- Email: [email protected]
Predictors of discontinuation of mechanical ventilation and extubation in burn patients
S84
Burns 3 3 S ( 2 0 0 7 ) S1–S172
Predictors of discontinuation of mechanical ventilation and extubation in burn patients Smailes S. St. Andrew, United Kingdom E-mail address: [email protected]. Aim: The aim of the study is two-fold. Firstly, to identify the rate of reintubation of burn patients in our unit. Secondly, to evaluate the validity and reliability of the spontaneous breathing trial and markers of infection and inflammation in predicting discontinuation of ventilation and extubation outcome in burn patients. Method: A retrospective review of the records of 132 consecutive mechanically ventilated adult burn patients (ventilated for more than 24 h) was performed in order to identify the rate of failed extubation in our unit. A prospective, evaluative, observational, non-interventional study is proceeding with direct data collection from the patients. This involves measurement of the rapid shallow breathing index, cough strength, magnitude of endotracheal secretions, white cell count, c-reactive protein and the urinary albumin:creatinine ratio from patients meeting the inclusion criteria and those deemed ready to discontinue ventilation by the anaesthetist. Results: Age (mean/range): 45.2 (17–91). Smoke inhalation injury: 81 (61.4%). Sex: M = 97; F = 35. Planned extubations: 87. Burn size TBSA% (mean/range): 37.7% (7–95). Failed extubations 23 (26.4%). There were 23 failed extubations in 19 patients. 17 failed extubations (74%) were in 14 patients with smoke inhalation injury. The reason for reintubation in the majority of patients was noted as the need for improved pulmonary toilet (74%), followed by the need for airway protection (13%) and for positive pressure ventilation (13%). 35 patients with smoke inhalation injury proceeded to tracheostomy (43.2%). Conclusions: The rate of failed extubation in this group of patients is considerably higher than that published in the literature from the general intensive care population. This finding highlights the clinical need for the development of a tool to assess the ability of the burn patient to discontinue mechanical ventilation and be extubated. Preferred presentation mode—oral doi:10.1016/j.burns.2006.10.198 The history of early tangential excision Prader S. a,b , Clemens S. a,b a
Spital Uster, Department of Surgery, Switzerland Childrens Hospital Zurich, Switzerland E-mail address: seraina [email protected] (S. Prader).
b
Today surgical approach on burns with early tangential excision and immediate grafting is an undisputed fact in the treatment of burns. But not even 50 years ago this surgical approach to the burn wound was unthinkable. The discussion who invented this revolutionary method has not ended until today. Our investigations about the beginnings of early tangential excision and immediate grafting brought extraordinary results: a woman in former Yugoslavia achieved to lay the foundations of today’s surgical treatment of burns! With our medical historical investigation we wanted to find out more about this woman who renewed the whole concept in the treatment of burns and fought for it against all scepticism and doubts. What was her incentive to dedicate her life to the investigation of burns? Why did she achieve, in a hospital in Maribor, Former-Yugoslavia, to lay the foundations of today’s surgical treatment of burns? What we discovered is a fascinating story about a woman who did not accept dogmas—a story about a woman who achieved to renew the treatment of burns thanks to her doubts and her curiosity. doi:10.1016/j.burns.2006.10.199
Burns 3 3 S ( 2 0 0 7 ) S1–S172
Predictors of discontinuation of mechanical ventilation and extubation in burn patients Smailes S. St. Andrew, United Kingdom E-mail address: [email protected]. Aim: The aim of the study is two-fold. Firstly, to identify the rate of reintubation of burn patients in our unit. Secondly, to evaluate the validity and reliability of the spontaneous breathing trial and markers of infection and inflammation in predicting discontinuation of ventilation and extubation outcome in burn patients. Method: A retrospective review of the records of 132 consecutive mechanically ventilated adult burn patients (ventilated for more than 24 h) was performed in order to identify the rate of failed extubation in our unit. A prospective, evaluative, observational, non-interventional study is proceeding with direct data collection from the patients. This involves measurement of the rapid shallow breathing index, cough strength, magnitude of endotracheal secretions, white cell count, c-reactive protein and the urinary albumin:creatinine ratio from patients meeting the inclusion criteria and those deemed ready to discontinue ventilation by the anaesthetist. Results: Age (mean/range): 45.2 (17–91). Smoke inhalation injury: 81 (61.4%). Sex: M = 97; F = 35. Planned extubations: 87. Burn size TBSA% (mean/range): 37.7% (7–95). Failed extubations 23 (26.4%). There were 23 failed extubations in 19 patients. 17 failed extubations (74%) were in 14 patients with smoke inhalation injury. The reason for reintubation in the majority of patients was noted as the need for improved pulmonary toilet (74%), followed by the need for airway protection (13%) and for positive pressure ventilation (13%). 35 patients with smoke inhalation injury proceeded to tracheostomy (43.2%). Conclusions: The rate of failed extubation in this group of patients is considerably higher than that published in the literature from the general intensive care population. This finding highlights the clinical need for the development of a tool to assess the ability of the burn patient to discontinue mechanical ventilation and be extubated. Preferred presentation mode—oral doi:10.1016/j.burns.2006.10.198 The history of early tangential excision Prader S. a,b , Clemens S. a,b a
Spital Uster, Department of Surgery, Switzerland Childrens Hospital Zurich, Switzerland E-mail address: seraina [email protected] (S. Prader).
b
Today surgical approach on burns with early tangential excision and immediate grafting is an undisputed fact in the treatment of burns. But not even 50 years ago this surgical approach to the burn wound was unthinkable. The discussion who invented this revolutionary method has not ended until today. Our investigations about the beginnings of early tangential excision and immediate grafting brought extraordinary results: a woman in former Yugoslavia achieved to lay the foundations of today’s surgical treatment of burns! With our medical historical investigation we wanted to find out more about this woman who renewed the whole concept in the treatment of burns and fought for it against all scepticism and doubts. What was her incentive to dedicate her life to the investigation of burns? Why did she achieve, in a hospital in Maribor, Former-Yugoslavia, to lay the foundations of today’s surgical treatment of burns? What we discovered is a fascinating story about a woman who did not accept dogmas—a story about a woman who achieved to renew the treatment of burns thanks to her doubts and her curiosity. doi:10.1016/j.burns.2006.10.199