212 The Impact of Tracheostomy in Burns: An Institutional Experience

Abstract

Tracheostomy is routinely performed in the critical care setting to improve mechanical ventilation, reduce lung infections and facilitate bronchial hygiene. The role for prophylactic tracheostomy in burn patients is not well defined. There are no consensus guidelines supporting timing parameters or placement techniques in the burn population. The primary objective of this study is to describe our institution’s experience with the use of percutaneous and open tracheostomies and to define the demographics, clinical course, and outcomes of patients with a burn injury who have received a tracheostomy. A retrospective chart review of 95 patients who received a percutaneous or open tracheostomy at an adult regional American Burn Association-verified burn centre between 2006 to 2016 was performed. Data collected include patient demographics, burn injury patterns, tracheostomy parameters and outcomes, ventilation and sedative requirements pre- and post-tracheostomy, and incidence of ventilator associated pneumonia. Flame burns were the primary mechanism of injury for 86.2% of patients who received a tracheostomy with an average TBSA 30.8%. Thirty six percent of patients presented with ≥ grade 2 inhalational injury. The average number of intubation days pre-tracheostomy was 16.6 days. Percutaneous tracheostomies were done in 56.5% of cases. Post-tracheostomy complications include dysphagia (25.0%), dysphonia (8.7%), tracheal stenosis (2.2%), and site infection (1.1%). Forty-two percent of patients had at least one ventilator associated pneumonia following tracheostomy with pseudomonas (28.2%) and staphylococcus (21.9%) as the most commonly cultured organisms. No significant differences were found in the average P/F ratio, mean PEEP and mean FiO2 requirements after 24 hours following tracheostomy. No significant differences were found in opiate and benzodiazepine administration post tracheostomy. Average time to decannulation was 33.4 days. Percutaneous and open tracheostomies can be used as part of an effective ventilatory management algorithm for burn patients. This ten year retrospective case review offers insight into our institution’s experience with tracheostomies for improvement to current clinical practice protocols for ventilatory management of the burn patient.