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Early Coagulopathy is Associated With Increased Incidence of Ventilator-Associated Events Among Burn Patients
Duraid Younan1, Russell Griffin, Maxwell Thompson
1*Division of Acute Care Surgery, Department of Surgery, University of Alabama in Birmingham, Birmingham, Alabama†Department of Epidemiology, University of Alabama in Birmingham, Birmingham, Alabama‡Department of Emergency Medicine, University of Alabama in Birmingham, Birmingham, Alabama§Department of Anesthesiology, University of Alabama in Birmingham, Birmingham, Alabama.
Insights
Coagulopathy in burn patients significantly increases the risk of ventilator-associated events (VAEs). Early identification and management of coagulopathy may help reduce VAEs in these critically ill patients.
Area of Science:
- Critical Care Medicine
- Trauma Surgery
- Infectious Disease Epidemiology
Background:
- Coagulopathy is a known complication of severe burn injuries.
- Previous research linked coagulopathy in spinal cord injury patients to increased ventilator-associated pneumonia (VAP).
- The relationship between coagulopathy and ventilator-associated events (VAEs) in burn patients remains under-investigated.
Purpose of the Study:
- To investigate the association between coagulopathy and the incidence of VAEs in patients admitted for burn care.
- To determine if coagulopathic burn patients have a higher risk of developing VAEs compared to non-coagulopathic patients.
- To explore the correlation between the severity of coagulopathy and VAE development.
Main Methods:
- A retrospective study included 263 burn patients requiring mechanical ventilation between 2011 and 2015.
- Patients were categorized into four international normalized ratio (INR) groups based on coagulopathy severity.
- Ventilator-associated events (VAEs) were classified according to CDC criteria; demographic and injury data were analyzed using ANOVA and chi-square tests.
Main Results:
- Patients with moderately and severely elevated INR experienced longer ventilation durations, more ICU days, and extended hospital stays.
- After adjusting for inhalation injury and total body surface area, severely elevated INR was associated with a >4-fold increased likelihood of any VAE.
- A severely elevated INR also significantly increased the likelihood of developing infection-related VAEs or possible VAP.
Conclusions:
- Early coagulopathy in burn patients is significantly associated with an increased incidence of VAEs.
- These findings suggest that early recognition and treatment of coagulopathy could potentially decrease VAEs in burn populations.
- Further research is warranted to confirm these associations and guide clinical interventions.
Objective:
Coagulopathy is known to be associated with burn injury. Our group has shown that, in spinal cord injury patients, coagulopathy is associated with an increase in ventilator-associated pneumonia (VAP). We hypothesized that the same association exists between coagulopathic burn patients and ventilator-associated events.
Methods:
Patients admitted for burn care between January 1, 2011 and December 31, 2015 who required mechanical ventilation were included in the study. Ventilator-associated events (VAEs) as defined by the Center for Disease Control were categorized as no event, ventilator-associated condition, infection-related ventilator-associated complication, and possible VAP. Demographic, injury characteristics were compared among four international normalized ratio (INR) categories using analysis of variance and chi-square tests.
Results:
Four hundred four patients were admitted for burn care, of whom 263 met the inclusion criteria. One hundred eleven had normal INR, 59 had a slightly elevated INR (1.2-1.4), 33 had a moderately elevated INR (1.4-1.6), and 60 had a severely elevated INR (>1.6). Those with moderately and severely elevated INR were ventilated for a longer period (P = 0.0034), had more days in the ICU (P = 0.0010), and had longer hospital stay (P = 0.0016). After adjusting for inhalation injury and total body surface area, patients with severely elevated INR were over four times as likely to have any VAE (OR: 4.16, 95% CI: 1.33-13.05) and 4.5 times as likely to develop infection-related ventilator-associated complication or possible ventilator-associated pneumonia combined (OR: 4.59, 1.35-15.67).
Conclusions:
Early coagulopathy is associated with a significantly increased incidence of VAEs in burn patients. While additional studies need to be conducted to verify these findings, early recognition and treatment could decrease VAEs.
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