Tracheostomy in the management of patients with thermal injuries.

Autor: Mourelo M; Department of Critical Care, University Hospital of A Coruna, A Coruña, Spain., Galeiras R; Department of Critical Care, University Hospital of A Coruna, A Coruña, Spain., Pértega S; Department of Clinical Epidemiology and Biostatistics, University Hospital of A Coruna, A Coruña, Spain., Freire D; Department of Critical Care, University Hospital of A Coruna, A Coruña, Spain., López E; Department of Plastic Surgery, Burn Unit, University Hospital of A Coruna, A Coruña, Spain., Broullón J; Department of Health Information Technology, University Hospital of A Coruna, A Coruña, Spain., Campos E; Department of Plastic Surgery, Burn Unit, University Hospital of A Coruna, A Coruña, Spain.
Jazyk: angličtina
Zdroj: Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine [Indian J Crit Care Med] 2015 Aug; Vol. 19 (8), pp. 449-55.
DOI: 10.4103/0972-5229.162460
Abstrakt: 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.
Databáze: MEDLINE
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