Early prediction of prolonged ventilator dependence in thermally injured patients.
BACKGROUND
Recent studies suggest that when prolonged ventilator dependence (PVD) can be predicted in trauma or intensive care unit patients, early tracheostomy may reduce hospital stay and improve utilization of resources. This study was performed to develop criteria predictive of PVD (> 14 days) in burn patients.


METHODS
We reviewed burn patients aged > or =16 years admitted between 1990 and 1994 who required ventilator support for > or =3 days. Using the variables full-thickness burn size, age, inhalation injury, and worst PaO2/FiO2 on ventilator day 3, an equation predicting PVD was created using logistic regression. The equation was tested by applying it to 1995 patients.


RESULTS
When a probability of >0.5 was considered predictive of PVD, the equation correctly predicted PVD in 82% of 1990 to 1994 patients (n = 110) and 90% of 1995 patients (n = 29).


CONCLUSIONS
PVD in burn patients can be predicted using objective variables in the early postburn period. Predictions can be used to select patients for prospective studies of early tracheostomy.
Sellers
B J
BJ
Intermountain Burn Center and the Department of Surgery, University of Utah, Salt Lake City 84132, USA.
Davis
B L
BL
Larkin
P W
PW
Morris
S E
SE
Saffle
J R
JR
D000328:Adult; D000367:Age Factors; D001784:Blood Gas Analysis; D002053:Burn Units / Q000706:statistics & numerical data*; D002056:Burns / Q000097:blood / Q000145:classification* / Q000473:pathology / Q000628:therapy*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D018579:Patient Selection; D011237:Predictive Value of Tests; D012042:Registries; D015203:Reproducibility of Results; D012121:Respiration, Artificial; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D015599:Trauma Severity Indices; D014589:Utah