Percutaneous dilational tracheotomy in adult burn patients
KeywordsRetrospective Chart Review Airway Management Lung Compliance Percutaneous Dilational Tracheotomy Total Body Surface Area
Few studies have focused on the safety and potential benefits of tracheotomy in burn patients. The purpose of this study is to determine the safety and efficacy of percutaneous dilational tracheotomy (PDT) in patients with burn injury.
A retrospective chart review was completed for patients admitted to Baskent University Burn Institute, from January 2003 through December 2008, who underwent tracheotomy during their hospitalization. Parameters recorded included demographics, extent of burn, timing of tracheotomy and presence of inhalation injury. Other variables measured were the arterial blood gas findings and lung compliance before and after PDT and PDT-related complications and mortality.
Out of 325 patients, 17 patients (67% male) with a mean age of 33.1 ± 15.9 years and a mean total body surface area involvement of 51 ± 16% with a 40% of inhalation injury underwent PDT. Tracheotomies were performed within 48 hours after endotracheal intubations. All PDTs were performed at bedside by experienced staff anesthesiologists with direct bronchoscopic guidance. The site of intended tracheotomy was affected in 52% of patients. There were no procedural failures and no PDT-related complications and deaths. The calculated lung compliance and PaO2:FiO2 ratio improved after PDT (36.2 ± 12.9 vs 47.3 ± 16.5 ml/cmH2O and 243 ± 81 vs 350 ± 104, respectively).
The results suggest that PDT is an efficacious and safe technique for airway management in patients with burn injuries. Besides improved ventilatory mechanics, PDT may also benefit the patient with severe burns by earlier mobilization and ease of suctioning, oral intake and ability to communicate by mouthing words.