Is tracheostomy warranted in the burn patient? Indications and complications.
Considerable controversy exists as to whether a tracheostomy (TT) is ever indicated in burn patients. Eighty-eight tracheostomies were performed over a 48-month period. An inhalation injury was present in 59.6% of the patients, and 96% had preceding endotracheal intubation (ET). The mean duration of ET was 14 days. Seven percent, 17% and 58% of the TTs were performed within the 1st, 8th, and 14th postburn day, respectively. The indications for TT were: emergency airway access, 7%; complications secondary to ET, 8%; pulmonary sepsis, 75%; pulmonary failure, 10%. The mean duration of TT was 33 days (range: 1-209). Major complications associated with TT included: tracheomalacia, tracheostenosis, tracheoinnominate artery and tracheoesophageal fistulae, and posttracheostomy dysphagia. The decision to perform a TT or to continue with ET should not be predicated on an arbitrary number of days, but must be individualized and based on the clinical condition of the patient. The complications associated with a TT are related to previous ET and to the underlying pulmonary pathology necessitating ventilatory support.
Department of Surgery, University of Texas Health Science Center, Dallas.
J L
JL
Hunt
G F
GF
Purdue
T
T
Gunning
D000328:Adult; D002056:Burns / Q000628:therapy*; D003680:Deglutition Disorders / Q000209:etiology; D006801:Humans; D007442:Intubation, Intratracheal; D012189:Retrospective Studies; D013997:Time Factors; D014133:Tracheal Diseases / Q000209:etiology; D014135:Tracheal Stenosis / Q000209:etiology; D014139:Tracheostomy / Q000009:adverse effects