title: A Survey of Mechanical Ventilator Practices Across Burn Centers in North America.
abstract: Burn injury introduces unique clinical challenges that make it difficult to extrapolate mechanical ventilator (MV) practices designed for the management of general critical care patients to the burn population. We hypothesize that no consensus exists among North American burn centers with regard to optimal ventilator practices. The purpose of this study is to examine various MV practice patterns in the burn population and to identify potential opportunities for future research. A researcher designed, 24-item survey was sent electronically to 129 burn centers. The χ, Fisher's exact, and Cochran-Mantel-Haenszel tests were used to determine if there were significant differences in practice patterns. We analyzed 46 questionnaires for a 36% response rate. More than 95% of the burn centers reported greater than 100 annual admissions. Pressure support and volume assist control were the most common initial MV modes used with or without inhalation injury. In the setting of Berlin defined mild acute respiratory distress syndrome (ARDS), ARDSNet protocol and optimal positive end-expiratory pressure were the top ventilator choices, along with fluid restriction/diuresis as a nonventilator adjunct. For severe ARDS, airway pressure release ventilation and neuromuscular blockade were the most popular. The most frequently reported time frame for mechanical ventilation before tracheostomy was 2 weeks (25 of 45, 55%); however, all respondents reported in the affirmative that there are certain clinical situations where early tracheostomy is warranted. Wide variations in clinical practice exist among North American burn centers. No single ventilator mode or adjunct prevails in the management of burn patients regardless of pulmonary insult. Movement toward American Burn Association-supported, multicenter studies to determine best practices and guidelines for ventilator management in burn patients is prudent in light of these findings.
authors.affiliation: From the *United States Army Institute of Surgical Research, Fort Sam Houston, Texas; †Uniformed Services University of the Health Sciences, Bethesda, Maryland; ‡Sunnybrook Health Sciences Centre, Toronto, Canada; §Massachusetts General Hospital, Boston; ¶Arizona Burn Center, Phoenix; ‖University of California Irvine Regional Burn Center, Orange; #University of Wisconsin Hospital, Madison; **University of Alberta, Edmonton, Canada; ††Shriners Hospital for Children, Galveston, Texas; ††Memphis Burn Center, Memphis, Tennessee; and §§Mount Sinai Beth Israel Medical Center, New York, New York.
authors.forename: Kevin K
authors.initials: KK
authors.lastname: Chung
authors.forename: Ryan Y
authors.initials: RY
authors.lastname: Rhie
authors.forename: Jonathan B
authors.initials: JB
authors.lastname: Lundy
authors.forename: Robert
authors.initials: R
authors.lastname: Cartotto
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Henderson
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Pressman
authors.forename: Victor C
authors.initials: VC
authors.lastname: Joe
authors.forename: James K
authors.initials: JK
authors.lastname: Aden
authors.forename: Ian R
authors.initials: IR
authors.lastname: Driscoll
authors.forename: Lee D
authors.initials: LD
authors.lastname: Faucher
authors.forename: Robert C
authors.initials: RC
authors.lastname: McDermid
authors.forename: Ronald P
authors.initials: RP
authors.lastname: Mlcak
authors.forename: William L
authors.initials: WL
authors.lastname: Hickerson
authors.forename: James C
authors.initials: JC
authors.lastname: Jeng
mesh_terms: D002053:Burn Units; D006801:Humans; D009656:North America; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012121:Respiration, Artificial / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires