Acute upper airway injury in burn patients. Serial changes of flow-volume curves and nasopharyngoscopy

Serial flow-volume curves and fiberoptic nasopharyngoscopy were performed in 36 patients with cutaneous burns and/or smoke inhalation. Baseline flow-volume curve patterns were abnormal in 26 (72.2%) patients, and follow-up studies demonstrated significant reductions (p < 0.04) in inspiratory and expiratory flow rates in the 6 patients who required endotracheal intubation because of anatomic upper airway obstruction. None of the patients with stable or increased flow rate measurements required intubation. The progression of upper airway edema in 14 patients was characterized by obliteration of the aryepiglottic folds, arytenoid eminences, and interarytenoid areas by boggy, edematous tissue that prolapsed to occlude the airway. These changes correlated with an increased size of cutaneous burns (p < 0.0001), the presence of burns of the face and neck (p < 0.05), and more rapid intravenously administered fluid resuscitation (p < 0.04). Anatomic and physiologic changes consistent with upper airway dysfunction occur frequently in burn victims. Progression of these abnormalities correlates with the severity and distribution of cutaneous injury and is influenced by intravenously administered fluid.