Tracheostomy in burns patients revisited

Shweta Aggarwal, Sarah Smailes, Peter Dziewulski

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

Objective: The use of tracheostomy in burns patients has been controversial. A retrospective study was conducted to assess the use, complications and outcome of tracheostomy in ventilated adult burns patients. Methods: Data was collected retrospectively regarding the extent of injury in each patient, the indication for tracheostomy, and outcome in terms of length of stay, days of mechanical ventilation, airway and pulmonary complications and survival. Patients were followed until discharge from the unit or death. Results: Comparing patients who received tracheostomy to those who had translaryngeal intubation showed similar age distribution and no significant difference in the total burn surface area (TBSA). The use of tracheostomy was significantly higher in patients with TBSA >60%. Inhalation injury was significantly higher and mean probability of survival (ABSI), significantly lower in patients receiving tracheostomy. Duration of mechanical ventilation, length of stay in HDU/ITU and the incidence of pulmonary sepsis were significantly higher in tracheostomy group patients. However, there was no significant difference in mortality between the two groups. Conclusion: Burn survivors with TBSA >60% are more likely to undergo repeated surgery and have burns to the head and neck region, therefore increasing the requirement for tracheostomy. Tracheostomy is a safe procedure with minimal perioperative complications. Late complications in this patient group may be related to duration of intubation and mechanical ventilation and the presence of an airway burn. Tracheostomy was associated with a higher prevalence of chest infection. We suspect that the cause of this is multifactorial, possibly due to a higher incidence of inhalation injury, greater burn size and prolonged mechanical ventilation in this group. Crown

Original languageEnglish (US)
Pages (from-to)962-966
Number of pages5
JournalBurns
Volume35
Issue number7
DOIs
StatePublished - Nov 1 2009
Externally publishedYes

Fingerprint

Tracheostomy
Burns
Artificial Respiration
Intubation
Inhalation
Length of Stay
Wounds and Injuries
Lung
Survival
Incidence
Age Distribution
Crowns
Survivors
Sepsis
Neck
Thorax
Retrospective Studies
Head
Mortality

Keywords

  • Burns
  • Endotracheal intubation
  • Inhalation injury
  • Tracheostomy

ASJC Scopus subject areas

  • Surgery
  • Emergency Medicine
  • Critical Care and Intensive Care Medicine

Cite this

Tracheostomy in burns patients revisited. / Aggarwal, Shweta; Smailes, Sarah; Dziewulski, Peter.

In: Burns, Vol. 35, No. 7, 01.11.2009, p. 962-966.

Research output: Contribution to journalArticle

Aggarwal, Shweta ; Smailes, Sarah ; Dziewulski, Peter. / Tracheostomy in burns patients revisited. In: Burns. 2009 ; Vol. 35, No. 7. pp. 962-966.
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abstract = "Objective: The use of tracheostomy in burns patients has been controversial. A retrospective study was conducted to assess the use, complications and outcome of tracheostomy in ventilated adult burns patients. Methods: Data was collected retrospectively regarding the extent of injury in each patient, the indication for tracheostomy, and outcome in terms of length of stay, days of mechanical ventilation, airway and pulmonary complications and survival. Patients were followed until discharge from the unit or death. Results: Comparing patients who received tracheostomy to those who had translaryngeal intubation showed similar age distribution and no significant difference in the total burn surface area (TBSA). The use of tracheostomy was significantly higher in patients with TBSA >60{\%}. Inhalation injury was significantly higher and mean probability of survival (ABSI), significantly lower in patients receiving tracheostomy. Duration of mechanical ventilation, length of stay in HDU/ITU and the incidence of pulmonary sepsis were significantly higher in tracheostomy group patients. However, there was no significant difference in mortality between the two groups. Conclusion: Burn survivors with TBSA >60{\%} are more likely to undergo repeated surgery and have burns to the head and neck region, therefore increasing the requirement for tracheostomy. Tracheostomy is a safe procedure with minimal perioperative complications. Late complications in this patient group may be related to duration of intubation and mechanical ventilation and the presence of an airway burn. Tracheostomy was associated with a higher prevalence of chest infection. We suspect that the cause of this is multifactorial, possibly due to a higher incidence of inhalation injury, greater burn size and prolonged mechanical ventilation in this group. Crown",
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