[The preventive and therapeutic effect of advanced airway management on pulmonary infection in patients with inhalation injury after tracheotomy].
OBJECTIVE
To observe the preventive and therapeutic effect of advanced airway management on pulmonary infection in patients with inhalation injury after tracheotomy.


METHODS
fourteen burn patients with inhalation injury admitted to our hospital from January 2001 to December 2004 were enrolled as control (C) group, and they were treated with conventional systemic therapy and management of airway. Twenty-seven burn patients with inhalation injury admitted to our hospital from January 2005 to October 2009 were enrolled as advanced (A) group, and they were treated with conventional systemic therapy and advanced airway management, including bedside isolation of airway, fixation of both oxygen supply tube and humidifying tube, humidification in specific body position, thinning of sputum, lavement of airway and procedural sputum elimination, steam inhalation combined with medicine, and suction of sputum with interrupted negative pressure. Result of bacterial culture of sputum (the 7th day after tracheotomy) and chest X-ray (at admission and the 7th day after tracheotomy), pulmonary infection, change in blood gas analysis index and oxygen saturation (SO(2)), (within 7 days after tracheotomy), and the number of patients curd in 2 groups were observed and compared.


RESULTS
(1) Positive result of bacterial culture of sputum was observed in 11 (78.6%) patients in C group and 12 (44.4%) patients in A group. The difference between them was statistically significant (chi(2) = 4.36, P < 0.05). The main bacterium detected was Pseudomonas aeruginosa. (2) Pneumonia was suspected in 7 patients (25.9%) in A group by chest X-ray, which was obviously fewer than that in C group (8 Cases, 57.1%, chi(2) = 3.87, P < 0.05). The result was in accordance with the diagnosis of pulmonary infection. (3) No CO(2) retention, SO(2) and PaCO(2) abnormality caused by asphyxia was observed in 2 groups, PaCO(2) value in A group was close to that in C group (t = 0.89, P > 0.05). (4) In C group, 9 (64.3%) patients were cured, 5 patients died of pneumonia, wound sepsis, and MODS. In A group, 25 (92.6%) patients were cured, 2 patients died of MODS. Number of cure was obviously larger in A group than in C group (chi(2)= 5.22, P < 0.05).


CONCLUSIONS
The advanced airway management has better effects on isolation and humidification of airway, and thinning, drainage, and elimination of sputum. And it can decrease the probability of blind suction and injury to airway, and it prevents pulmonary infection following tracheotomy.
Department of Burns and Plastic Surgery, the 181th Hospital of PLA, Guilin 541002, China.
Ya-lin
YL
Tong
Hong-cheng
HC
Miao
Xiao-yan
XY
Feng
Fu-wang
FW
Yang
Jin-hong
JH
Zhu
Zhen-yu
ZY
Gong
Jian-jun
JJ
Deng
Xiao-chen
XC
Jiang
Fu-jun
FJ
Zhu
Hai-ming
HM
Xin
D000328:Adult; D058109:Airway Management; D002059:Burns, Inhalation / Q000628:therapy*; D005260:Female; D006801:Humans; D008171:Lung Diseases / Q000209:etiology / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D012141:Respiratory Tract Infections / Q000209:etiology / Q000517:prevention & control*; D014140:Tracheotomy; D055815:Young Adult