Citation Information :
Mourelo M, Galeiras R, Pértega S, Freire D, López E, Broullón J, Campos E. Tracheostomy in the management of patients with thermal injuries. Indian J Crit Care Med 2015; 19 (8):449-455.
Objective: To assess the use and clinical impact of tracheostomy in burn patients. Summary Background Data: The role of tracheostomy in the management of burn patients is controversial, with only a few recent studies conducted in this population. Methods: Retrospective study of all adult burn patients who underwent a tracheostomy in a Burns Unit between 1995 and 2013. These were compared with a control group (1:1) who underwent orotracheal intubation. Hospital records were reviewed to obtain demographic and clinical information, including those related to respiratory support and tracheostomy. The McNemar′s Chi-square and Signed-Rank Tests were used to study differences in morbimortality between both groups. Results: A total of n = 20 patients underwent tracheostomy (0.9% of admissions, 56.0 ± 19.5 years, 60.0% women). The most common indication was long-term ventilation (75%), 24.6 ± 19.7 days after admission. Thirteen patients were successfully decannulated with a fatal complication observed in one case. Patients in the tracheostomy group were found to require longer-term mechanical ventilation (43.2 vs. 20.4 days; P = 0.004), with no differences in respiratory infection rates (30.0% vs. 31.6%; P = 0.687) or mortality (30.0% vs. 42.1%; P = 0.500). Ventilator weaning times (15.7 vs. 3.3 days; P = 0.001) and hospital stays (99.1 vs. 53.1 days; P = 0.030) were longer in the tracheostomy group, with no differences in duration of sedation. Conclusions: Tracheostomy may be a safe procedure in burn patients and is not associated with higher rates of mortality or respiratory infection. Tracheostomy patients showed longer mechanical ventilation times and higher morbidity, probably not attributable to tracheostomy.
Young D, Harrison DA, Cuthbertson BH, Rowan K, TracMan Collaborators. Effect of early vs late tracheostomy placement on survival in patients receiving mechanical ventilation: The TracMan randomized trial. JAMA 2013;309:2121-9.
Terragni PP, Antonelli M, Fumagalli R, Faggiano C, Berardino M, Pallavicini FB, et al. Early vs late tracheotomy for prevention of pneumonia in mechanically ventilated adult ICU patients: A randomized controlled trial. JAMA 2010;303:1483-9.
Angus DC. When should a mechanically ventilated patient undergo tracheostomy? JAMA 2013;309:2163-4.
Freeman BD, Morris PE. Tracheostomy practice in adults with acute respiratory failure. Crit Care Med 2012;40:2890-6.
Koch T, Hecker B, Hecker A, Brenck F, Preuß M, Schmelzer T, et al. Early tracheostomy decreases ventilation time but has no impact on mortality of intensive care patients: A randomized study. Langenbecks Arch Surg 2012;397:1001-8.
Blot F, Similowski T, Trouillet JL, Chardon P, Korach JM, Costa MA, et al. Early tracheotomy versus prolonged endotracheal intubation in unselected severely ill ICU patients. Intensive Care Med 2008;34:1779-87.
Gravvanis AI, Tsoutsos DA, Iconomou TG, Papadopoulos SG. Percutaneous versus conventional tracheostomy in burned patients with inhalation injury. World J Surg 2005;29:1571-5.
Aggarwal S, Smailes S, Dziewulski P. Tracheostomy in burns patients revisited. Burns 2009;35:962-6.
Saffle JR, Morris SE, Edelman L. Early tracheostomy does not improve outcome in burn patients. J Burn Care Rehabil 2002;23:431-8.
Kagan RJ, Gamelli R, Kemalyan N, Saffle JR. Tracheostomy in thermally injured patients: Does diagnosis-related group 483 adequately estimate resource use and hospital costs? J Trauma 2004;57:861-6.
DuBose CM, Groher MG, Mann GC, Mozingo DW. Pattern of dysphagia recovery after thermal burn injury. J Burn Care Rehabil 2005;26:233-7.
Clayton N, Kennedy P, Maitz P. The severe burns patient with tracheostomy: Implications for management of dysphagia, dysphonia and laryngotracheal pathology. Burns 2010;36:850-5.
Gotsman MS, Whitby JL. Respiratory infection following tracheostomy. Thorax 1964;19:89-96.
Moylan JA Jr, West JT, Nash G, Bowen JA, Pruitt BA Jr. Tracheostomy in thermally injured patients: A review of five years′ experience. Am Surg 1972;38:119-23.
Galeiras R, Lorente JA, Pértega S, Vallejo A, Tomicic V, de la Cal MA, et al. A model for predicting mortality among critically ill burn victims. Burns 2009;35:201-9.
Eckhauser FE, Billote J, Burke JF, Quinby WC. Tracheostomy complicating massive burn injury. A plea for conservatism. Am J Surg 1974;127:418-23.
Jones WG, Madden M, Finkelstein J, Yurt RW, Goodwin CW. Tracheostomies in burn patients. Ann Surg 1989;209:471-4.
Isaev GA. On the indications and effectiveness of tracheostomy in the treatment of burns. Khirurgiia (Mosk) 1968;44:80-2.
Foley FD, Moncrief JA, Mason AD Jr. Pathology of the lung in fatally burned patints. Ann Surg 1968;167:251-64.
Hunt JL, Purdue GF, Gunning T. Is tracheostomy warranted in the burn patient? Indications and complications. J Burn Care Rehabil 1986;7:492-5.