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Related Experiment Videos

Tracheostomies in burn patients.

W G Jones1, M Madden, J Finkelstein

  • 1Department of Surgery, New York Hospital-Cornell Medical Center, New York.

Annals of Surgery
|April 1, 1989
PubMed
Summary

Tracheostomies in burn patients with inhalation injuries are used for specific reasons, not routinely. This study found they did not increase sepsis or mortality, but some patients developed late airway issues.

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Area of Science:

  • Burn Care
  • Trauma Surgery
  • Respiratory Medicine

Background:

  • Tracheostomies in burn patients with inhalation injuries were historically used prophylactically.
  • Current practice reserves tracheostomies for specific indications like prolonged respiratory failure or airway loss.

Purpose of the Study:

  • To evaluate the outcomes of tracheostomies performed for specific indications in burned patients with inhalation injuries.
  • To analyze the incidence of pulmonary sepsis, mortality, and late upper airway sequelae.

Main Methods:

  • A retrospective review of 3246 burn patients over 5 years.
  • Analysis of 99 tracheostomies performed for indicated reasons (prolonged respiratory failure or acute airway loss).
  • Assessment of sputum colonization, pulmonary sepsis, mortality, and late upper airway complications (tracheal stenosis, tracheoesophageal fistula, tracheoarterial fistula).

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Main Results:

  • Sputum colonization was universal in tracheostomized patients.
  • Tracheostomy did not significantly increase rates of pulmonary sepsis or mortality.
  • Twenty-eight patients (28.3%) developed late upper airway sequelae.
  • Tracheoarterial fistula correlated with duration of intubation.
  • Tracheoesophageal fistula was associated with older age and tracheal necrosis at tracheostomy.

Conclusions:

  • Tracheostomies for specific indications in burn patients with inhalation injuries are safe regarding sepsis and mortality.
  • Late upper airway sequelae can occur, with different risk factors for specific complications.
  • Understanding the pathogenesis of these sequelae is crucial for patient management.