Tracheostomy in the Young Pediatric Burn Patient

Tracheostomy in pediatric burn patients

“…This is similar to a published report that indicates that mortality in pediatric patients with a tracheostomy is related to the severity of illness and not complications from the tracheostomy [13]. In addition, the decannulation rate and complications presented in our study are similar to a previous report in pediatric burn patients [2]. Thus, tracheostomy appears to be safe and effective for pediatric burn patients.…”

“…Past controversies about tracheostomies in burn patients have been resolved by current reports that indicate due to lower airway ventilation volumes and lower tracheostomy cuff pressures, tracheostomies are generally safe and effective [2,6,9,10]. However, although tracheostomies provide safe airways for pediatric burn patients, decisions on removal of tracheostomies may be influenced by age related factors and established guidelines for tracheostomy care to reduce time to decannulation have not been well studied especially in children [11,12].…”

“…Establishment of secure and stable airways is an essential element in the acute management critically ill pediatric burn patients [1]. Tracheostomies are sometimes performed in pediatric burn patients due to difficulty in establishing and maintaining a secure oral or nasal airway, extensive burn or severe inhalation injury necessitating prolonged mechanical ventilation, and severe prolonged pulmonary dysfunction [2].…”

Fluid Resuscitation in Major Burns

“…The dangers of fluid overresuscitation, which have been highlighted, include pulmonary oedema, 10 the need for fasciotomy in uninjured limbs 11 and the need for tracheostomy in patients with scald burns 12 . Our patient group had no life‐threatening pulmonary oedema, and findings of fluid overload on chest X‐ray features also correlate poorly with clinical fluid overload.…”

Evolution of Burn Resuscitation in Operation Iraqi Freedom

“…We have termed the effects of over-resuscitation as "resuscitation morbidity," a constellation of complications that may include abdominal compartment syndrome (ACS), airway obstruction, extremity compartment syndromes, and pulmonary edema. [12][13][14][15] A resuscitation volume greater than 237 ml/kg over the course of 12 hours (or 16 liters during a 12-hour period in a 70-kg man) appears to be the threshold for the development of ACS. 16 ACS results in decreased renal blood flow and subsequent renal failure, intestinal ischemia, respiratory failure, and death if not recognized even and treated early.…”