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Namavarian A, Levy BB, Tepsich M, McKinnon NK, Siu JM, Propst EJ, Wolter NE. Percutaneous tracheostomy in the pediatric population: A systematic review. Int J Pediatr Otorhinolaryngol 2024; 177:111856. [PMID: 38185003 DOI: 10.1016/j.ijporl.2024.111856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 12/25/2023] [Accepted: 01/02/2024] [Indexed: 01/09/2024]
Abstract
OBJECTIVE Percutaneous tracheostomy is routinely performed in adult patients but is seldomly used in the pediatric population due to concerns regarding safety and limited available evidence. This study aims to consolidate the current literature on percutaneous tracheostomy in the pediatric population. METHODS A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted. MEDLINE, EMBASE, CINAHL, and Web of Science were searched for studies on pediatric percutaneous tracheostomy (age ≤18). The Joanna Briggs Institute and ROBINS-I tools were used for quality appraisal. RESULTS Twenty-one articles were included resulting in 143 patients. Patient age ranged from 2 days to 17 years, with the largest subpopulation of patients (n = 57, 40 %) being adolescents (age between 12 and 17 years old). Main indications for percutaneous tracheostomy included prolonged ventilation (n = 6), respiratory insufficiency (n = 5), and upper airway obstruction (n = 5). One-third (n = 47) of percutaneous tracheostomies were completed at the bedside in an intensive care unit. Select studies reported on surgical time and time from intubation to tracheostomy with a mean of 13.8 (SD = 7.8) minutes (n = 27) and 8.9 (SD = 2.8) days (n = 35), respectively. Major postoperative complications included tracheoesophageal fistula (n = 4, 2.8 %) and pneumothorax (n = 3, 2.1 %). There were four conversions to open tracheostomy. CONCLUSION Percutaneous tracheostomy had a similar risk of complications to open surgical tracheostomy in children and adolescents and can be performed at the bedside in a select group of patients if necessary. However, we feel that consideration must be given to the varying anatomical considerations in children and adolescents compared with adults, and therefore suggest that this procedure be reserved for adolescent patients with a thin body habitus and clearly demarcated and palpable anatomical landmarks who require a tracheostomy. When performed, we strongly support using endoscopic guidance and a surgeon who has the ability to convert to an open tracheostomy if required.
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Affiliation(s)
- Amirpouyan Namavarian
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - Ben B Levy
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | | | - Nicole K McKinnon
- Hospital for Sick Children, Toronto, ON, Canada; Department of Paediatrics, University of Toronto, Toronto, ON, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, ON, Canada
| | - Jennifer M Siu
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada; Hospital for Sick Children, Toronto, ON, Canada
| | - Evan J Propst
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada; Hospital for Sick Children, Toronto, ON, Canada
| | - Nikolaus E Wolter
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada; Hospital for Sick Children, Toronto, ON, Canada.
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Chandra FA, Sedono R, Purwamidjaja DB, Agustin R. The Importance of Early Percutaneous Dilatational Tracheostomy in Inhalation Injury: A Case Report. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2023; 16:11795476231166241. [PMID: 37065638 PMCID: PMC10102926 DOI: 10.1177/11795476231166241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 03/12/2023] [Indexed: 04/18/2023]
Abstract
Maintaining a patent airway is critical for treating patients with severe inhalation injuries. Percutaneous Dilatational Tracheostomy (PDT) has been used effectively for many patients treated in the Intensive Care Unit (ICU). In addition to its safety for use at the bedside, according to Friedman et al. PDT has the same or even lower complication rate than surgical tracheostomy. PDT can be performed in a shorter time and is more cost-effective. Herein, we report a 44 year old obese woman who sustained an inhalation injury related to a burn. The patient fell headfirst into a pot of boiling water at the time of the burn. The patient showed signs of inhalation injury and suffered a second-to-third degree burn injury. She was treated in the ICU, and early PDT was performed. The procedure was performed by first locating the trachea, followed by a 1-cm incision made between the second and third tracheal ring. She was intubated successfully and treated in the ICU for 7 days. The anesthesiologist chose to perform an early PDT to prevent further complications. This procedure was done successfully despite many comorbidities from the patient, such as being an obese female and having a short neck, which makes finding the exact location for the incision challenging. In this case, the early decision to proceed with PDT showed promising results in decreasing the patient's mortality risk.
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Affiliation(s)
- Ferdinand A Chandra
- Anaesthesia and Intensive Care Department,
Cipto Mangunkusumo Hospital, University of Indonesia, Jakarta, Indonesia
| | - Rudyanto Sedono
- Anaesthesia and Intensive Care Department,
Cipto Mangunkusumo Hospital, University of Indonesia, Jakarta, Indonesia
| | - Dis Bima Purwamidjaja
- Anaesthesia and Intensive Care Department,
Cipto Mangunkusumo Hospital, University of Indonesia, Jakarta, Indonesia
| | - Rita Agustin
- Anaesthesia and Intensive Care Department,
Cipto Mangunkusumo Hospital, University of Indonesia, Jakarta, Indonesia
- Rita Agustin, Faculty of Medicine, University of
Indonesia, Jakarta Garden City, Lantana Garden No 181, Cakung, Jakarta Timur, Jakarta,
13960, Indonesia.
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Janik S, Grasl S, Yildiz E, Besser G, Kliman J, Hacker P, Frommlet F, Fochtmann-Frana A, Erovic BM. A new nomogram to predict the need for tracheostomy in burned patients. Eur Arch Otorhinolaryngol 2020; 278:3479-3488. [PMID: 33346855 PMCID: PMC8328908 DOI: 10.1007/s00405-020-06541-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 12/01/2020] [Indexed: 11/30/2022]
Abstract
Purpose To evaluate the impact of tracheostomy on complications, dysphagia and outcome in second and third degree burned patients. Methods Inpatient mortality, dysphagia, severity of burn injury (ABSI, TBSA) and complications in tracheotomized burn patients were compared to (I) non-tracheotomized burn patients and (II) matched tracheotomized non-burn patients. Results 134 (30.9%) out of 433 patients who underwent tracheostomy, had a significantly higher percentage of inhalation injury (26.1% vs. 7.0%; p < 0.001), higher ABSI (8.9 ± 2.1 vs. 6.0 ± 2.7; p < 0.001) and TBSA score (41.4 ± 19.7% vs. 18.6 ± 18.8%; p < 0.001) compared to 299 non-tracheotomized burn patients. However, complications occurred equally in tracheotomized burn patients and matched controls and tracheostomy was neither linked to dysphagia nor to inpatient mortality at multivariate analysis. In particular, dysphagia occurred in 6.2% of cases and was significantly linked to length of ICU stay (OR 6.2; p = 0.021), preexisting neurocognitive impairments (OR 5.2; p = 0.001) and patients’ age (OR 3.4; p = 0.046). A nomogram was calculated based on age, TBSA and inhalation injury predicting the need for a tracheostomy in severely burned patients. Conclusion Using the new nomogram we were able to predict with significantly higher accuracy the need for tracheostomy in severely burned patients. Moreover, tracheostomy is safe and is not associated with higher incidenc of complications, dysphagia or worse outcome.
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Affiliation(s)
- Stefan Janik
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University Vienna, Vienna, Austria
| | - Stefan Grasl
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University Vienna, Vienna, Austria
| | - Erdem Yildiz
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University Vienna, Vienna, Austria
| | - Gerold Besser
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University Vienna, Vienna, Austria
| | - Jonathan Kliman
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University Vienna, Vienna, Austria
| | - Philipp Hacker
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University Vienna, Vienna, Austria
| | - Florian Frommlet
- Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Alexandra Fochtmann-Frana
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University Vienna, Vienna, Austria
| | - Boban M Erovic
- Institute of Head and Neck Diseases, Evangelical Hospital Vienna, Hans-Sachs Gasse 10-12, Vienna, Austria.
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Wang Y, Zhang X, Liu T, Liu M, Li H, Huang Y, Hu X, He W, Luo G, Qian W. Epidemiology and Outcome Analysis of Burns During Explosion Accident at a Major Center in Southwestern China From 2002 to 2016. J Burn Care Res 2020; 42:49-62. [PMID: 32632451 DOI: 10.1093/jbcr/iraa103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Explosions always lead to serious public health, social, and economic problems. We investigated the epidemiology, outcomes, and costs of burn patients caused by explosion accident in Southwest China to explore more effective prevention and treatment strategies. This retrospective study included 497 inpatients with burns during explosion accident admitted to the Institute of Burn Research of Army Medical University from 2002 to 2016. A total of 497 cases (77.78% males) were found, accounting for 2.37% of the total burn patients. The average age was 34.38 ± 15.02 years. The most common etiology was gas explosions (51.51%). Most of the cases were caused by work-related activities. The average TBSA was 31.30 ± 28.32%. The median length of stay (LOS) was 31 days. The LOS was correlated with TBSA, full-thickness burns, older age, number of operations and outcome. The major factors determining the cost were larger TBSA, full-thickness burns, and higher cure rate. The mortality was 6.44%. Larger TBSA and older age were the most important risk factors for the mortality. This study suggested that special attention should be paid to prevent burns during explosion accident in adult males with occupational exposure. In the future, more effective and practical strategies for preventing and treating burns during explosion accident based on related risk factors should be implemented.
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Affiliation(s)
- Yangping Wang
- Institute of Burn Research, State Key Laboratory of Trauma, Burn and Combined Injury, Key Laboratory of Disease Proteomics of Chongqing, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Xiaorong Zhang
- Institute of Burn Research, State Key Laboratory of Trauma, Burn and Combined Injury, Key Laboratory of Disease Proteomics of Chongqing, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Tengfei Liu
- Institute of Burn Research, State Key Laboratory of Trauma, Burn and Combined Injury, Key Laboratory of Disease Proteomics of Chongqing, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Menglong Liu
- Institute of Burn Research, State Key Laboratory of Trauma, Burn and Combined Injury, Key Laboratory of Disease Proteomics of Chongqing, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Haisheng Li
- Institute of Burn Research, State Key Laboratory of Trauma, Burn and Combined Injury, Key Laboratory of Disease Proteomics of Chongqing, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Yong Huang
- Institute of Burn Research, State Key Laboratory of Trauma, Burn and Combined Injury, Key Laboratory of Disease Proteomics of Chongqing, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Xiaohong Hu
- Institute of Burn Research, State Key Laboratory of Trauma, Burn and Combined Injury, Key Laboratory of Disease Proteomics of Chongqing, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Weifeng He
- Institute of Burn Research, State Key Laboratory of Trauma, Burn and Combined Injury, Key Laboratory of Disease Proteomics of Chongqing, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Gaoxing Luo
- Institute of Burn Research, State Key Laboratory of Trauma, Burn and Combined Injury, Key Laboratory of Disease Proteomics of Chongqing, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Wei Qian
- Institute of Burn Research, State Key Laboratory of Trauma, Burn and Combined Injury, Key Laboratory of Disease Proteomics of Chongqing, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
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5
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Tracheostomy and mortality in patients with severe burns: A nationwide observational study. Burns 2018; 44:1954-1961. [PMID: 29980328 DOI: 10.1016/j.burns.2018.06.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Revised: 04/27/2018] [Accepted: 06/15/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Tracheostomy is often performed in patients with severe burns who are undergoing prolonged mechanical ventilation. However, the appropriate timing of tracheostomy and its effect on mortality remain unknown. The aim of this study was to determine whether tracheostomy can reduce mortality in patients with severe burns. METHODS Using the Japanese Diagnosis Procedure Combination database from April 2010 to March 2014, we extracted data on adult patients with severe burns (burn index score of ≥15) who started mechanical ventilation within 3days of admission. We estimated the hazard ratio for 28-day in-hospital mortality associated with tracheotomy performed from day 5 to 28. We adjusted for baseline and time-dependent confounders using inverse probability of treatment weighting methods and fitted a marginal structural Cox proportional hazard model. RESULTS We identified 680 eligible patients (94 in the tracheostomy group, 2289 person-days; 586 in the non-tracheostomy group, 11,197 person-days). Patients who underwent a tracheostomy had worse prognostic factors for mortality. After adjustment for these factors, the hazard ratio for 28-day mortality associated with tracheostomy compared with non-tracheostomy was 0.73 (95% confidence interval, 0.39-1.34). CONCLUSIONS There was no significant association between 28-day in-hospital mortality and early tracheostomy in adult patients with severe burns.
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Raimondi N, Vial MR, Calleja J, Quintero A, Cortés Alban A, Celis E, Pacheco C, Ugarte S, Añón JM, Hernández G, Vidal E, Chiappero G, Ríos F, Castilleja F, Matos A, Rodriguez E, Antoniazzi P, Teles JM, Dueñas C, Sinclair J, Martínez L, Von der Osten I, Vergara J, Jiménez E, Arroyo M, Rodriguez C, Torres J, Fernandez-Bussy S, Nates JL. Evidence-based guides in tracheostomy use in critical patients. Med Intensiva 2017; 41:94-115. [PMID: 28188061 DOI: 10.1016/j.medin.2016.12.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 11/20/2016] [Accepted: 12/02/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Provide evidence based guidelines for tracheostomy in critically ill adult patients and identify areas needing further research. METHODS A task force composed of representatives of 10 member countries of the Pan-American and Iberic Federation of Societies of Critical and Intensive Therapy Medicine and of the Latin American Critical Care Trial Investigators Network developed recommendations based on the Grading of Recommendations Assessment, Development and Evaluation system. RESULTS The group identified 23 relevant questions among 87 issues that were initially identified. In the initial search, 333 relevant publications were identified of which 226 publications were chosen. The task force generated a total of 19 recommendations: 10 positive (1B=3, 2C=3, 2D=4) and 9 negative (1B=8, 2C=1). A recommendation was not possible in six questions. CONCLUSION Percutaneous techniques are associated with a lower risk of infections compared to surgical tracheostomy. Early tracheostomy only seems to reduce the duration of ventilator use but not the incidence of pneumonia, the length of stay, or the long-term mortality rate. The evidence does not support the use of routine bronchoscopy guidance or laryngeal masks during the procedure. Finally, proper prior training is as important or even a more significant factor in reducing complications than the technique used.
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Affiliation(s)
- N Raimondi
- Hospital Municipal Juan A. Fernández, Universidad de Buenos Aires, Argentina
| | - M R Vial
- MD Anderson Cancer Center, The University of Texas, Texas, United States; Clínica Alemana de Santiago, Universidad del Desarrollo, Santiago, Chile
| | - J Calleja
- Hospital Zambrano Hellion, Instituto Tecnológico de Monterrey, Monterrey, Nuevo León, México
| | - A Quintero
- Instituto Medico de Alta Tecnología, Universidad del Sinú, Montería, Colombia
| | - A Cortés Alban
- Clínica Mayor de Temuco, Hospital de Nueva Imperial, Universidad Mayor de Temuco, Temuco, Chile
| | - E Celis
- Hospital Universitario Fundación Santa Fé de Bogotá, Bogotá, Colombia
| | - C Pacheco
- Hospital Universitario de Caracas, Caracas, Venezuela
| | - S Ugarte
- Hospital del Salvador, Clínica Indisa, Universidad de Chile, Santiago, Chile
| | - J M Añón
- Hospital Universitario la Paz -Carlos III. IdiPaz, Madrid, España
| | - G Hernández
- Complejo Hospitalario de Toledo, Toledo, España
| | - E Vidal
- Hospital Ángeles Lomas, Hospital Español de México, Ciudad de México, México
| | - G Chiappero
- Hospital Juan A. Fernández CABA, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - F Ríos
- Hospital Nacional Alejandro Posadas, Sanatorio Las Lomas, San Isidro, Buenos Aires, Argentina
| | - F Castilleja
- Hospital Zambrano Hellion, Instituto Tecnológico de Monterrey, Monterrey, Nuevo León, México
| | - A Matos
- Complejo Hospitalario Caja de Seguro Social, Panamá
| | - E Rodriguez
- Complejo Hospitalario Caja de Seguro Social, Panamá
| | - P Antoniazzi
- Hospital Santa Casa, Ribeirao Preto, Sao Paulo, Brazil
| | - J M Teles
- Hospital de Urgências de Goiânia, Goiás, Brazil
| | - C Dueñas
- Gestión Salud, Santa Cruz de Bocagrande, Universidad de Cartagena, Cartagena, Colombia
| | - J Sinclair
- Hospital Punta Pacífica, Johns Hopkins Medicine, Universidad de Panamá, Ciudad de Panamá, Panamá
| | - L Martínez
- Hospital Policlínica Metropolitana, Caracas, Venezuela
| | - I Von der Osten
- Hospital Central "Miguel Pérez Carreño" IVSS, Universidad Central de Venezuela, Caracas, Venezuela
| | - J Vergara
- Hospital Luis Vernaza, Universidad de Especialidades Espíritu Santo "UEES", Guayaquil, Ecuador
| | - E Jiménez
- Baylor Scott & White Health, Texas A&M Health Science Center College of Medicine, Temple, Texas, Estados Unidos
| | - M Arroyo
- Clínica Santa Sofía, Caracas, Venezuela
| | - C Rodriguez
- Instituto Medico de Alta Tecnología, Universidad del Sinú, Montería, Colombia
| | - J Torres
- Clínica Alemana de Santiago, Universidad del Desarrollo, Santiago, Chile
| | - S Fernandez-Bussy
- Clínica Alemana de Santiago, Universidad del Desarrollo, Santiago, Chile; Division of Pulmonary, Critical Care & Sleep Medicine, University of Florida, Gainesville, Florida, Estados Unidos
| | - J L Nates
- MD Anderson Cancer Center, The University of Texas, Texas, United States.
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7
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Raimondi N, Vial MR, Calleja J, Quintero A, Cortés A, Celis E, Pacheco C, Ugarte S, Añón JM, Hernández G, Vidal E, Chiappero G, Ríos F, Castilleja F, Matos A, Rodriguez E, Antoniazzi P, Teles JM, Dueñas C, Sinclair J, Martínez L, von der Osten I, Vergara J, Jiménez E, Arroyo M, Rodríguez C, Torres J, Fernandez-Bussy S, Nates JL. Evidence-based guidelines for the use of tracheostomy in critically ill patients. J Crit Care 2016; 38:304-318. [PMID: 28103536 DOI: 10.1016/j.jcrc.2016.10.009] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 10/10/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To provide evidence-based guidelines for tracheostomy in critically ill adult patients and identify areas needing further research. METHODS A taskforce composed of representatives of 10 member countries of the Pan-American and Iberic Federation of Societies of Critical and Intensive Therapy Medicine and of the Latin American Critical Care Trial Investigators Network developed recommendations based on the Grading of Recommendations Assessment, Development and Evaluation system. RESULTS The group identified 23 relevant questions among 87 issues that were initially identified. In the initial search, 333 relevant publications were identified, of which 226 publications were chosen. The taskforce generated a total of 19 recommendations, 10 positive (1B, 3; 2C, 3; 2D, 4) and 9 negative (1B, 8; 2C, 1). A recommendation was not possible in 6 questions. CONCLUSIONS Percutaneous techniques are associated with a lower risk of infections compared with surgical tracheostomy. Early tracheostomy only seems to reduce the duration of ventilator use but not the incidence of pneumonia, the length of stay, or the long-term mortality rate. The evidence does not support the use of routine bronchoscopy guidance or laryngeal masks during the procedure. Finally, proper prior training is as important or even a more significant factor in reducing complications than the technique used.
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Affiliation(s)
- Néstor Raimondi
- Hospital Municipal Juan A. Fernández, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Macarena R Vial
- MD Anderson Cancer Center, The University of Texas, Houston, TX, USA; Clínica Alemana de Santiago, Universidad del Desarrollo, Santiago, Chile
| | - José Calleja
- Hospital Zambrano Hellion, Instituto Tecnológico de Monterrey, Monterrey, México
| | - Agamenón Quintero
- Instituto Médico de Alta Tecnología, Universidad del Sinú, Montería, Córdoba, Colombia
| | - Albán Cortés
- Clínica Mayor de Temuco, Hospital de Nueva Imperial, Universidad Mayor de Temuco, Temuco, Chile
| | - Edgar Celis
- Hospital Universitario Fundación Santa Fé de Bogotá, Bogotá, Colombia
| | - Clara Pacheco
- Hospital Universitario de Caracas, Caracas, Venezuela
| | - Sebastián Ugarte
- Hospital del Salvador, Clínica Indisa, Universidad de Chile, Santiago, Chile
| | - José M Añón
- Hospital Universitario La Paz-Carlos III. IdiPaz, Madrid, Spain
| | | | - Erick Vidal
- Hospital Ángeles Lomas, Hospital Español de México, Ciudad de México, México
| | - Guillermo Chiappero
- Hospital Juan A. Fernández CABA, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Fernando Ríos
- Hospital Nacional Alejandro Posadas, Sanatorio Las Lomas, San Isidro, Buenos Aires, Argentina
| | - Fernando Castilleja
- Hospital Zambrano Hellion, Instituto Tecnológico de Monterrey, Monterrey, México
| | - Alfredo Matos
- Complejo Hospitalario Caja de Seguro Social, Ciudad de Panamá, Panamá
| | - Enith Rodriguez
- Complejo Hospitalario Caja de Seguro Social, Ciudad de Panamá, Panamá
| | - Paulo Antoniazzi
- Hospital Santa Casa de Ribeirão Preto, Centro Universitário Barao de Maua, São Paulo, Brazil
| | | | - Carmelo Dueñas
- Gestión Salud, Santa Cruz de Bocagrande, Universidad de Cartagena, Cartagena, Colombia
| | - Jorge Sinclair
- Hospital Punta Pacífica, Johns Hopkins Medicine, Universidad de Panamá, Ciudad de Panamá, Panamá
| | | | - Ingrid von der Osten
- Hospital Central "Miguel Pérez Carreño" IVSS, Universidad Central de Venezuela, Caracas, Venezuela
| | - José Vergara
- Hospital Luis Vernaza, Universidad de Especialidades Espíritu Santo "UEES,", Guayaquil, Ecuador
| | - Edgar Jiménez
- Baylor Scott & White Health, Texas A&M Health Science Center College of Medicine, Temple, TX, USA
| | | | - Camilo Rodríguez
- Instituto Médico de Alta Tecnología, Universidad del Sinú, Montería, Córdoba, Colombia
| | - Javier Torres
- Clínica Alemana de Santiago, Universidad del Desarrollo, Santiago, Chile
| | - Sebastián Fernandez-Bussy
- Clínica Alemana de Santiago, Universidad del Desarrollo, Santiago, Chile; Division of Pulmonary, Critical Care & Sleep Medicine, University of Florida, Gainesville, FL
| | - Joseph L Nates
- MD Anderson Cancer Center, The University of Texas, Houston, TX, USA.
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Ziegler B, Hirche C, Horter J, Kiefer J, Grützner PA, Kremer T, Kneser U, Münzberg M. In view of standardization Part 2: Management of challenges in the initial treatment of burn patients in Burn Centers in Germany, Austria and Switzerland. Burns 2016; 43:318-325. [PMID: 27665246 DOI: 10.1016/j.burns.2016.08.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 08/03/2016] [Accepted: 08/05/2016] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Initial therapy of severe burns in specialized burn trauma centers is a challenging task faced by the treating multi-professional and interdisciplinary team. A lack of consistent operating procedures and varying structural conditions was recently demonstrated in preliminary data of our group. These results raised the question on how specific treatment measures in acute burn care are met in the absence of standardized guidelines. MATERIAL AND METHODS A specific questionnaire containing 57 multiple-choice questions was sent to all 22 major burn centers in Germany, Austria and Switzerland. The survey included standards of airway management and ventilation, fluid management and circulation, body temperature monitoring and management, topical burn wound treatment and a microbiological surveillance. Additionally, the distribution of standardized course systems was covered. RESULTS 17 out of 22 questionnaires (77%) were returned completed. Regarding volume resuscitation, results showed a similar approach in estimating initial fluid while discrepancies persisted in the use of colloidal fluid and human albumin. Elective tracheostomy and the need for bronchoscopy with suspected inhalation injury were the most controversial issues revealed by the survey. Topical treatment of burned body surface also followed different principles regarding the use of synthetic epidermal skin substitutes or enzymatic wound debridement. Less discrepancy was found in basic diagnostic measures, body temperature management, estimation of the extent of burns and microbiological surveillance. CONCLUSION While many burn-related issues are clearly not questionable and managed in a similar way in most participating facilities, we were able to show that the most contentious issues in burn trauma management involve initial volume resuscitation, management of inhalation trauma and topical burn wound treatment. Further research is required to address these topics and evaluate a potential superiority of a regime in order to increase the level of evidence.
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Affiliation(s)
- Benjamin Ziegler
- Department of Hand, Plastic and Reconstructive Surgery-Burn Center, BG Trauma Center Ludwigshafen/Rhine, Hand and Plastic Surgery, University Heidelberg, Ludwig-Guttmann-Str. 13, D-67071 Ludwigshafen, Germany
| | - Christoph Hirche
- Department of Hand, Plastic and Reconstructive Surgery-Burn Center, BG Trauma Center Ludwigshafen/Rhine, Hand and Plastic Surgery, University Heidelberg, Ludwig-Guttmann-Str. 13, D-67071 Ludwigshafen, Germany
| | - Johannes Horter
- Department of Hand, Plastic and Reconstructive Surgery-Burn Center, BG Trauma Center Ludwigshafen/Rhine, Hand and Plastic Surgery, University Heidelberg, Ludwig-Guttmann-Str. 13, D-67071 Ludwigshafen, Germany
| | - Jurij Kiefer
- Department of Hand, Plastic and Reconstructive Surgery-Burn Center, BG Trauma Center Ludwigshafen/Rhine, Hand and Plastic Surgery, University Heidelberg, Ludwig-Guttmann-Str. 13, D-67071 Ludwigshafen, Germany
| | - Paul Alfred Grützner
- Department of Trauma and Orthopedic Surgery, Air Rescue Center, BG Trauma Center Ludwigshafen/Rhine, Ludwig-Guttmann-Str. 13, D-67071 Ludwigshafen, Germany
| | - Thomas Kremer
- Department of Hand, Plastic and Reconstructive Surgery-Burn Center, BG Trauma Center Ludwigshafen/Rhine, Hand and Plastic Surgery, University Heidelberg, Ludwig-Guttmann-Str. 13, D-67071 Ludwigshafen, Germany
| | - Ulrich Kneser
- Department of Hand, Plastic and Reconstructive Surgery-Burn Center, BG Trauma Center Ludwigshafen/Rhine, Hand and Plastic Surgery, University Heidelberg, Ludwig-Guttmann-Str. 13, D-67071 Ludwigshafen, Germany
| | - Matthias Münzberg
- Department of Trauma and Orthopedic Surgery, Air Rescue Center, BG Trauma Center Ludwigshafen/Rhine, Ludwig-Guttmann-Str. 13, D-67071 Ludwigshafen, Germany.
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Mourelo M, Galeiras R, Pértega S, Freire D, López E, Broullón J, Campos E. Tracheostomy in the management of patients with thermal injuries. Indian J Crit Care Med 2015; 19:449-55. [PMID: 26321803 PMCID: PMC4548413 DOI: 10.4103/0972-5229.162460] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Objective: To assess the use and clinical impact of tracheostomy in burn patients. Summary Background Data: The role of tracheostomy in the management of burn patients is controversial, with only a few recent studies conducted in this population. Methods: Retrospective study of all adult burn patients who underwent a tracheostomy in a Burns Unit between 1995 and 2013. These were compared with a control group (1:1) who underwent orotracheal intubation. Hospital records were reviewed to obtain demographic and clinical information, including those related to respiratory support and tracheostomy. The McNemar's Chi-square and Signed-Rank Tests were used to study differences in morbimortality between both groups. Results: A total of n = 20 patients underwent tracheostomy (0.9% of admissions, 56.0 ± 19.5 years, 60.0% women). The most common indication was long-term ventilation (75%), 24.6 ± 19.7 days after admission. Thirteen patients were successfully decannulated with a fatal complication observed in one case. Patients in the tracheostomy group were found to require longer-term mechanical ventilation (43.2 vs. 20.4 days; P = 0.004), with no differences in respiratory infection rates (30.0% vs. 31.6%; P = 0.687) or mortality (30.0% vs. 42.1%; P = 0.500). Ventilator weaning times (15.7 vs. 3.3 days; P = 0.001) and hospital stays (99.1 vs. 53.1 days; P = 0.030) were longer in the tracheostomy group, with no differences in duration of sedation. Conclusions: Tracheostomy may be a safe procedure in burn patients and is not associated with higher rates of mortality or respiratory infection. Tracheostomy patients showed longer mechanical ventilation times and higher morbidity, probably not attributable to tracheostomy.
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Affiliation(s)
- Mónica Mourelo
- Department of Critical Care, University Hospital of A Coruna, A Coruña, Spain
| | - Rita Galeiras
- Department of Critical Care, University Hospital of A Coruna, A Coruña, Spain
| | - Sonia Pértega
- Department of Clinical Epidemiology and Biostatistics, University Hospital of A Coruna, A Coruña, Spain
| | - David Freire
- Department of Critical Care, University Hospital of A Coruna, A Coruña, Spain
| | - Eugenia López
- Department of Plastic Surgery, Burn Unit, University Hospital of A Coruna, A Coruña, Spain
| | - Javier Broullón
- Department of Health Information Technology, University Hospital of A Coruna, A Coruña, Spain
| | - Eva Campos
- Department of Plastic Surgery, Burn Unit, University Hospital of A Coruna, A Coruña, Spain
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10
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Rudmik L, An W, Livingstone D, Matthews W, Seikaly H, Scrimger R, Marshall D. Making a case for high-volume robotic surgery centers: A cost-effectiveness analysis of transoral robotic surgery. J Surg Oncol 2015; 112:155-63. [DOI: 10.1002/jso.23974] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 06/23/2015] [Indexed: 12/30/2022]
Affiliation(s)
- Luke Rudmik
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery; University of Calgary; Calgary Alberta Canada
| | - Wenyi An
- Department of Community Health Sciences; University of Calgary; Calgary Alberta Canada
| | - Devon Livingstone
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery; University of Calgary; Calgary Alberta Canada
| | - Wayne Matthews
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery; University of Calgary; Calgary Alberta Canada
| | - Hadi Seikaly
- D ivision of Otolaryngology-Head and Neck Surgery; Department of Surgery; University of Alberta; Edmonton Alberta Canada
| | - Rufus Scrimger
- Division of Radiation Oncology; Department of Oncology; University of Alberta; Edmonton Alberta Canada
| | - Deborah Marshall
- Canada Research Chair; Health Services and Systems Research; Department of Community Health Sciences; University of Calgary; Calgary Alberta Canada
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11
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Blet A, Benyamina M, Legrand M. Manifestations respiratoires précoces d’un patient brûlé grave. MEDECINE INTENSIVE REANIMATION 2015; 24:433-443. [PMID: 32288740 PMCID: PMC7117817 DOI: 10.1007/s13546-015-1084-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 05/08/2015] [Indexed: 11/29/2022]
Affiliation(s)
- A. Blet
- Département d’anesthésie-réanimation et centre de traitement des brûlés, AP–HP, groupe hospitalier Saint-Louis-Lariboisière, F-75010 Paris, France
- Université Paris-Diderot, F-75475 Paris, France
- UMR Inserm 942, Institut national de la santé et de la recherche médicale (Inserm), hôpital Lariboisière, F-75010 Paris, France
| | - M. Benyamina
- Département d’anesthésie-réanimation et centre de traitement des brûlés, AP–HP, groupe hospitalier Saint-Louis-Lariboisière, F-75010 Paris, France
- Université Paris-Diderot, F-75475 Paris, France
| | - M. Legrand
- Département d’anesthésie-réanimation et centre de traitement des brûlés, AP–HP, groupe hospitalier Saint-Louis-Lariboisière, F-75010 Paris, France
- Université Paris-Diderot, F-75475 Paris, France
- UMR Inserm 942, Institut national de la santé et de la recherche médicale (Inserm), hôpital Lariboisière, F-75010 Paris, France
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Hop MJ, Polinder S, van der Vlies CH, Middelkoop E, van Baar ME. Costs of burn care: A systematic review. Wound Repair Regen 2014; 22:436-50. [DOI: 10.1111/wrr.12189] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 04/01/2014] [Indexed: 11/30/2022]
Affiliation(s)
- M. Jenda Hop
- Association of Dutch Burn Centers; Burn Center; Maasstad Hospital; Rotterdam The Netherlands
- Department of Plastic, Reconstructive and Hand Surgery; MOVE Research Institute; VU University Medical Center; Amsterdam The Netherlands
| | - Suzanne Polinder
- Department of Public Health; Erasmus Medical Center; Rotterdam The Netherlands
| | | | - Esther Middelkoop
- Department of Plastic, Reconstructive and Hand Surgery; MOVE Research Institute; VU University Medical Center; Amsterdam The Netherlands
- Association of Dutch Burn Centers; Red Cross Hospital; Beverwijk The Netherlands
| | - Margriet E. van Baar
- Association of Dutch Burn Centers; Burn Center; Maasstad Hospital; Rotterdam The Netherlands
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Abstract
As a result of continuous development in the treatment of burns, the LD50 (the burn size lethal to 50% of the population) for thermal injuries has risen from 42% total body surface area (TBSA) during the 1940s and 1950s to more than 90% TBSA for young thermally injured patients. This vast improvement in survival is due to simultaneous developments in critical care, advancements in resuscitation, control of infection through early excision, and pharmacologic support of the hypermetabolic response to burns. This article reviews these recent advances and how they influence modern intensive care of burns.
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Affiliation(s)
- Shawn P Fagan
- Sumner Redstone Burn Center, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Mary-Liz Bilodeau
- Sumner Redstone Burn Center, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Jeremy Goverman
- Sumner Redstone Burn Center, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
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Smailes S, Ives M, Richardson P, Martin R, Dziewulski P. Percutaneous dilational and surgical tracheostomy in burn patients: Incidence of complications and dysphagia. Burns 2014; 40:436-42. [DOI: 10.1016/j.burns.2013.07.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Revised: 07/24/2013] [Accepted: 07/26/2013] [Indexed: 10/26/2022]
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Snell JA, Loh NHW, Mahambrey T, Shokrollahi K. Clinical review: the critical care management of the burn patient. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2013; 17:241. [PMID: 24093225 PMCID: PMC4057496 DOI: 10.1186/cc12706] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Between 4 and 22% of burn patients presenting to the emergency department are admitted to critical care. Burn injury is characterised by a hypermetabolic response with physiologic, catabolic and immune effects. Burn care has seen renewed interest in colloid resuscitation, a change in transfusion practice and the development of anti-catabolic therapies. A literature search was conducted with priority given to review articles, meta-analyses and well-designed large trials; paediatric studies were included where adult studies were lacking with the aim to review the advances in adult intensive care burn management and place them in the general context of day-to-day practical burn management.
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Meaudre E, Montcriol A, Bordes J, Cotte J, Cathelinaud O, Boret H, Goutorbe P, Palmier B. Trachéotomie chirurgicale et trachéotomie percutanée en réanimation. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/s0246-0289(12)44767-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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17
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Kasten KR, Makley AT, Kagan RJ. Update on the critical care management of severe burns. J Intensive Care Med 2011; 26:223-36. [PMID: 21764766 DOI: 10.1177/0885066610390869] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Care of the severely injured patient with burn requires correct diagnosis, appropriately tailored resuscitation, and definitive surgical management to reduce morbidity and mortality. Currently, mortality rates related to severe burn injuries continue to steadily decline due to the standardization of a multidisciplinary approach instituted at tertiary health care centers. Prompt and accurate diagnoses of burn wounds utilizing Lund-Browder diagrams allow for appropriate operative and nonoperative management. Coupled with diagnostic improvements, advances in resuscitation strategies involving rates, volumes, and fluid types have yielded demonstrable benefits related to all aspects of burn care. More recently, identification of comorbid conditions such as inhalation injury and malnutrition have produced appropriate protocols that aid the healing process in severely injured patients with burn. As more patients survive larger burn injuries, the early diagnosis and successful treatment of secondary and tertiary complications are becoming commonplace. While advances in this area are exciting, much work to elucidate immune pathways, diagnostic tests, and effective treatment regimens still remain. This review will provide an update on the critical care management of severe burns, touching on accurate diagnosis, resuscitation, and acute management of this difficult patient population.
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Affiliation(s)
- Kevin R Kasten
- Department of Surgery, University of Cincinnati, Cincinnati, OH 45229, USA
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18
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Semi-open percutaneous tracheostomy in burn patients. Burns 2011; 37:1072-8. [DOI: 10.1016/j.burns.2011.03.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2011] [Accepted: 03/06/2011] [Indexed: 11/19/2022]
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White HN, Sharp DB, Castellanos PF. Suspension laryngoscopy-assisted percutaneous dilatational tracheostomy in high-risk patients. Laryngoscope 2011; 120:2423-9. [PMID: 21058392 DOI: 10.1002/lary.21019] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVES/HYPOTHESIS To describe the outcomes of bedside percutaneous dilatational tracheostomy (PDT) extended to the care of high-risk patients in the intensive care unit (ICU) by the use of suspension laryngoscopy (SL) to secure the airway. STUDY DESIGN Retrospective chart review. METHODS The records of 117 consecutive patients who underwent suspension laryngoscopy-assisted percutaneous dilatational tracheostomy (SL-PDT) between April 2006 and May 2009 at our institution were reviewed. Data gathered included patient demographics, anatomical conditions, ventilator settings, intraoperative findings, presence of coagulopathy or anti-coagulation, and outcomes. RESULTS One hundred seventeen patients underwent SL-PDT. Eighty (68%) were considered high risk by virtue of one or more of the following: morbid obesity, coagulopathy, prior neck surgery or head and neck trauma, laryngotracheal stenosis or tracheomalacia, a high-riding innominate artery, or high ventilator demands. Thirty-five patients (30%) had two or more of these risk factors. A total of 11 (13.7 %) complications occurred in the high-risk group. Two major and nine minor complications occurred during the study. There were no adverse sequelae. CONCLUSIONS SL-PDT is a safe and effective means of bedside airway management in critically ill patients. This new technique offers several advantages over traditional percutaneous dilatational tracheostomy (T-PDT) and can be safely employed by otolaryngologists, especially in high-risk patients. This is most useful when T-PDT is considered untenable or when transport to the operating room for a standard open tracheostomy is considered too cumbersome or potentially dangerous.
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Affiliation(s)
- Hilliary N White
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
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20
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Pappas S, Maragoudakis P, Vlastarakos P, Assimakopoulos D, Mandrali T, Kandiloros D, Nikolopoulos TP. Surgical versus percutaneous tracheostomy: an evidence-based approach. Eur Arch Otorhinolaryngol 2010; 268:323-30. [DOI: 10.1007/s00405-010-1398-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2010] [Accepted: 09/29/2010] [Indexed: 08/30/2023]
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Thaler U, Kraincuk P, Kamolz LP, Frey M, Metnitz PGH. [Inhalation injury--epidemiology, diagnosis and therapy]. Wien Klin Wochenschr 2010; 122:11-21. [PMID: 20177854 DOI: 10.1007/s00508-010-1303-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2009] [Accepted: 01/13/2010] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Inhalation injury is a vitally threatening medical syndrome, which might appear in patients with or without burn injuries. Thus, knowledge about development, diagnosis and treatment of inhalation injury should be available for each physician working in an intensive care unit. METHODS This review starts with the causal and formal pathogenesis of inhalation injuries. Furthermore, diagnosis and treatment in the critical care setting are presented, followed by the discussion of possible complications. Specific intoxications such as carbon monoxide are due to their importance separately discussed. CONCLUSIONS Inhalation injury present with an attributable excess mortality and thus worsen the prognosis of burned patients. New insights into the pathogenesis of inhalation injury, however, have led to improved therapeutic possibilities with improved outcome. Necessary prerequisites are a timely diagnosis and restrictive volume management, especially in patients with extensive burns. Prospective studies are needed to be able to answer the many emerging questions.
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Affiliation(s)
- Ulrich Thaler
- Universitätsklinik für Anästhesie, Allgemeine Intensivmedizin und Schmerztherapie, Medizinische Universität Wien, Wien, Austria
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22
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Percutaneous tracheostomy after full thickness burns to the neck: why not? Burns 2010; 36:740; author reply 736-7. [PMID: 20071092 DOI: 10.1016/j.burns.2009.10.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2009] [Accepted: 10/20/2009] [Indexed: 11/20/2022]
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Inhalation injury in southwest China--the evolution of care. Burns 2009; 36:506-10. [PMID: 19857928 DOI: 10.1016/j.burns.2009.07.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2009] [Revised: 07/13/2009] [Accepted: 07/14/2009] [Indexed: 11/20/2022]
Abstract
AIM This study aims to review the changes in management of inhalation injury and the associated reduction in mortality over the past 2 decades. METHODS The records of burn patients with inhalation injury hospitalised in our institute from 1986 to 2005 were retrospectively analysed. The incidence of inhalation injury and the associated mortality were analysed. Meanwhile, the relationship of inhalation injury with age, total burn area, tracheostomy intubation and mechanical ventilation were studied. RESULTS The incidence of inhalation injury was 8.01% in the total 10 608 hospitalised burn patients during the 20 years surveyed. Inhalation injury was always associated with large-sized burn and was more common in adults. The incidence of tracheostomy and mechanical ventilation increased from 39.46 and 30.28% in the period from 1986 to 1995 to 70.12 and 39.74% from 1996 to 2005, respectively. The overall mortality of inhalation-injured burn patients was 15.88% compared with 0.82% of the non-inhalation group. The mortality of the burn patients with inhalation injury dropped from 25.29% during the first 10 years to 11.71% during the second decade (p<0.01). Mortality secondary to inhalation injury as the lead cause decreased from 14.56 to 6.29% (p<0.01). CONCLUSION The care of inhalation injury has made significant progress over the past 2 decades. The early diagnosis of inhalation injury, early airway control and pulmonary function assistance with mechanical ventilation contribute to the reduction of mortality.
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Sakata S, Hallett KB, Brandon MS, McBride CA. Easy come, easy go: a simple and effective orthodontic enamel anchor for endotracheal tube stabilization in a child with extensive facial burns. Burns 2009; 35:983-6. [PMID: 19447552 DOI: 10.1016/j.burns.2009.01.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2008] [Revised: 01/12/2009] [Accepted: 01/14/2009] [Indexed: 11/15/2022]
Abstract
Endotracheal tube stabilization in patients with facial burns is crucial and often challenging. We present a simple method of securing an endotracheal tube using two orthodontic brackets bonded to the maxillary central incisor teeth and a 0.08'' stainless steel ligature wire. Our technique is less traumatic, and is easier to maintain oral hygiene than with previously described methods. This anchorage system takes 5 min to apply and can be removed on the ward without the need for a general anaesthetic.
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Affiliation(s)
- Shinichiro Sakata
- The Stuart Pegg Paediatric Burns Centre, Royal Children's Hospital, Herston, Queensland 4029, Australia.
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Lima AGD, Marques A, Toro IFC. Postintubation injuries and open surgical tracheostomy: should we always perform isthmectomy? J Bras Pneumol 2009; 35:227-33. [PMID: 19390720 DOI: 10.1590/s1806-37132009000300006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2008] [Accepted: 08/19/2008] [Indexed: 08/30/2023] Open
Abstract
OBJECTIVE To evaluate the influence of the surgical team (general surgery or thoracic surgery) and the surgical technique (with or without isthmectomy) on the incidence of postintubation injuries in the airways of tracheostomized patients. METHODS Between January 1st and August 31st, 2007, 164 patients admitted to the adult intensive care unit and tracheally intubated for more than 24 h were studied prospectively at the Sumaré State Hospital, located at the city of Sumare, Brazil. When tracheostomy was necessary, these patients were randomly assigned to thoracic or general surgery teams. All of the patients were submitted to fiberoptic tracheoscopy for decannulation or late evaluation of the airway. RESULTS Of the 164 patients in the study, 90 (54.88%) died (due to causes unrelated to the procedure), 67 (40.85%) completed follow-up, and 7 (4.27%) were lost to follow-up. Of the 67 patients who completed follow-up, 32 had undergone tracheostomy (21 by the general surgery team and 11 by the thoracic surgery team), and 22 had been submitted to isthmectomy (11 by the general surgery team and 11 by the thoracic surgery team). There was no difference between the surgical teams in terms of the incidence of stomal complications. However, there was a significant difference when the surgical techniques (with or without isthmectomy) were compared. CONCLUSIONS Not performing isthmectomy in parallel with tracheostomy leads the surgeon to open the tracheal stoma more distally than expected. In such cases, there were more stomal complications.
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Endotracheal tube stabilization using an orthodontic skeletal anchor in a patient with facial burns. Int J Oral Maxillofac Surg 2008; 37:386-7. [PMID: 18295451 DOI: 10.1016/j.ijom.2007.12.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2007] [Revised: 08/16/2007] [Accepted: 12/19/2007] [Indexed: 11/23/2022]
Abstract
Stabilizing the endotracheal tube is of vital importance in patients suffering facial burns or trauma in the intensive care unit, as well as during a general anaesthetic procedure. Here is presented a secure method using a simple orthodontic skeletal anchorage system on the maxilla and 0.4-mm stainless steel wire that does not require any work or place any burden on the teeth or gingival tissue, and does not require extensive surgery.
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Toxic Gas, Fume, and Smoke Inhalation. Crit Care Med 2008. [DOI: 10.1016/b978-032304841-5.50051-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Affiliation(s)
- Tina L Palmieri
- Shriners Hospitals for Children-Northern California, and Department of Surgery, University of California-Davis, 2425 Stockton Boulevard, Sacramento, CA 95817, USA
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Abstract
We sought to evaluate the incidence, morbidity, and mortality of pneumonia among inhalation injury patients requiring admission to our burn unit. We undertook a retrospective study of 228 consecutive patients with inhalation injury who were admitted to the burn unit of a level one trauma center between 2001 and 2004. Of the remaining 117 patients with inhalation injury and requiring hospitalization for at least 48 hours, 32 (27%) developed pneumonia. The average patient with inhalation injury and pneumonia developed their infiltrate on day 6 +/- 5 days and required 3 +/- 4 burn operations. There was no difference seen in age, sex, or carboxyhemoglobin level between inhalation injury patients with and without pneumonia (P > .05). The inhalation injury patients that had an associated TBSA burn of at least 20% had a 60% (12/20) pneumonia rate, which was significantly higher then the 21% (20/97) pneumonia rate observed in patients with an association burn less then 20%. The overall mortality of patients with inhalation injury and pneumonia was 19% (6/32), double the mortality rate of 9% (8/85) found in patients with inhalation injury and no pneumonia. The average length of stay of inhalation injury patients with pneumonia was significantly longer (47 +/- 44 days) then inhalation injury patients without pneumonia (26 +/- 54 days; P < .05). The presence of pneumonia among inhalation injury patients significantly increased length of stay and doubled mortality rates. Admission carboxyhemoglobin levels, age, and sex had no relationship to the development of pneumonia. An increase in TBSA burn was associated with a higher pneumonia rate.
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Affiliation(s)
- David A Edelman
- Wayne State University/Detroit Medical Center, Michigan 48201, USA
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Abstract
BACKGROUND Management of burn patients requires a complex interaction of surgical, medical, critical care, and rehabilitation approaches. Severe burn patients are some of the most challenging critically ill patients who may have multiple-system organ failure with life-threatening complications. OBJECTIVE To review and highlight some of the recent advances in burn critical care. We focused on some of the new treatment modalities in the management of respiratory complications, advances in burn resuscitation, management of the metabolic response to burns, and recent ideas in burn immunotherapy. DATA SOURCE A search of the MEDLINE database and manual review of published articles and abstracts from national and international meetings. DATA SYNTHESES AND CONCLUSIONS: The respiratory management of burn patients includes strategies to minimize iatrogenic injury with low tidal volume ventilation, to improve ventilation/perfusion mismatch, and to diagnosis pneumonia. Many aspects of burn resuscitation remain controversial, and the best form of fluid resuscitation has yet to be identified. Recent research in the metabolic response to thermal injury has identified many potentially beneficial treatments. Although immunomodulation therapy is promising, currently most of these treatments are not clinically viable, and further clinical and translational research is warranted.
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