Ventilation practices in burn patients-an international prospective observational cohort study.

Autor: Schultz MJ; Academic Medical Center, University of Amsterdam, Amsterdam, AZ 1105, The Netherlands., Horn J; Academic Medical Center, University of Amsterdam, Amsterdam, AZ 1105, The Netherlands., Hollmann MW; Academic Medical Center, University of Amsterdam, Amsterdam, AZ 1105, The Netherlands., Preckel B; Academic Medical Center, University of Amsterdam, Amsterdam, AZ 1105, The Netherlands., Glas GJ; Academic Medical Center, University of Amsterdam, Amsterdam, AZ 1105, The Netherlands., Colpaert K; Ghent University Hospital, Ghent 9000, Belgium., Malbrain M; Vrije Universiteit Brussel, Brussel, Jette 1090, Belgium., Neto AS; ABC Medical School, São Paulo, Bangú, SP 5001, Brazil., Asehnoune K; Service d'Anesthésie Réanimation Chirurgicale, Nantes 44093, France., de Abreu MG; University Hospital Carl Gustav Carus, Dresden 01307, Germany., Martin-Loeches I; St James University Hospital, Dublin D08 NHY1, Ireland., Pelosi P; University of Genoa, Genoa, GE 16128, Italy., Sjöberg F; Linköping University Hospital, Linköping 581 85, Sweden., Binnekade JM; Academic Medical Center, University of Amsterdam, Amsterdam, AZ 1105, The Netherlands., Cleffken B; Maasstad Hospital, Rotterdam, DZ 3079, The Netherlands., Juffermans NP; Academic Medical Center, University of Amsterdam, Amsterdam, AZ 1105, The Netherlands., Knape P; Red Cross Hospital, Beverwijk, LE 1942, The Netherlands., Loef BG; Martini Hospital, Groningen, NT 9728, The Netherlands., Mackie DP; Red Cross Hospital, Beverwijk, LE 1942, The Netherlands., Enkhbaatar P; University of Texas Medical Branch, Galveston, TX 77555, USA., Depetris N; Turin CTO Burn Center, Turin, TO 10126, Italy., Perner A; Rigshospitalet, Copenhagen 2100, Denmark., Herrero E; La Paz University Hospital, Madrid 28046, Spain., Cachafeiro L; La Paz University Hospital, Madrid 28046, Spain., Jeschke M; Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, Toronto M4N 3M5, Canada., Lipman J; Royal Brisbane and Women's Hospital, Queensland University, Herston, QLD 4029, Australia., Legrand M; GH St-Louis- Lariboisière, APHP, Paris 75010, France., Horter J; BG Klinik Ludwigshafen, Ludwigshafen 67071, Germany., Lavrentieva A; Papanikoalou Hospital, Thessaloniki 546 21, Greece., Glas G; Academic Medical Center, University of Amsterdam, Amsterdam, AZ 1105, The Netherlands., Kazemi A; Middlemore Hospital, Otahuhu, Auckland 2025, New Zealand., Guttormsen AB; Haukeland University Hospital, Bergen 5021, Norway., Huss F; Uppsala University Hospital, Uppsala 751 85, Sweden., Kol M; Concord Repatriation General Hospital NSW, University of Sydney, Concord 2139, Australia., Wong H; Concord Repatriation General Hospital NSW, University of Sydney, Concord 2139, Australia., Starr T; Royal Brisbane and Women's Hospital, Queensland University, Herston, QLD 4029, Australia., De Crop L; Ghent University Hospital, Ghent 9000, Belgium., de Oliveira Filho W; Ziekenhuis Netwerk Antwerpen-Stuivenberg, Antwerpen 2060, Belgium., Manoel Silva Junior J; Hospital e Pronto Socorro 28 de Agosto, Manaus 69057-000, Brazil., Grion CMC; Universidade de Sao Paulo, Sao Paulo 01246-903, Brazil., Jeschke MG; Universidade Estadual de Londrina, Londrina 86057-970, Brazil., Burnett M; Universidade Estadual de Londrina, Londrina 86057-970, Brazil., Mondrup F; Rigshospitalet, Copenhagen 2100, Denmark., Ravat F; Sunnybrook Health Sciences Centre, Toronto M4N 3M5, Canada., Fontaine M; Sunnybrook Health Sciences Centre, Toronto M4N 3M5, Canada., Asehoune K; CHU Lyon St Luc, Lyon 69007, France., Floch RL; CHU Lyon St Luc, Lyon 69007, France., Jeanne M; CHU Nantes Service dánesthesie reanimation chirugicale, Nantes 44093, France., Bacus M; CHU Nantes Service dánesthesie reanimation chirugicale, Nantes 44093, France., Chaussard M; Hopital Roger Salengro, CHRU Lille, Lille 59037, France., Lehnhardt M; Saint-Louis Hospital, Paris 75010, France., Mikhail BD; Saint-Louis Hospital, Paris 75010, France., Gille J; BG University Hospital Bergmannsheil, Bochum 44789, Germany., Sharkey A; St James University Hospital, Dublin D08 NHY1, Ireland., Trommel N; Maasstad Hospital, Rotterdam, DZ 3079, The Netherlands., Reidinga AC; Martini Hospital, Groningen, NT 9728, The Netherlands., Vieleers N; Red Cross Hospital, Beverwijk, LE 1942, The Netherlands., Tilsley A; Middlemore Hospital, Otahuhu, Auckland 2025, New Zealand., Onarheim H; Haukeland University Hospital, Bergen 5021, Norway., Bouza MT; St George Leipzig, Leipzig 04129, Germany., Agrifoglio A; La Paz University Hospital, Madrid 28046, Spain., Fredén F; Uppsala University Hospital, Uppsala 751 85, Sweden., Palmieri T; St. James Hospital, Dublin D08 NHY1, Ireland., Painting LE; St. James Hospital, Dublin D08 NHY1, Ireland.
Jazyk: angličtina
Zdroj: Burns & trauma [Burns Trauma] 2021 Dec 16; Vol. 9, pp. tkab034. Date of Electronic Publication: 2021 Dec 16 (Print Publication: 2021).
DOI: 10.1093/burnst/tkab034
Abstrakt: Background: It is unknown whether lung-protective ventilation is applied in burn patients and whether they benefit from it. This study aimed to determine ventilation practices in burn intensive care units (ICUs) and investigate the association between lung-protective ventilation and the number of ventilator-free days and alive at day 28 (VFD-28).
Methods: This is an international prospective observational cohort study including adult burn patients requiring mechanical ventilation. Low tidal volume ( V T ) was defined as V T  ≤ 8 mL/kg predicted body weight (PBW). Levels of positive end-expiratory pressure (PEEP) and maximum airway pressures were collected. The association between V T and VFD-28 was analyzed using a competing risk model. Ventilation settings were presented for all patients, focusing on the first day of ventilation. We also compared ventilation settings between patients with and without inhalation trauma.
Results: A total of 160 patients from 28 ICUs in 16 countries were included. Low V T was used in 74% of patients, median V T size was 7.3 [interquartile range (IQR) 6.2-8.3] mL/kg PBW and did not differ between patients with and without inhalation trauma ( p  = 0.58). Median VFD-28 was 17 (IQR 0-26), without a difference between ventilation with low or high V T ( p  = 0.98). All patients were ventilated with PEEP levels ≥5 cmH 2 O; 80% of patients had maximum airway pressures <30 cmH 2 O.
Conclusion: In this international cohort study we found that lung-protective ventilation is used in the majority of burn patients, irrespective of the presence of inhalation trauma. Use of low V T was not associated with a reduction in VFD-28.
Trial Registration: Clinicaltrials.gov NCT02312869. Date of registration: 9 December 2014.
(© The Author(s) 2021. Published by Oxford University Press.)
Databáze: MEDLINE
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