Weaning of Children With Burn Injury by Noninvasive Ventilation: A Clinical Experience

Abstract

The aim of this study was to report the respiratory management of a cohort of infants admitted to a Pediatric Intensive Care Unit (PICU) over a 7-year period due to severe burn injury and the potential benefits of noninvasive ventilation (NIV). A retrospective review of all pediatric patients admitted to PICU between 2009 and 2016 was conducted. From 2009 to 2016, 118 infants and children with burn injury were admitted to our institution (median age 16 months [IQR = 12.2–20]); 51.7% of them had face burns, 37.3% underwent tracheal intubation, and 30.5% had a PICU stay greater than 7 days. Ventilated patients had a longer PICU stay (13 days [IQR = 8–26] vs 4.5 days [IQR = 2–13]). Both ventilation requirement and TBSA% correlated with PICU stay (r = .955, p < .0001 and r = .335, p = .002, respectively), while ventilation was best related in those >1 week (r = .964, p < .0001 for ventilation, and r = −.079, p = .680, for TBSA%). NIV was introduced in 10 patients, with the aim of shorten the invasive ventilation requirement. As evidenced in our work, mechanical ventilation is frequently needed in burned children admitted to PICU and it is one of the main factors influencing PICU length of stay. No difference was found in terms of PICU length of stay and invasive mechanical ventilation time between children who underwent NIV and children who did not, despite children who underwent NIV had a larger burn surface. NIV can possibly shorten the total invasive ventilation time and related complications.

Noninvasive Bi-Level Positive Airway Pressure Ventilation in Blunt Chest Trauma

“…(2019) [11] Eligibility criteria for inclusion were as follows: severe blunt chest trauma, with an injury severity score (ISS) of >15, and a thorax abbreviated injury score (AIS) >3; pulmonary contusion of>10% of the total lung volume, documented by admission computed tomographic scan; need for tracheal intubation and mechanical ventilation for at least the first 48 h post trauma. Also, Piastra M et al (2019) [12] The effectiveness of NPPV was demonstrated by an improvement in the PaO2, an increase in the tidal volume and a decrease in the respiratory rate.…”

Analysis of risk factors of prolonged mechanical ventilation in patients with severe burn injury

“…3,4 In a recent study, prolonged mechanical ventilation significantly extended the length of intensive care and hospital stay for burn patients. 5,6 The leading causes were the weakness of the respiratory muscles, ventilator-related pneumonia, lung injury, and other related complications caused by prolonged mechanical ventilation. [7][8][9] Regarding prolonged mechanical ventilation, independent risk factors have been reported in many studies, including patients with various types of surgery 10,11 and critically ill patients.…”

“…However, mechanical ventilation is still a life‐saving intervention for critically ill patients 3,4 . In a recent study, prolonged mechanical ventilation significantly extended the length of intensive care and hospital stay for burn patients 5,6 . The leading causes were the weakness of the respiratory muscles, ventilator‐related pneumonia, lung injury, and other related complications caused by prolonged mechanical ventilation 7–9 .…”

Navigating the Multiverse: Heterogeneity in Pediatric Burn Care in the United States*

“…Nearly 27% of the pediatric burn patients in the VPS database were diagnosed with acute respiratory distress syndrome, and 26% had two or more organ failures. Single-center retrospective studies in PICUs outside the United States also report high rates of IMV utilization, ranging from 21% to 37% of cases (5, 14). Unfortunately, these IMV utilization rates are not easily compared with the report by Garren et al (1), which drew from all acute burn admissions and not only their ICU admissions.…”

“…Nearly 27% of the pediatric burn patients in the VPS database were diagnosed with acute respiratory distress syndrome, and 26% had two or more organ failures. Single-center retrospective studies in PICUs outside the United States also report high rates of IMV utilization, ranging from 21% to 37% of cases (5,14). Unfortunately, these IMV utilization rates are not easily compared with the report by Garren et al (1), which drew from all acute burn admissions and Although studies like the one by Garren et al (1) add to our understanding of pediatric burn intensive care, a more comprehensive look at children across the pediatric burn care multiverse is needed to fully understand IMV and other critical care resource utilization in this population.…”