• Pierre Esnault, Bertrand Prunet, Jean Cotte, Hélène Marsaa, Nicolas Prat, Guillaume Lacroix, Philippe Goutorbe, Ambroise Montcriol, Eric Dantzer, and Eric Meaudre.
• Burn Intensive Care Unit, Sainte Anne Military Teaching Hospital, Toulon, France. Electronic address: pierre.esnault@gmail.com.
• Am J Emerg Med. 2014 Oct 1;32(10):1174-8.

IntroductionFace and/or neck burn (FNB) exposes patients to the double respiratory risk of obstruction and hypoxia, and these risks may require a tracheal intubation. This study aims to describe the incidence and the characteristics of difficult intubation in FNB patients.MethodsWe conducted a 5-year retrospective, single-center study including all patients meeting the following criteria: 18 years of age or older, an FNB at least 1% of burned surface area with a severity equal to or greater than the superficial second degree, and intubation and a burn center admission within the first 24 hours after the burn. Patients were compared according to the difficulty of their intubation.ResultsBetween January 2007 and December 2011, we included 134 patients. The incidence of difficult intubation was 11.2% but was greater in the burn center than in the pre-burn center: 16.9% vs 3.5% (P = .02). The most important difference between patients with or without difficult intubation was the time between the burn injury and the intubation: 210 (105-290) vs 120 (60-180) minutes (P = .047). After multivariate analysis, an intubation performed at a burn center was independently associated with difficult intubation: odds ratio = 3.2; 95% confidence interval, 1.1-528.ConclusionsThis study underlines the high incidence of difficult intubation in FNB patients, greater than 11.2%, and demonstrates that intubation is more difficult when realized at a burn center, probably because it is performed later, allowing for development of cervical and laryngeal edema.Copyright © 2014 Elsevier Inc. All rights reserved.

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