{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T05:47:24Z","timestamp":1793771244999,"version":"4.6.1"},"reference-count":47,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2019,7,23]],"date-time":"2019-07-23T00:00:00Z","timestamp":1563840000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,10,16]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Inhalation injury is independently associated with burn mortality, yet little information is available on the incidence, risk factors, or functional outcomes of thermal injury to the airway. In patients with thermal inhalation injury, we sought to define the incidence of laryngotracheal stenosis (LTS), delineate risk factors associated with LTS development, and assess long-term tracheostomy dependence as a proxy for laryngeal function. Retrospective cohort study of adult patients treated for thermal inhalation injury at a single institution burn critical care unit from 2012 to 2017. Eligible patients\u2019 records were assessed for LTS (laryngeal, subglottic, or tracheal stenosis). Patient characteristics, burn injury characteristics, and treatment-specific covariates were assessed. Descriptive statistics, Mann\u2013Whitney U-tests, odds ratio, and chi-square tests compared LTS versus non-LTS groups. Of 129 patients with thermal inhalation injury during the study period, 8 (6.2%) developed LTS. When compared with the non-LTS group, patients with LTS had greater mean TBSA (mean 30.3, Interquartile Range 7\u201357.5 vs 10.5, Interquartile Range 0\u201315.12, P = .01), higher grade of inhalation injury (mean 2.63 vs 1.80, P = .05), longer duration of intubation (12.63 vs 5.44; P &amp;lt; .001), and greater inflammatory response (mean white blood cell count on presentation 25.8 vs 14.9, P = .02, mean hyperglycemia on presentation 176.4 vs 136.9, P = .01). LTS patients had a significantly higher rate of tracheostomy dependence at last follow-up (50 vs 1.7%, P &amp;lt; .001). Six percent of patients with thermal inhalation injury develop LTS. LTS was associated with more severe thermal airway injury, longer duration of intubation, and more severe initial host inflammation. Patients with inhalation injury and LTS are at high risk for tracheostomy dependence. In burn patients with thermal inhalation injury, laryngeal evaluation and directed therapy should be incorporated early into multispecialty pathways of care.<\/jats:p>","DOI":"10.1093\/jbcr\/irz133","type":"journal-article","created":{"date-parts":[[2019,7,23]],"date-time":"2019-07-23T16:33:10Z","timestamp":1563899590000},"page":"961-965","source":"Crossref","is-referenced-by-count":12,"title":["Incidence of Laryngotracheal Stenosis after Thermal Inhalation Airway Injury"],"prefix":"10.1093","volume":"40","author":[{"given":"Anne Sun","family":"Lowery","sequence":"first","affiliation":[{"name":"Department of Otolaryngology, Vanderbilt University School of Medicine, Nashville, Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Greg","family":"Dion","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology and Head and Neck Surgery, Brooke Army Medical Center, Fort Sam Houston, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Callie","family":"Thompson","sequence":"additional","affiliation":[{"name":"Division of Trauma and Surgical Critical Care, Vanderbilt University Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liza","family":"Weavind","sequence":"additional","affiliation":[{"name":"Division of Anesthesiology Critical Care Medicine, Vanderbilt University Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin","family":"Shinn","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology and Head and Neck Surgery, Vanderbilt University Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stuart","family":"McGrane","sequence":"additional","affiliation":[{"name":"Division of Anesthesiology Critical Care Medicine, Vanderbilt University Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Blair","family":"Summitt","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Gelbard","sequence":"additional","affiliation":[{"name":"Division of Trauma and Surgical Critical Care, Vanderbilt University Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2019,7,23]]},"reference":[{"key":"2020071622422400300_CIT0001","doi-asserted-by":"crossref","first-page":"1470","DOI":"10.1016\/j.burns.2014.09.015","article-title":"Inhalation injury in burn patients: establishing the link between diagnosis and prognosis","volume":"40","author":"You","year":"2014","journal-title":"Burns"},{"key":"2020071622422400300_CIT0002","doi-asserted-by":"crossref","first-page":"260","DOI":"10.1016\/S0196-0644(82)80096-6","article-title":"The abbreviated burn severity index","volume":"11","author":"Tobiasen","year":"1982","journal-title":"Ann Emerg Med"},{"key":"2020071622422400300_CIT0003","doi-asserted-by":"crossref","first-page":"362","DOI":"10.1056\/NEJM199802053380604","article-title":"Objective estimates of the probability of death from burn injuries","volume":"338","author":"Ryan","year":"1998","journal-title":"N Engl J Med"},{"key":"2020071622422400300_CIT0004","doi-asserted-by":"crossref","first-page":"320","DOI":"10.1016\/j.burns.2007.06.003","article-title":"Improving the ability to predict mortality among burn patients","volume":"34","author":"McGwin","year":"2008","journal-title":"Burns"},{"key":"2020071622422400300_CIT0005","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1186\/s13054-015-1077-4","article-title":"Diagnosis and management of inhalation injury: an updated review","volume":"19","author":"Walker","year":"2015","journal-title":"Crit Care"},{"key":"2020071622422400300_CIT0006","doi-asserted-by":"crossref","first-page":"835","DOI":"10.1016\/j.burns.2012.12.010","article-title":"Predicting survival in thermal injury: a systematic review of methodology of composite prediction models","volume":"39","author":"Hussain","year":"2013","journal-title":"Burns"},{"key":"2020071622422400300_CIT0007","doi-asserted-by":"crossref","first-page":"761","DOI":"10.1016\/j.burns.2004.05.012","article-title":"Outcome measures in burn care. Is mortality dead?","volume":"30","author":"Pereira","year":"2004","journal-title":"Burns"},{"key":"2020071622422400300_CIT0008","doi-asserted-by":"crossref","first-page":"1013","DOI":"10.1016\/S0140-6736(11)61345-7","article-title":"Burn size and survival probability in paediatric patients in modern burn care: a prospective observational cohort study","volume":"379","author":"Kraft","year":"2012","journal-title":"Lancet"},{"key":"2020071622422400300_CIT0009","doi-asserted-by":"crossref","first-page":"1187","DOI":"10.1016\/j.burns.2011.06.004","article-title":"Temperature distribution in the upper airway after inhalation injury","volume":"37","author":"Rong","year":"2011","journal-title":"Burns"},{"key":"2020071622422400300_CIT0010","doi-asserted-by":"crossref","first-page":"464","DOI":"10.1056\/NEJMra1601128","article-title":"Fire-related inhalation injury","volume":"375","author":"Sheridan","year":"2016","journal-title":"N Engl J Med"},{"key":"2020071622422400300_CIT0011","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1016\/j.burns.2013.06.010","article-title":"Pathological changes of the three clinical types of laryngeal burns based on a canine model","volume":"40","author":"Cheng","year":"2014","journal-title":"Burns"},{"issue":"1 Pt 1","key":"2020071622422400300_CIT0012","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1177\/000348948909800106","article-title":"Management of patients with glottic and subglottic stenosis resulting from thermal burns","volume":"98","author":"Flexon","year":"1989","journal-title":"Ann Otol Rhinol Laryngol"},{"key":"2020071622422400300_CIT0013","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1016\/j.burns.2016.08.013","article-title":"Recent trends in burn epidemiology worldwide: a systematic review","volume":"43","author":"Smolle","year":"2017","journal-title":"Burns"},{"key":"2020071622422400300_CIT0014","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1097\/BCR.0B013E31802C889F","article-title":"Inhalation injury, pulmonary perturbations, and fluid resuscitation","volume":"28","author":"Endorf","year":"2007","journal-title":"J Burn Care Res"},{"key":"2020071622422400300_CIT0015","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1177\/0003489415608867","article-title":"Predictors of posterior glottic stenosis: a multi-institutional case-control study","volume":"125","author":"Hillel","year":"2016","journal-title":"Ann Otol Rhinol Laryngol"},{"key":"2020071622422400300_CIT0016","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1288\/00005537-198403000-00014","article-title":"A prospective study of laryngotracheal sequelae in long-term intubation","volume":"94","author":"Whited","year":"1984","journal-title":"Laryngoscope"},{"key":"2020071622422400300_CIT0017","doi-asserted-by":"crossref","first-page":"683","DOI":"10.1097\/BCR.0b013e31818481ce","article-title":"Insulin resistance postburn: underlying mechanisms and current therapeutic strategies","volume":"29","author":"Gauglitz","year":"2008","journal-title":"J Burn Care Res"},{"key":"2020071622422400300_CIT0018","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1097\/SLA.0b013e3181856241","article-title":"Pathophysiologic response to severe burn injury","volume":"248","author":"Jeschke","year":"2008","journal-title":"Ann Surg"},{"key":"2020071622422400300_CIT0019","doi-asserted-by":"crossref","first-page":"715645","DOI":"10.1155\/2013\/715645","article-title":"Curbing inflammation in burn patients","volume":"2013","author":"Farina","year":"2013","journal-title":"Int J Inflam"},{"key":"2020071622422400300_CIT0020","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1093\/jbcr\/iry059","article-title":"Early surgical management of thermal airway injury: a case series","volume":"40","author":"Jayawardena","year":"2019","journal-title":"J Burn Care Res"},{"key":"2020071622422400300_CIT0021","doi-asserted-by":"crossref","first-page":"961","DOI":"10.1001\/jamaoto.2014.1663","article-title":"An in situ, in vivo murine model for the study of laryngotracheal stenosis","volume":"140","author":"Hillel","year":"2014","journal-title":"JAMA Otolaryngol Head Neck Surg"},{"key":"2020071622422400300_CIT0022","first-page":"9","article-title":"Whole body and skeletal muscle protein turnover in recovery from burns","volume":"3","author":"Porter","year":"2013","journal-title":"Int J Burns Trauma"},{"key":"2020071622422400300_CIT0023","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1001\/jamaoto.2018.3793","article-title":"Association between red blood cell distribution width and outcomes of open airway reconstruction surgery in adults","volume":"145","author":"Xie","year":"2019","journal-title":"JAMA Otolaryngol Head Neck Surg"},{"key":"2020071622422400300_CIT0024","doi-asserted-by":"crossref","first-page":"1065","DOI":"10.1177\/0194599818825471","article-title":"Laryngotracheal reconstruction in adults aged 60 years and older","volume":"160","author":"Rehman","year":"2019","journal-title":"Otolaryngol Head Neck Surg"},{"key":"2020071622422400300_CIT0025","doi-asserted-by":"crossref","first-page":"1913","DOI":"10.1097\/CCM.0b013e31821b85c6","article-title":"Red cell distribution width and all-cause mortality in critically ill patients","volume":"39","author":"Bazick","year":"2011","journal-title":"Crit Care Med"},{"key":"2020071622422400300_CIT0026","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1016\/j.jcrc.2016.03.005","article-title":"Elevated red cell distribution width at initiation of critical care is associated with mortality in surgical intensive care unit patients","volume":"34","author":"Otero","year":"2016","journal-title":"J Crit Care"},{"key":"2020071622422400300_CIT0027","doi-asserted-by":"crossref","first-page":"3658","DOI":"10.21037\/jtd.2016.12.44","article-title":"Prognostic significance of red cell distribution width in elderly patients undergoing resection for non-small cell lung cancer","volume":"8","author":"Ichinose","year":"2016","journal-title":"J Thorac Dis"},{"key":"2020071622422400300_CIT0028","doi-asserted-by":"crossref","first-page":"547","DOI":"10.5603\/KP.a2015.0213","article-title":"Raised red cell distribution width as a prognostic marker in aortic valve replacement surgery","volume":"74","author":"Duchnowski","year":"2016","journal-title":"Kardiol Pol"},{"key":"2020071622422400300_CIT0029","doi-asserted-by":"crossref","first-page":"141","DOI":"10.3944\/AOTT.2014.2859","article-title":"Red cell distribution width and mortality in patients with hip fracture treated with partial prosthesis","volume":"48","author":"Zehir","year":"2014","journal-title":"Acta Orthop Traumatol Turc"},{"key":"2020071622422400300_CIT0030","doi-asserted-by":"crossref","first-page":"132","DOI":"10.3109\/14017431.2012.736636","article-title":"Red cell distribution width predicts new-onset atrial fibrillation after coronary artery bypass grafting","volume":"47","author":"Erta\u015f","year":"2013","journal-title":"Scand Cardiovasc J"},{"key":"2020071622422400300_CIT0031","first-page":"177","article-title":"Epidemiology of trauma deaths","volume":"22","author":"Solagberu","year":"2003","journal-title":"West Afr J Med"},{"key":"2020071622422400300_CIT0032","doi-asserted-by":"crossref","first-page":"1805","DOI":"10.1007\/s00405-012-1940-8","article-title":"Laryngotracheal stenosis and restenosis. What has the influence on the final outcome?","volume":"269","author":"Jovi\u0107","year":"2012","journal-title":"Eur Arch Otorhinolaryngol"},{"key":"2020071622422400300_CIT0033","first-page":"54","article-title":"Post-intubation tracheal stenosis","volume":"62","author":"Spittle","year":"2001","journal-title":"Hosp Med"},{"key":"2020071622422400300_CIT0034","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1097\/00003246-199701000-00018","article-title":"Influence of airway pressure on minimum occlusive endotracheal tube cuff pressure","volume":"25","author":"Guyton","year":"1997","journal-title":"Crit Care Med"},{"key":"2020071622422400300_CIT0035","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1288\/00005537-198808001-00001","article-title":"Laryngeal injury from prolonged endotracheal intubation","volume":"98","author":"Weymuller","year":"1988","journal-title":"Laryngoscope"},{"key":"2020071622422400300_CIT0036","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1288\/00005537-197703000-00006","article-title":"Glottic and subglottic stenosis from endotracheal intubation","volume":"87","author":"Hawkins","year":"1977","journal-title":"Laryngoscope"},{"key":"2020071622422400300_CIT0037","doi-asserted-by":"crossref","first-page":"1402","DOI":"10.1111\/anae.12026","article-title":"Size matters: choosing the right tracheal tube","volume":"67","author":"Mir","year":"2012","journal-title":"Anaesthesia"},{"key":"2020071622422400300_CIT0038","doi-asserted-by":"crossref","first-page":"1225","DOI":"10.1002\/lary.21752","article-title":"Selection and placement of oral ventilation tubes based on tracheal morphometry","volume":"121","author":"Coordes","year":"2011","journal-title":"Laryngoscope"},{"issue":"10 Pt 1","key":"2020071622422400300_CIT0039","doi-asserted-by":"crossref","first-page":"839","DOI":"10.1177\/000348949810701005","article-title":"Posterior glottic stenosis: a canine model","volume":"107","author":"Courey","year":"1998","journal-title":"Ann Otol Rhinol Laryngol"},{"key":"2020071622422400300_CIT0040","doi-asserted-by":"crossref","first-page":"1417","DOI":"10.1097\/01.mlg.0000225377.33945.14","article-title":"Early endoscopic treatment of acute inflammatory airway lesions improves the outcome of postintubation airway stenosis","volume":"116","author":"Nouraei","year":"2006","journal-title":"Laryngoscope"},{"key":"2020071622422400300_CIT0041","doi-asserted-by":"crossref","first-page":"1326","DOI":"10.1016\/j.burns.2011.03.016","article-title":"Pulmonary function, exercise capacity and physical activity participation in adults following burn","volume":"37","author":"Willis","year":"2011","journal-title":"Burns"},{"key":"2020071622422400300_CIT0042","doi-asserted-by":"crossref","first-page":"1004","DOI":"10.1016\/j.burns.2012.12.014","article-title":"Hospitalized pediatric burns in North China: a 10-year epidemiologic review","volume":"39","author":"Zhu","year":"2013","journal-title":"Burns"},{"key":"2020071622422400300_CIT0043","doi-asserted-by":"crossref","first-page":"e006184","DOI":"10.1136\/bmjopen-2014-006184","article-title":"A review of the international Burn Injury Database (iBID) for England and Wales: descriptive analysis of burn injuries 2003-2011","volume":"5","author":"Stylianou","year":"2015","journal-title":"BMJ Open"},{"key":"2020071622422400300_CIT0044","doi-asserted-by":"crossref","first-page":"1406","DOI":"10.1016\/j.burns.2014.03.003","article-title":"Epidemiology and trends in severe burns in the Netherlands","volume":"40","author":"Dokter","year":"2014","journal-title":"Burns"},{"key":"2020071622422400300_CIT0045","doi-asserted-by":"crossref","first-page":"358","DOI":"10.1111\/j.1445-2197.2007.04060.x","article-title":"Increasing numbers of admissions to the adult burns service at the royal adelaide hospital 2001-2004","volume":"77","author":"Greenwood","year":"2007","journal-title":"ANZ J Surg"},{"key":"2020071622422400300_CIT0046","doi-asserted-by":"crossref","first-page":"S27","DOI":"10.1016\/j.burns.2004.10.004","article-title":"Burn epidemiology in the brisbane and Queensland area","volume":"31","author":"Pegg","year":"2005","journal-title":"Burns"},{"key":"2020071622422400300_CIT0047","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1097\/BCR.0b013e31815f6efd","article-title":"Improved survival following thermal injury in adult patients treated at a regional burn center","volume":"29","author":"Gomez","year":"2008","journal-title":"J Burn Care Res"}],"container-title":["Journal of Burn Care &amp; Research"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/jbcr\/advance-article-pdf\/doi\/10.1093\/jbcr\/irz133\/29400216\/irz133.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/jbcr\/article-pdf\/40\/6\/961\/30161772\/irz133.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/jbcr\/article-pdf\/40\/6\/961\/30161772\/irz133.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,9,24]],"date-time":"2022-09-24T12:04:04Z","timestamp":1664021044000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jbcr\/article\/40\/6\/961\/5537071"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,7,23]]},"references-count":47,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2019,7,23]]},"published-print":{"date-parts":[[2019,10,16]]}},"URL":"https:\/\/doi.org\/10.1093\/jbcr\/irz133","relation":{},"ISSN":["1559-047X","1559-0488"],"issn-type":[{"value":"1559-047X","type":"print"},{"value":"1559-0488","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2019,11]]},"published":{"date-parts":[[2019,7,23]]}}}