Quality of artificial airway management and its modifiable predictors in burn patients with inhalation injury: a retrospective cohort study

To evaluate the quality of artificial airway management in patients with burn injury combined with inhalation injury and identify independent influencing factors, with the aim of optimizing clinical care protocols. A retrospective case analysis combined with a structured nursing staff questionnaire survey was conducted. Clinical data were collected from 223 patients admitted to the Burn Intensive Care Unit between January and December 2025. Patient variables included sex, age, TBSA, concurrent ARDS, timing of airway establishment, and airway-related complications. Forty-nine nursing staff members were surveyed on clinical experience, training receipt, annual training frequency, and documentation practices. Multivariable logistic regression was performed to identify independent predictors of suboptimal airway management quality. The timely airway establishment rate was 82.1%, and the overall quality compliance rate was 73.5%. Multivariable analysis identified five independent factors significantly associated with for suboptimal airway management quality: TBSA ≥ 60%, concurrent ARDS, delayed airway establishment, nursing experience < 3 years, and annual training frequency < 2 sessions (all P < 0.05). Suboptimal airway management quality remains a clinically significant concern, manifesting as inconsistent protocol adherence and incomplete documentation. Institutions are recommended to implement risk stratification frameworks, standardized assessment tools, tiered competency-based training programs, and multidisciplinary collaboration to improve patient outcomes. Not applicable.