• Harmeet K Bhullar, Ar Kar Aung, Linda Graudins, Josh Ihle, Douglas Gin, Heather Cleland, and Mei TehBingBEar, Nose and Throat Department, Alfred Health, 55 Commercial Road, Melbourne, 3004, Victoria, Australia; Department of Surgery, Monash University, Victoria, Australia. Electronic address: bm_teh@yahoo.co.uk..
• Ear, Nose and Throat Department, Alfred Health, 55 Commercial Road, Melbourne, 3004, Victoria, Australia; Central Clinical School, Monash University, Victoria, Australia. Electronic address: hkbhullar88@gmail.com.
• Burns. 2020 May 1; 46 (3): 682-686.

BackgroundStevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare life-threatening hypersensitivity conditions associated with epidermal detachment and mucositis. The indication for flexible nasoendoscopy (FNE) and overall predictive factors for early intubation are unclear.ObjectivesTo describe the incidence of airway involvement and the key indicators for intubation in our SJS or TEN patient cohort. To determine the association between FNE findings and early intubation.MethodsA retrospective review of 45 patients with biopsy proven SJS or TEN admitted to an Australian tertiary burns centre from 2010 to 2017.ResultsThirty-five patients were diagnosed with TEN (77.8%), followed by overlap syndrome (SJS-TEN) (n = 6, 13.3%) and SJS (n = 4, 8.9%). Twenty (44.4%) patients were intubated; and all 20 had a diagnosis of TEN (100.0%) (p < 0.05). Intubated patients had a higher increase in total body surface area percentage(%) from day 1-3 [10.0% (IQR 0.0-23.8%)] and a longer length of stay [26.0 days (IQR 12.5-34.0)], compared to non-intubated patients [0.0% (IQR 0.0-4.0%)], [10.0 days (IQR 6.0-14.0)] (p < 0.05) respectively. The main indications for intubation were to facilitate operative and dressing management (47.4%) followed by airway involvement (26.3%). FNE was performed on 32 patients (71.1%), however FNE findings did not significantly influence intubation rates.ConclusionMore than half (n = 20, 57.1%) of the 35 patients diagnosed with TEN underwent intubation, mainly to facilitate operative and dressing management. FNE was performed on most patients, however there was no clear association between FNE findings and early intubation.Crown Copyright © 2019. Published by Elsevier Ltd. All rights reserved.

38 keywords...

hide…