Abstract
BackgroundIt is unknown whether lung-protective ventilation is applied in burn patients and whether they benefit from it. This study aimed to determine ventilation practices in burn intensive care units (ICUs) and investigate the association between lung-protective ventilation and the number of ventilator-free days and alive at day 28 (VFD-28).MethodsThis is an international prospective observational cohort study including adult burn patients requiring mechanical ventilation. Low tidal volume (VT) was defined as VT ≤ 8 mL/kg predicted body weight (PBW). Levels of positive end-expiratory pressure (PEEP) and maximum airway pressures were collected. The association between VT and VFD-28 was analyzed using a competing risk model. Ventilation settings were presented for all patients, focusing on the first day of ventilation. We also compared ventilation settings between patients with and without inhalation trauma.ResultsA total of 160 patients from 28 ICUs in 16 countries were included. Low VT was used in 74% of patients, median VT size was 7.3 [interquartile range (IQR) 6.2–8.3] mL/kg PBW and did not differ between patients with and without inhalation trauma (p = 0.58). Median VFD-28 was 17 (IQR 0–26), without a difference between ventilation with low or high VT (p = 0.98). All patients were ventilated with PEEP levels ≥5 cmH2O; 80% of patients had maximum airway pressures <30 cmH2O.ConclusionIn this international cohort study we found that lung-protective ventilation is used in the majority of burn patients, irrespective of the presence of inhalation trauma. Use of low VT was not associated with a reduction in VFD-28.Trial registration Clinicaltrials.gov NCT02312869. Date of registration: 9 December 2014.
Highlights
It is unknown whether lung-protective ventilation is applied in burn patients and whether they benefit from it
The study protocol was centrally approved by the Institutional Review Board (IRB) of the Academic Medical Center at the University of Amsterdam, The Netherlands (W14_314#15.0178)
In our study, applied fraction of inspired oxygen (FiO2) did not differ significantly between patients with and without inhalation trauma and medians were comparable to FiO2 applied to critically ill patients without acute respiratory distress syndrome (ARDS) [4]
Summary
It is unknown whether lung-protective ventilation is applied in burn patients and whether they benefit from it. Low V T was used in 74% of patients, median V T size was 7.3 [interquartile range (IQR) 6.2–8.3] mL/kg PBW and did not differ between patients with and without inhalation trauma (p = 0.58). Conclusion: In this international cohort study we found that lung-protective ventilation is used in the majority of burn patients, irrespective of the presence of inhalation trauma. Ventilator settings important in ‘ventilator-induced lung injury’ (VILI) include tidal volume (VT) and positive end-expiratory pressure (PEEP). VT sizes of ≤8 mL/kg predicted body weight (PBW) are preferred [3,4] as patients with and without acute respiratory distress syndrome (ARDS) benefit from low VT [1,5,6,7,8]. A trend towards the use of moderate PEEP, generally between 5 and 10 cmH2O, has been reported [4,11]
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