Upper airway involvement in Stevens–Johnson syndrome and toxic epidermal necrolysis

Bhullar, Harmeet K.; Aung, Ar Kar; Graudins, Linda V; Ihle, Joshua F.; Gin, Douglas L.; Cleland, Heather; Teh, Bing Mei

doi:10.1016/j.burns.2019.09.006

Cited by 8 publications

(17 citation statements)

References 15 publications

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“…43 A later study, however, reported that only 26.3% of patients were intubated for airway management, while most patients underwent elective intubation for surgical procedures and better management of pain during dressing change. 44 Other common reasons for intubation in SJS and TEN included shock, depressed mental status, and cardiac arrest. 43,44 Several potential predictors of requirement for mechanical ventilation have been identified (Table 1).…”

Section: Indications and Risk Factors For Intubationmentioning

confidence: 99%

Managing respiratory complications in Stevens‐Johnson Syndrome and Toxic Epidermal Necrolysis

Lee

et al. 2021

Int J Dermatology

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In the recently published guidelines by the Society of Dermatology Hospitalists on the management of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), a brief section was included on airway management. These recommendations provide an easy reference on how to manage respiratory complications of the disease. Understanding the evidence that underlies these recommendations would offer physicians greater clarity on the considerations behind every decision and treatment offered. We present a review of the literature on respiratory manifestations associated with SJS and TEN. In addition, we aim to address specific concerns regarding the respiratory management of these patients.These include issues such as the indications and optimal timing of intubation, tracheostomy, role of flexible nasoendoscopy, bronchoscopy, ventilation strategies, and management of chronic respiratory complications.

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Section: Indications and Risk Factors For Intubationmentioning

confidence: 99%

Managing respiratory complications in Stevens‐Johnson Syndrome and Toxic Epidermal Necrolysis

Lee

et al. 2021

Int J Dermatology

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“…Most patients with SJS and TEN who have airway or oral mucosal involvement do not require intubation. 22 Sloughing of the mucosa of the tongue, palate, and oropharynx is very common but does not typically compromise the airway. Patients with oral mucosal sloughing may have trouble chewing and swallowing food.…”

Section: Airway Assessment and Managementmentioning

confidence: 99%

“…15 Symptoms such as hoarseness, coughing, coughing up blood, or shortness of breath signal progressive airway involvement and should be further investigated to determine the need for airway protection. 22…”

Section: Airway Assessment and Managementmentioning

confidence: 99%

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Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: A Guide for Nurses

Hanson

Bettencourt

2020

AACN Advanced Critical Care

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Nurses are central to the care of patients with Stevens-Johnson syndrome and toxic epidermal necrolysis. Patients with these conditions present with nuanced symptoms and have complex nursing care needs. Although much of the exact pathophysiology of these diseases is not known, all nurses benefit from a fundamental understanding of the genesis of skin manifestations, associated pharmacology, and prognosis. The care of patients hospitalized with Stevens-Johnson syndrome and toxic epidermal necrolysis consists of wound care, infection prevention, comfort management, hydration and nutrition, psychosocial support, and the prevention of long-term complications. This article provides an overview of these diseases, including clinical diagnosis, history and physical assessment, related pharmacology, and nursing care priorities. A description of the current state of the science in clinical management for nurses at all levels is provided, with an emphasis on nursing’s contribution to the best possible patient outcomes.

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“…Involvement of the larynx and supraglottis presents risk for sloughing of necrosed tissue, which can be aspirated and lead to acute airway compromise, tracheal obstruction, or laryngospasm. Although cases of laryngeal SJS have been reported, 2–4 SJS with laryngoscopic photo‐documentation has not been reported in the literature.…”

Section: Introductionmentioning

confidence: 99%

A Rare Laryngeal Presentation of Stevens‐Johnson Syndrome

2021

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Stevens‐Johnson syndrome (SJS) is a rare but severe mucocutaneous epidermolysis commonly triggered by medications. SJS is characterized by mucocutaneous lesions of the trunk, face, and limbs, as well as the oral cavity, gastrointestinal tract, and respiratory tract. Although uncommon, laryngeal involvement in SJS can lead to severe respiratory, phonatory and deglutitive complications. Providers caring for patients with SJS should maintain a high index of suspicion for laryngeal involvement and low threshold to solicit Otolaryngology consultation. Laryngeal complications can be more expediently managed when anticipated early in the course of disease. Laryngoscope, 131:2519–2522, 2021

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Upper airway involvement in Stevens–Johnson syndrome and toxic epidermal necrolysis

Cited by 8 publications

References 15 publications

Managing respiratory complications in Stevens‐Johnson Syndrome and Toxic Epidermal Necrolysis

Managing respiratory complications in Stevens‐Johnson Syndrome and Toxic Epidermal Necrolysis

Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: A Guide for Nurses

A Rare Laryngeal Presentation of Stevens‐Johnson Syndrome

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