Long-Term Laryngotracheal Complications After Inhalation Injury: A Scoping Review

Abstract

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. 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. 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 lesions were most frequently in the trachea (36.9%), followed by the glottis (34.7%) and subglottis (19.0%). 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.

Factors Associated with Self-Reported Voice Change in the Hospitalized Burn Population: A Burn Model System National Database Study

“…Additionally, dysphonia negatively impacts quality of life, including social interactions, work performance, and pain [34]. A scoping review examining the long-term laryngotracheal complications after inhalation injury noted that dysphonia was a frequent sequela after injury [35]. Close monitoring and timely interventions to address dysphonia are important.…”

“…Studies have shown that prolonged intubation can exacerbate the risk of vocal cord injury, thus emphasizing the potential benefits of minimizing the duration of intubation to mitigate voice quality complications [16]. Over the last two decades, many have debated the proper timing of tracheostomy for patients with prolonged mechanical ventilation [16,18,35]. The American College of Chest Physicians guidelines recommend considering a tracheostomy in patients receiving mechanical ventilation for more than 21 days [36,37].…”