Indications for intubation and early tracheostomy in patients with Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis

Williams, Robbie; Hodge, Juvonda; Ingram, Walter L.

doi:10.1016/j.amjsurg.2015.12.011

Cited by 18 publications

(18 citation statements)

References 43 publications

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“…14,147 Patients with SJS/TEN may experience airway compromise requiring intubation and early tracheostomy (before ventilator day 10) prior to the onset of respiratory failure, predicted by oral mucosal involvement and initial BSA of 70% or more, progression of BSA from hospital day 1 to hospital day 3 by 15% or more, neurologic diagnosis preventing airway protection, or documented airway involvement on direct laryngoscopy. 148 Improved survival is attributed to aggressive wound care after airway protection. Ventilation strategies should mimic those used in acute respiratory distress syndrome, such as low tidal volume 149 and early prone positioning.…”

Section: Airway Managementmentioning

confidence: 99%

Society of Dermatology Hospitalists supportive care guidelines for the management of Stevens-Johnson syndrome/toxic epidermal necrolysis in adults

Seminario‐Vidal

Kroshinsky

Malachowski

et al. 2020

Journal of the American Academy of Dermatology

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Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are life-threatening conditions with high morbidity and mortality. Supportive care management of SJS/TEN is highly variable. A systematic review of the literature was performed by dermatologists, ophthalmologists, intensivists and gynecologists with expertise in SJS/TEN to generate statements for supportive care guideline development. Members of the Society of Dermatology Hospitalists (SDH) with expertise in SJS/TEN were invited to participate in a modified, online Delphi-consensus. 9-point Likert scale questionnaires regarding 135 statements were administered. The RAND/UCLA appropriateness method was employed to evaluate and select proposed statements for guideline inclusion; statements with median ratings of 6.5-9 and disagreement index ≤1 were included in the guideline. For the final round, the guidelines were appraised by all the participants. An evidence-based discussion and recommendations for hospital setting and care team, wound care, ocular care, oral care, urogenital care, pain management, infection surveillance, fluid and electrolyte management, nutrition and stress ulcer prophylaxis, airway management, and anticoagulation in adult patients with SJS/TEN are included.

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Section: Airway Managementmentioning

confidence: 99%

Society of Dermatology Hospitalists supportive care guidelines for the management of Stevens-Johnson syndrome/toxic epidermal necrolysis in adults

Seminario‐Vidal

Kroshinsky

Malachowski

et al. 2020

Journal of the American Academy of Dermatology

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“…Basis of treatment involves discontinuation of the offending agent, as well as supportive care. 11 , 12 …”

Section: Introductionmentioning

confidence: 99%

Stevens-Johnson syndrome and toxic epidermal necrolysis: epidemiological and clinical outcomes analysis in public hospitals

Arantes

Reis²,

Novaes

et al. 2017

An. Bras. Dermatol.

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BackgroundAdverse drug reactions are harmful and involuntary responses to drugs that occur at doses normally used for a given condition. Among them are Stevens-Johnson syndrome and toxic epidermal necrolysis, both rare and potentially fatal conditions.ObjectivesTo analyze the epidemiological and clinical characteristics related to patients diagnosed with Stevens-Johnson syndrome and toxic epidermal necrolysis in public hospitals in the Federal District - Brazil.MethodsRetrospective, cross-sectional and descriptive study, in which data were collected referring to patients hospitalized in the public healthcare system of the Federal District from 1999 to 2014. Results: Between 1999 and 2014, 86 cases of hospitalized patients with diagnosis of Stevens-Johnson syndrome and toxic epidermal necrolysis in the Federal District were reported. The majority of patients were women; the most affected age group was 0 to 10 years. Patients older than 60 years (elderly) represent 6.98% of the cases. Most patients admitted to the referral hospital were discharged. However, occurrence of deaths exceeded that of discharge in elderly patients.Limitations of the studyThere is fragility in the registry of hospitalization of patients, both in the hospital information system and in the medical records of the reference hospital.ConclusionThere is a need for greater production and better dissemination of information on the incidence of adverse drug reactions.

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“…43,45,46 Progression of BSA involvement from day 1 to day 3 by 10-15% is also associated with intubation. 44,46 In a meta-analysis, both baseline and final affected BSA of greater than 30%, and additional factors including bacteremia, shock, and organ failure predicted subsequent need for mechanical ventilation. 47…”

Section: Indications and Risk Factors For Intubationmentioning

confidence: 98%

“…Early-onset respiratory manifestations and progression of BSA involvement over the first 3 days also portend a higher risk of intubation. [44][45][46] The average duration from admission to intubation is 3 days. 45 Over 85% of patients who eventually require mechanical ventilation would have been intubated by day 6.…”

Section: Timing Of Intubationmentioning

confidence: 99%

Managing respiratory complications in Stevens‐Johnson Syndrome and Toxic Epidermal Necrolysis

Lee

et al. 2021

Int J Dermatology

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In the recently published guidelines by the Society of Dermatology Hospitalists on the management of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), a brief section was included on airway management. These recommendations provide an easy reference on how to manage respiratory complications of the disease. Understanding the evidence that underlies these recommendations would offer physicians greater clarity on the considerations behind every decision and treatment offered. We present a review of the literature on respiratory manifestations associated with SJS and TEN. In addition, we aim to address specific concerns regarding the respiratory management of these patients.These include issues such as the indications and optimal timing of intubation, tracheostomy, role of flexible nasoendoscopy, bronchoscopy, ventilation strategies, and management of chronic respiratory complications.

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Indications for intubation and early tracheostomy in patients with Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis

Cited by 18 publications

References 43 publications

Society of Dermatology Hospitalists supportive care guidelines for the management of Stevens-Johnson syndrome/toxic epidermal necrolysis in adults

Society of Dermatology Hospitalists supportive care guidelines for the management of Stevens-Johnson syndrome/toxic epidermal necrolysis in adults

Stevens-Johnson syndrome and toxic epidermal necrolysis: epidemiological and clinical outcomes analysis in public hospitals

Managing respiratory complications in Stevens‐Johnson Syndrome and Toxic Epidermal Necrolysis

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