The airway is at risk by three major mechanisms:

  • Generalised oedema as a systemic response from an increasing burn size and depth can cause swelling of the airway and compromise airflow9, 10.
  • Localised oedema as a result or direct thermal damage to the airway can obstruct airflow9
  • Inhalation injury as a result of heat, smoke or toxic chemicals can cause damage to the airway.9


Factors that increase the suspicion of airway obstruction or inhalation injury include: 10

Hoarse voice
Respiratory distress/ stridor
Carbonaceous sputum
Singed nasal/facial hairs
Inflamed oropharynx
Burns to the face/oropharynx
History of burns in an enclosed space
Raised blood gas carbon monoxide (CO) level

Figure 9

Airway compromise can develop over a matter of hours and may only come to light when the patient is in crisis9. Figure 10 shows airway change over a period of 1 hour.

Figure 10

adapted from Airway swelling after laryngeal burn induced by swallowing hot food: Korean J Otorhinolaryngol-Head Neck Surg. 2015 Sep;58(9):634-636.


  1. Sit patient upright9
  2. Any suspected airway injury necessitates senior anaesthetic review to identify and predict deterioration9.
  3. If indicated, early intubation with an uncut tube9 prevents the tube moving in the event of further swelling10

Common pitfalls

  • Failure to recognise or predict the deteriorating airway.