title: Increase in early mechanical ventilation of burn patients: an effect of current emergency trauma management?
abstract: BACKGROUND
  Data relating to patients admitted with extensive burn injuries in the Netherlands have revealed a marked increase in patients whose initial care included mechanical ventilation (MV). The increase was abrupt, dating from 1997, and has been sustained since. The aim of this study is to quantify this observation and to discuss possible causes.
  
  
  METHODS
  The study included 258 consecutive patients with burns >30% total body surface area admitted to the Beverwijk burns center. Patients were divided into two groups based on admission date: group 1 from 1987 to 1996 (n=135) and group 2 from 1997 to 2006 (n=123). Data were analyzed using χ or analysis of variance.
  
  
  RESULTS
  There were no differences between groups in demographics, facial burns, inhalation injury, and % total body surface area. However, the number of patients subjected to MV at admission increased from 38% to 76% (group 1 vs. 2; p<0.001). In 57% of patients who were intubated based on the suspicion of inhalation injury, this condition could not be confirmed (p<0.05 vs. 9% [1987-1996]).
  
  
  CONCLUSIONS
  This study has confirmed that a higher proportion of patients were treated with MV since 1997, whereas the severity of burn injury remained unchanged throughout the study period. In the absence of a clinical explanation, we surmise that there has been a change within Dutch casualty departments in the initial management of major burn injury. The change coincides with the implementation of the Advanced Life Trauma Support training course as the accepted standard of trauma care in Dutch hospitals.
authors: Department of Anesthesiology, Red Cross Hospital, Beverwijk, The Netherlands.
authors: David P
authors: DP
authors: Mackie
authors: Frederieke
authors: F
authors: van Dehn
authors: Paul
authors: P
authors: Knape
authors: Roelf S
authors: RS
authors: Breederveld
authors: Christa
authors: C
authors: Boer