Laryngotracheal stenosis post mechanical ventilation in paediatric burns patients

Introduction: The duration of endotracheal intubation is thought to be the most important factor in the development of acquired laryngotracheal stenosis (LTS); however, there is a paucity of studies examining the incidence of LTS in the paediatric burn population. The aim of this study was to determine the incidence of LTS in paediatric burns patients requiring mechanical ventilation to develop guidelines for consideration of a tracheostomy. Methods: A retrospective review of all children treated at The Children's Hospital at Westmead (CHW) Burns Unit (BU) from December 2009 to December 2019 who required intubation for their burn injury. Results: During the 10-year study period 115 patients required endotracheal intubation after having sustained a burn injury. Of these 11 were excluded. The mean age was 6.2 years (0-16), with the majority of patients being male (65%). The average TBSA was 18.5% with a range of 0.1-70%. Flame was the most common mechanism of burn (n = 59). Burns to the head and/ or neck were the most common indication for intubation with the mean duration of intubation 6.1 days (range 0-40). Tracheostomies were performed on two patients (1.9%). LTS was found in two patients (1.9%). Conclusion: LTS in the paediatric burn population post mechanical ventilation appears to be a rare event. Endotracheal intubation can safely be used as the route of airway access in paediatric burns patients. Based on our experience, a definitive recommendation on the timing of tracheostomy in the paediatric burn patient cannot be made.