Ventilation strategies in burn intensive care: A retrospective observational study
Consensus regarding optimal burns intensive care (BICU) patient management is lacking. This study aimed to assess whether ventilation strategies, cardiovascular support and sedation in BICU patients have changed over time, and whether this affects outcome. A retrospective observational study compari...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Oxford University Press
2014-01-01
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| Series: | Burns & Trauma |
| Subjects: | |
| Online Access: | http://www.burnstrauma.com/article.asp?issn=2321-3868;year=2014;volume=2;issue=1;spage=29;epage=35;aulast=Palazzo |
| _version_ | 1819000484105551872 |
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| author | Stefano Palazzo Emma James-Veldsman Caroline Wall Michelle Hayes Marcela Vizcaychipi |
| author_facet | Stefano Palazzo Emma James-Veldsman Caroline Wall Michelle Hayes Marcela Vizcaychipi |
| author_sort | Stefano Palazzo |
| collection | DOAJ |
| description | Consensus regarding optimal burns intensive care (BICU) patient management is lacking. This study aimed to assess whether ventilation strategies, cardiovascular support and sedation in BICU patients have changed over time, and whether this affects outcome. A retrospective observational study comparing two 12-patient BICU cohorts (2005/06 and 2010/11) was undertaken. Demographic and admission characteristics, ventilation parameters, sedation, fluid resuscitation, cardiovascular support and outcome (length of stay, mortality) data were collected from patient notes. Data was analysed using T-tests, Fisher's exact and Mann-Whitney U tests. In our study cohort groups were equivalent in demographic and admission parameters. There were equal ventilator-free days in the two cohorts 10 ± 12.7 vs. 13.3 ± 12.2 ventilator free days; <i>P</i> = 0.447). The 2005/06 cohort were mechanically ventilated more often than in 2010/11 cohort (568 ventilator days/1000 patient BICU days vs. 206 ventilator days/1000 patient BICU days; <i>P</i> = 0.001). The 2005/06 cohort were ventilated less commonly in tracheostomy group/endotracheal tube spontaneous (17.8% vs. 26%; <i>P</i> = 0.001) and volume-controlled modes (34.4% vs. 40.8%; <i>P</i> = 0.001). Patients in 2010/11 cohort were more heavily sedated (<i>P</i> = 0.001) with more long-acting sedative drug use (<i>P</i> = 0.001) than the 2005/06 cohort, fluid administration was equivalent. Patient outcome did not vary. Inhalational injury patients were ventilated in volume-controlled (44.5% vs. 28.1%; <i>P</i> = 0.001) and pressure-controlled modes (18.2% vs. 9.5%; <i>P</i> = 0.001) more frequently than those without. Outcome did not vary. This study showed there has been shift away from mechanical ventilation, with increased use of tracheostomy/tracheal tube airway spontaneous ventilation. Inhalation injury patients require more ventilatory support though patient outcomes do not differ. Prospective trials are required to establish which strategies confer benefit. |
| first_indexed | 2024-12-20T22:34:03Z |
| format | Article |
| id | doaj.art-bd67b52204f24dc0aae80068ddc5f230 |
| institution | Directory Open Access Journal |
| issn | 2321-3868 2321-3876 |
| language | English |
| last_indexed | 2024-12-20T22:34:03Z |
| publishDate | 2014-01-01 |
| publisher | Oxford University Press |
| record_format | Article |
| series | Burns & Trauma |
| spelling | doaj.art-bd67b52204f24dc0aae80068ddc5f2302022-12-21T19:24:39ZengOxford University PressBurns & Trauma2321-38682321-38762014-01-0121293510.4103/2321-3868.126090Ventilation strategies in burn intensive care: A retrospective observational studyStefano PalazzoEmma James-VeldsmanCaroline WallMichelle HayesMarcela VizcaychipiConsensus regarding optimal burns intensive care (BICU) patient management is lacking. This study aimed to assess whether ventilation strategies, cardiovascular support and sedation in BICU patients have changed over time, and whether this affects outcome. A retrospective observational study comparing two 12-patient BICU cohorts (2005/06 and 2010/11) was undertaken. Demographic and admission characteristics, ventilation parameters, sedation, fluid resuscitation, cardiovascular support and outcome (length of stay, mortality) data were collected from patient notes. Data was analysed using T-tests, Fisher's exact and Mann-Whitney U tests. In our study cohort groups were equivalent in demographic and admission parameters. There were equal ventilator-free days in the two cohorts 10 ± 12.7 vs. 13.3 ± 12.2 ventilator free days; <i>P</i> = 0.447). The 2005/06 cohort were mechanically ventilated more often than in 2010/11 cohort (568 ventilator days/1000 patient BICU days vs. 206 ventilator days/1000 patient BICU days; <i>P</i> = 0.001). The 2005/06 cohort were ventilated less commonly in tracheostomy group/endotracheal tube spontaneous (17.8% vs. 26%; <i>P</i> = 0.001) and volume-controlled modes (34.4% vs. 40.8%; <i>P</i> = 0.001). Patients in 2010/11 cohort were more heavily sedated (<i>P</i> = 0.001) with more long-acting sedative drug use (<i>P</i> = 0.001) than the 2005/06 cohort, fluid administration was equivalent. Patient outcome did not vary. Inhalational injury patients were ventilated in volume-controlled (44.5% vs. 28.1%; <i>P</i> = 0.001) and pressure-controlled modes (18.2% vs. 9.5%; <i>P</i> = 0.001) more frequently than those without. Outcome did not vary. This study showed there has been shift away from mechanical ventilation, with increased use of tracheostomy/tracheal tube airway spontaneous ventilation. Inhalation injury patients require more ventilatory support though patient outcomes do not differ. Prospective trials are required to establish which strategies confer benefit.http://www.burnstrauma.com/article.asp?issn=2321-3868;year=2014;volume=2;issue=1;spage=29;epage=35;aulast=PalazzoBurnsintensive careventilationinhalation injury |
| spellingShingle | Stefano Palazzo Emma James-Veldsman Caroline Wall Michelle Hayes Marcela Vizcaychipi Ventilation strategies in burn intensive care: A retrospective observational study Burns & Trauma Burns intensive care ventilation inhalation injury |
| title | Ventilation strategies in burn intensive care: A retrospective observational study |
| title_full | Ventilation strategies in burn intensive care: A retrospective observational study |
| title_fullStr | Ventilation strategies in burn intensive care: A retrospective observational study |
| title_full_unstemmed | Ventilation strategies in burn intensive care: A retrospective observational study |
| title_short | Ventilation strategies in burn intensive care: A retrospective observational study |
| title_sort | ventilation strategies in burn intensive care a retrospective observational study |
| topic | Burns intensive care ventilation inhalation injury |
| url | http://www.burnstrauma.com/article.asp?issn=2321-3868;year=2014;volume=2;issue=1;spage=29;epage=35;aulast=Palazzo |
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