A nationwide multicenter cohort study of airway management and outcomes in patients with fire-related inhalation injury.

OBJECTIVE

To clarify current management strategies and clinical outcomes of patients with fire-related inhalation injury in Japan and to evaluate the usefulness of flexible endoscopic examination in early airway assessment.

METHODS

This multicenter retrospective cohort study included patients diagnosed with airway, laryngeal, or tracheal burns across participating institutions nationwide. Patients intubated before hospital arrival and those who opted out were excluded. Clinical data from the initial visit to 6-12 months of follow-up were analyzed. Factors associated with endotracheal intubation were evaluated using multivariable logistic regression.

RESULTS

A total of 202 patients were included. Endotracheal intubation was performed in 94 patients (46.5%). Multivariable logistic regression identified dyspnea, laryngeal edema, tracheal erythema, and absence of endoscopic evaluation as independent factors associated with intubation. No cases required delayed intubation after initial management. Delayed subglottic stenosis occurred in two patients 6-12 months after injury.

CONCLUSION

While airway management appeared to be clinically reasonable under current practice, a substantial proportion of symptom-based intubations may have been avoidable. Flexible endoscopic evaluation plays a critical role in accurate airway assessment and may help prevent unnecessary intubation.