Benefits of early tracheostomy in severely burned children

Research output: Contribution to journalArticle

52 Citations (Scopus)

Abstract

Objective: The role of tracheostomy in burn patients is controversial. Previous studies, primarily in adults, suggested that severely burned patients with tracheostomies have a higher incidence of tracheostomy site infections, mortality, and pneumonia. The purpose of this study is to determine the safety and efficacy of early tracheostomy in severely burned children. Design: Case series study analyzing mechanical ventilation and sedation requirements before and 24 hrs after tracheostomy. Setting: Regional pediatric burn center. Patients: All children admitted to a regional pediatric burn center requiring tracheostomy from March 1, 1998, to October 1, 2001. Methods: Data were recorded on patients' demographics, extent of burn, presence of inhalation injury, and mortality. Mechanical ventilation variables measured pretracheostomy (pre) and posttracheostomy (post) and included mode of ventilation, ventilator settings, peak inspiratory pressures, and arterial blood gases (Pao2, Paco2, pH, and oxygen saturation). Calculated variables included compliance, Pao2:Fio2 ratio, and minute ventilation. Tracheostomy-related variables recorded included the interval to tracheostomy insertion, the duration of tracheostomy, and tracheostomy complications. Main Results: A total of 38 patients (with a mean age of 4.7 ± 0.6 yrs and a mean total body surface area involvement of 54% ± 4%, 63% with inhalation injury) underwent tracheostomy a mean of 3.9 ± 0.7 days after admission. Overall mortality was 21%. There were no tracheostomy site infections, tracheostomy-related deaths, or tracheal stenoses in survivors. Peak inspiratory pressures were lower after tracheostomy (30.4 ± 1.4 [pre] vs. 27.6 ± 1.5 cm H2O [post]; p < .05), ventilatory volumes were higher (190 ± 22 mL [pre] vs. 225.5 ± 25 [post]; p < .05), compliance improved (10.5 ± 1.4 [pre] vs. 15.1 ± 2.3 mL/cm H2O [post]; p < .05), and the Pao2:Fio2 ratio improved (300.6 ± 20 [pre] vs. 348.6 ± 16 [post]). There was no difference in oxygenation, ventilation, minute ventilation, or pH after tracheostomy. Conclusions: Early tracheostomy in severely burned children is safe and effective. It provides a secure airway and may result in improvement in ventilator management for these children.

Original languageEnglish (US)
Pages (from-to)922-924
Number of pages3
JournalCritical Care Medicine
Volume30
Issue number4
StatePublished - 2002
Externally publishedYes

Fingerprint

Tracheostomy
Ventilation
Burn Units
Mechanical Ventilators
Artificial Respiration
Compliance
Mortality
Inhalation Burns
Pediatrics
Tracheal Stenosis
Body Surface Area
Wounds and Injuries
Infection
Inhalation

Keywords

  • Burns
  • Complications
  • Lung compliance
  • Mechanical ventilation
  • Pediatrics
  • Tracheostomies

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Benefits of early tracheostomy in severely burned children. / Palmieri, Tina L; Jackson, William; Greenhalgh, David G.

In: Critical Care Medicine, Vol. 30, No. 4, 2002, p. 922-924.

Research output: Contribution to journalArticle

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title = "Benefits of early tracheostomy in severely burned children",
abstract = "Objective: The role of tracheostomy in burn patients is controversial. Previous studies, primarily in adults, suggested that severely burned patients with tracheostomies have a higher incidence of tracheostomy site infections, mortality, and pneumonia. The purpose of this study is to determine the safety and efficacy of early tracheostomy in severely burned children. Design: Case series study analyzing mechanical ventilation and sedation requirements before and 24 hrs after tracheostomy. Setting: Regional pediatric burn center. Patients: All children admitted to a regional pediatric burn center requiring tracheostomy from March 1, 1998, to October 1, 2001. Methods: Data were recorded on patients' demographics, extent of burn, presence of inhalation injury, and mortality. Mechanical ventilation variables measured pretracheostomy (pre) and posttracheostomy (post) and included mode of ventilation, ventilator settings, peak inspiratory pressures, and arterial blood gases (Pao2, Paco2, pH, and oxygen saturation). Calculated variables included compliance, Pao2:Fio2 ratio, and minute ventilation. Tracheostomy-related variables recorded included the interval to tracheostomy insertion, the duration of tracheostomy, and tracheostomy complications. Main Results: A total of 38 patients (with a mean age of 4.7 ± 0.6 yrs and a mean total body surface area involvement of 54{\%} ± 4{\%}, 63{\%} with inhalation injury) underwent tracheostomy a mean of 3.9 ± 0.7 days after admission. Overall mortality was 21{\%}. There were no tracheostomy site infections, tracheostomy-related deaths, or tracheal stenoses in survivors. Peak inspiratory pressures were lower after tracheostomy (30.4 ± 1.4 [pre] vs. 27.6 ± 1.5 cm H2O [post]; p < .05), ventilatory volumes were higher (190 ± 22 mL [pre] vs. 225.5 ± 25 [post]; p < .05), compliance improved (10.5 ± 1.4 [pre] vs. 15.1 ± 2.3 mL/cm H2O [post]; p < .05), and the Pao2:Fio2 ratio improved (300.6 ± 20 [pre] vs. 348.6 ± 16 [post]). There was no difference in oxygenation, ventilation, minute ventilation, or pH after tracheostomy. Conclusions: Early tracheostomy in severely burned children is safe and effective. It provides a secure airway and may result in improvement in ventilator management for these children.",
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T1 - Benefits of early tracheostomy in severely burned children

AU - Palmieri, Tina L

AU - Jackson, William

AU - Greenhalgh, David G

PY - 2002

Y1 - 2002

N2 - Objective: The role of tracheostomy in burn patients is controversial. Previous studies, primarily in adults, suggested that severely burned patients with tracheostomies have a higher incidence of tracheostomy site infections, mortality, and pneumonia. The purpose of this study is to determine the safety and efficacy of early tracheostomy in severely burned children. Design: Case series study analyzing mechanical ventilation and sedation requirements before and 24 hrs after tracheostomy. Setting: Regional pediatric burn center. Patients: All children admitted to a regional pediatric burn center requiring tracheostomy from March 1, 1998, to October 1, 2001. Methods: Data were recorded on patients' demographics, extent of burn, presence of inhalation injury, and mortality. Mechanical ventilation variables measured pretracheostomy (pre) and posttracheostomy (post) and included mode of ventilation, ventilator settings, peak inspiratory pressures, and arterial blood gases (Pao2, Paco2, pH, and oxygen saturation). Calculated variables included compliance, Pao2:Fio2 ratio, and minute ventilation. Tracheostomy-related variables recorded included the interval to tracheostomy insertion, the duration of tracheostomy, and tracheostomy complications. Main Results: A total of 38 patients (with a mean age of 4.7 ± 0.6 yrs and a mean total body surface area involvement of 54% ± 4%, 63% with inhalation injury) underwent tracheostomy a mean of 3.9 ± 0.7 days after admission. Overall mortality was 21%. There were no tracheostomy site infections, tracheostomy-related deaths, or tracheal stenoses in survivors. Peak inspiratory pressures were lower after tracheostomy (30.4 ± 1.4 [pre] vs. 27.6 ± 1.5 cm H2O [post]; p < .05), ventilatory volumes were higher (190 ± 22 mL [pre] vs. 225.5 ± 25 [post]; p < .05), compliance improved (10.5 ± 1.4 [pre] vs. 15.1 ± 2.3 mL/cm H2O [post]; p < .05), and the Pao2:Fio2 ratio improved (300.6 ± 20 [pre] vs. 348.6 ± 16 [post]). There was no difference in oxygenation, ventilation, minute ventilation, or pH after tracheostomy. Conclusions: Early tracheostomy in severely burned children is safe and effective. It provides a secure airway and may result in improvement in ventilator management for these children.

AB - Objective: The role of tracheostomy in burn patients is controversial. Previous studies, primarily in adults, suggested that severely burned patients with tracheostomies have a higher incidence of tracheostomy site infections, mortality, and pneumonia. The purpose of this study is to determine the safety and efficacy of early tracheostomy in severely burned children. Design: Case series study analyzing mechanical ventilation and sedation requirements before and 24 hrs after tracheostomy. Setting: Regional pediatric burn center. Patients: All children admitted to a regional pediatric burn center requiring tracheostomy from March 1, 1998, to October 1, 2001. Methods: Data were recorded on patients' demographics, extent of burn, presence of inhalation injury, and mortality. Mechanical ventilation variables measured pretracheostomy (pre) and posttracheostomy (post) and included mode of ventilation, ventilator settings, peak inspiratory pressures, and arterial blood gases (Pao2, Paco2, pH, and oxygen saturation). Calculated variables included compliance, Pao2:Fio2 ratio, and minute ventilation. Tracheostomy-related variables recorded included the interval to tracheostomy insertion, the duration of tracheostomy, and tracheostomy complications. Main Results: A total of 38 patients (with a mean age of 4.7 ± 0.6 yrs and a mean total body surface area involvement of 54% ± 4%, 63% with inhalation injury) underwent tracheostomy a mean of 3.9 ± 0.7 days after admission. Overall mortality was 21%. There were no tracheostomy site infections, tracheostomy-related deaths, or tracheal stenoses in survivors. Peak inspiratory pressures were lower after tracheostomy (30.4 ± 1.4 [pre] vs. 27.6 ± 1.5 cm H2O [post]; p < .05), ventilatory volumes were higher (190 ± 22 mL [pre] vs. 225.5 ± 25 [post]; p < .05), compliance improved (10.5 ± 1.4 [pre] vs. 15.1 ± 2.3 mL/cm H2O [post]; p < .05), and the Pao2:Fio2 ratio improved (300.6 ± 20 [pre] vs. 348.6 ± 16 [post]). There was no difference in oxygenation, ventilation, minute ventilation, or pH after tracheostomy. Conclusions: Early tracheostomy in severely burned children is safe and effective. It provides a secure airway and may result in improvement in ventilator management for these children.

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KW - Complications

KW - Lung compliance

KW - Mechanical ventilation

KW - Pediatrics

KW - Tracheostomies

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