Outcomes of Tracheostomy on Burn Inhalation Injury

Samuel Ruiz; Salomon Puyana; Mark McKenney; Shaikh Hai; Haaris Mir

Outcomes of Tracheostomy on Burn Inhalation Injury

Eplasty. 2023 Jul 20:23:e43. eCollection 2023.

Authors

Samuel Ruiz¹, Salomon Puyana², Mark McKenney^{1

3}, Shaikh Hai¹, Haaris Mir⁴

Affiliations

¹ Department of Surgery, HCA Florida - Kendall Hospital, Miami, Florida.
² Department of Plastic Surgery, Tulane University, New Orleans, Louisiana.
³ Department of Surgery, University of South Florida, Tampa, Florida.
⁴ HCA Miami Burn Center, Miami, Florida.

PMID: 37664813
PMCID: PMC10472420

Abstract

Background: Tracheostomy has been proposed for patients with expected prolonged intubation. This study aims to determine the outcomes of tracheostomy on patients with burn inhalation injuries requiring mechanical ventilation.

Methods: This study is a retrospective review from 2011 to 2019. Inclusion criteria were recording of inhalation injury, ventilator support (at least 24 hours), and total body surface area of <15%. The patients were stratified into 2 groups: tracheostomy (group 1) versus no tracheostomy (group 2). The outcome measures were in-hospital mortality rate, hospital length of stay, intensive care unit length of stay, ventilator days, and ventilator- associated pneumonia (VAP).

Results: A total of 33 burn patients met our inclusion criteria. Group 1 consisted of 10 patients and group 2 of 23 patients. There was no statistically significant difference in terms of percent total body surface area. There was a higher intensive care unit length of stay at 23.8 days in group 1 compared with 3.16 days in group 2, a higher hospital length of stay at 28.4 days in group 1 compared with 5.26 days in group 2, and higher ventilator days in group 1 with 20.8 days compared with 2.5 days in group 2. There was no statistically significant difference between the 2 groups in terms of mortality. The incidence of VAP was also significantly higher in group 1 than in group 2.

Conclusions: The ideal timing and implementation of tracheostomy with inhalation injury has yet to be determined. In this study, tracheostomy was associated with much longer lengths of stay and pneumonia. The impact of the underlying lung injury versus the tracheostomy itself on these observations is unclear. The challenge of characterizing the severity of an inhalation injury based on early visual inspection remains.

Keywords: Burns; Inhalation Injury; Outcomes; Tracheostomy.

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