702 Acute Burn Treatment and Mechanical Ventilation

Abstract

Abstract Introduction Our aim was to explore MV during the acute burn treatment and factors associated with successful extubation. Methods A retrospective review was performed on all burn patients that required MV in a reference burn center from December 2015 to April 2018. Patients successfully extubated or on trach collar (Group1) were compared to those that required re-intubation or died on MV (group2). The patients were also grouped depending on duration of MV, after excluding the patients that died under MV: Group A, 3 or less days; Group B, 4 or more days. A p 0.05 was considered significant. Results Out of a total of 104 burn patients on MV, 7 patients arrived intubated after coding on the field, were confirmed dead on the first 24 hours, and were excluded from the analysis. The mean expected mortality rate was 21.5±31%, 19 (19.5%) died during the admission. The patients remained intubated for 13±19 days, tracheostomy was performed in 20 (21%), after 26±15 days. Fifty-five (56.7%) of the patients were smokers or former smokers, 34 (35%) were illicit drug users, 16 (16.5%) had alcohol intoxication when burned. Inhalation injury was suspected in 80 (82.5%) of the patients, and confirmed in 41 (42.3%). Group 1 was younger: 48.42±18.66 vs 59.15 ± 21.38, p=0.032. Although a smaller rate of confirmed inhalation injury was seen among group1, it was not statistically significant (Group1: 25 (36.8%); group2: 16 (55.2%) (P=0.09). The TBSA burned was bigger on group 2: 18.4%±19.72 vs 34.39%±25.86, p=0.002. History of drug use was not associated with extubation success: group1: 26 (38%); group2: 8 (27.6%); (P=0.314). The expected mortality was significantly higher among group2: 10%±16.1% vs 48.54%±39.33%, p< 0.001. Group1 was associated with the use of less albumin and crystalloids on the first 24h and a bigger volume of urine on Day1 (Table1). A sub-analysis of the group that required re-intubation (n=10) and the successfully extubated showed an increased rate of psychiatric illness among the group requiring re-intubation: 18 (26.5%) vs 7 (70%), p< 0.001. The group that required a shorter time on the MV (GroupA) had a shorter length of stay, smaller percentage of TBSA, required fewer surgeries, and received less albumin and crystalloids on Day1 (Table2). Conclusions Lower expected mortality and age, and smaller %TBSA burned are associated with a successful extubation. Psychiatric illness may be associated with the need for re-intubation. Applicability of Research to Practice This study highlights the association of psychiatric illness and difficulty extubating the burn patient.