhalation and mucosal injury. The authors are from University Hospital (CHUV) Lausanne.
Patient selection: burn patient with possible smoke inhalation
Grading schema:
(1) changes to oro/rhino/pharyngo/laryngeal mucosa on ENT exam (pretracheal)
(2) changes to tracheobronchial mucosa
Parameter
Finding
Points
ENT grade
no lesion
0
any of: singed vibrissae; mucosal edema; mucosal hyperemia; hypersecretion
I
stenosing edema of laryngeal margin
I+
any of: non-circumferential bullae; noncircumferential detachment; noncircumferential erosion; noncircumferential exudate
II
any of: circumferential erosion or exudate;
profound ulcers; partial necrosis
III
tracheobronchial grade
no lesion
0
any of: mucosal edema; mucosal hyperemia; hypersecretion
I
any of: non-circumferential bullae; non-circumferential erosion; noncircumferential exudates
II
any of: circumferential erosions or exudates; profound ulcers; partial necrosis
III
where:
• Vibrissae are hairs on the philtrum and distal nares.
Suffix
ENT Grade
TB Grade
soot
S
S
lesions limited to trachea
C (central)
lesions extending beyond carina
P (peripheral)
Length of mechanical ventilation is associated with the volume of resuscitation fluid administered in the first 24 hour, the presence of inhalation injury and the presence of soot.
The length of ICU stay was associated with total burn surface area.
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