A Survey of Mechanical Ventilator Practices Across Burn Centers in North America

Abstract

Burn injury introduces unique clinical challenges that make it difficult to extrapolate mechanical ventilator (MV) practices designed for the management of general critical care patients to the burn population. We hypothesize that no consensus exists among North American burn centers with regard to optimal ventilator practices. The purpose of this study is to examine various MV practice patterns in the burn population and to identify potential opportunities for future research. A researcher designed, 24-item survey was sent electronically to 129 burn centers. The χ2, Fisher’s exact, and Cochran–Mantel–Haenszel tests were used to determine if there were significant differences in practice patterns. We analyzed 46 questionnaires for a 36% response rate. More than 95% of the burn centers reported greater than 100 annual admissions. Pressure support and volume assist control were the most common initial MV modes used with or without inhalation injury. In the setting of Berlin defined mild acute respiratory distress syndrome (ARDS), ARDSNet protocol and optimal positive end-expiratory pressure were the top ventilator choices, along with fluid restriction/diuresis as a nonventilator adjunct. For severe ARDS, airway pressure release ventilation and neuromuscular blockade were the most popular. The most frequently reported time frame for mechanical ventilation before tracheostomy was 2 weeks (25 of 45, 55%); however, all respondents reported in the affirmative that there are certain clinical situations where early tracheostomy is warranted. Wide variations in clinical practice exist among North American burn centers. No single ventilator mode or adjunct prevails in the management of burn patients regardless of pulmonary insult. Movement toward American Burn Association–supported, multicenter studies to determine best practices and guidelines for ventilator management in burn patients is prudent in light of these findings.

Burns

“…In a survey of mechanical ventilator practices across burn centers in North America by Chung et al, 41 pressure support and volume assist control were the most common mechanical ventilation modes used in burn patients with or without inhalation injury. In the setting of Berlin defined mild ARDS, ARDSNet protocol and optimal positive end-expiratory pressure were the most common treatments used with fluid restriction/diuresis employed as a nonventilator adjunct.…”

“…In the setting of Berlin defined mild ARDS, ARDSNet protocol and optimal positive end-expiratory pressure were the most common treatments used with fluid restriction/diuresis employed as a nonventilator adjunct. 41 For severe ARDS, airway pressure release ventilation and neuromuscular blockade were most often used. 41 …”

“…41 For severe ARDS, airway pressure release ventilation and neuromuscular blockade were most often used. 41 …”

Acute Inhalation Injury

“…Yanık ve inhalasyon hasarı olan hastalarda, genel yoğun bakım ünitesindeki tipik ventilatör yönetim uygulamalarından farklı, bu hastalar için en iyi stratejileri belirleyen klinik çalışmalar eksiktir. İnhalasyon hasarı olan veya olmayan yanık hastalarında, basınç destek ventilasyonu ve volüm destek kontrol modları, en sık bildirilen başlangıç modlarıdır (51) . Ayrıca, yüksek frekanslı perküsyon ventilasyonu, yüksek frekanslı osilasyon ventilasyonu ve hava yolu basıncı bırakma ventilasyonu da dahil olmak üzere mekanik ventilasyonun diğer modları da kullanılmıştır (51,52) .…”

Unusual Relationship: Do Organs Talk to Each Other?*

“…It is furthermore not uncommon after burn, that renal function returns and dialysis can be stopped. Similarly, ARDS can be treated via critical care protocols and treatment bundles [7]. Because there are available treatment options one would expect a lower mortality for AKI and ARDS.…”