Abstract

Introduction: Lightning strikes cause a unique spectrum of cutaneous burn injuries that differ substantially from conventional thermal or high-voltage electrical burns. Despite the well-documented systemic lethality of lightning injuries, the burn-specific sequelae—including airway involvement and its contribution to ventilatory failure—remain underreported in the burn literature. Case Report: We present a 31-year-old woman who sustained multiple cutaneous burns following a lightning strike, including a circumferential necklace-pattern burn to the neck, a large midline torso burn, and burns to the right lower extremity and foot. Following resuscitation from ventricular fibrillation cardiac arrest, she required mechanical ventilation and experienced three sequential extubation failures before ultimately requiring tracheostomy. We propose that direct supraglottic and glottic injury, together with airway mucosal edema from localized thermal and electrical injury of the neck, compounded further by systemic inflammatory and infectious complications, contributed to her inability to sustain independent ventilation. Conclusions: In lightning strike victims with burns involving the neck or thorax, direct upper airway injury should be actively considered, excluded when possible, and closely monitored as a potential cause of extubation failure. A low threshold for early bronchoscopic airway assessment and conservative extubation protocols is warranted.

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