title: Tracheostomy in the management of patients with thermal injuries.
abstract: OBJECTIVE
  To assess the use and clinical impact of tracheostomy in burn patients.
  
  
  BACKGROUND
  The role of tracheostomy in the management of burn patients is controversial, with only a few recent studies conducted in this population.
  
  
  METHODS
  Retrospective study of all adult burn patients who underwent a tracheostomy in a Burns Unit between 1995 and 2013. These were compared with a control group (1:1) who underwent orotracheal intubation. Hospital records were reviewed to obtain demographic and clinical information, including those related to respiratory support and tracheostomy. The McNemar's Chi-square and Signed-Rank Tests were used to study differences in morbimortality between both groups.
  
  
  RESULTS
  A total of n = 20 patients underwent tracheostomy (0.9% of admissions, 56.0 ± 19.5 years, 60.0% women). The most common indication was long-term ventilation (75%), 24.6 ± 19.7 days after admission. Thirteen patients were successfully decannulated with a fatal complication observed in one case. Patients in the tracheostomy group were found to require longer-term mechanical ventilation (43.2 vs. 20.4 days; P = 0.004), with no differences in respiratory infection rates (30.0% vs. 31.6%; P = 0.687) or mortality (30.0% vs. 42.1%; P = 0.500). Ventilator weaning times (15.7 vs. 3.3 days; P = 0.001) and hospital stays (99.1 vs. 53.1 days; P = 0.030) were longer in the tracheostomy group, with no differences in duration of sedation.
  
  
  CONCLUSIONS
  Tracheostomy may be a safe procedure in burn patients and is not associated with higher rates of mortality or respiratory infection. Tracheostomy patients showed longer mechanical ventilation times and higher morbidity, probably not attributable to tracheostomy.
authors: Department of Critical Care, University Hospital of A Coruna, A Coruña, Spain.
authors: Mónica
authors: M
authors: Mourelo
authors: Department of Critical Care, University Hospital of A Coruna, A Coruña, Spain.
authors: Rita
authors: R
authors: Galeiras
authors: Department of Clinical Epidemiology and Biostatistics, University Hospital of A Coruna, A Coruña, Spain.
authors: Sonia
authors: S
authors: Pértega
authors: Department of Critical Care, University Hospital of A Coruna, A Coruña, Spain.
authors: David
authors: D
authors: Freire
authors: Department of Plastic Surgery, Burn Unit, University Hospital of A Coruna, A Coruña, Spain.
authors: Eugenia
authors: E
authors: López
authors: Department of Health Information Technology, University Hospital of A Coruna, A Coruña, Spain.
authors: Javier
authors: J
authors: Broullón
authors: Department of Plastic Surgery, Burn Unit, University Hospital of A Coruna, A Coruña, Spain.
authors: Eva
authors: E
authors: Campos
keywords: Burns; mechanical ventilation; tracheostomy