Factors associated with prolonged mechanical ventilation in the burn patient

We evaluated the incidence of short-term mechanical ventilation (STMV) in patients admitted to our national burn centre (CENAQUE) and clinical findings (CF) associated with prolonged mechanical ventilation (PMV).

Retrospective review of all burn adults admitted to CENAQUE with endotracheal intubation (EI) between 2010 and 2023. Data included demographics, injury characteristics, and CF at intubation. Patients were categorised as ≤ 2 days ventilation (STMV) or > 2 days (PMV). Multivariable logistic regression analysed associations between CF and PMV. Sensitivity (SE), specificity (SP), positive predictive value (PPV), and negative predictive value (NPV) were calculated for each CF.

Among 973 patients, STMV incidence was 42.3 % (n = 412). PMV was significantly associated with total body surface area burn (TBSA) (OR 1.094; 1.076-1.113; p < 0.001), age (OR 1.031; 1.022-1.040; p < 0.001), full-thickness facial burn (FTFB) (OR 2.152; 1.131-4.096; p = 0.020), shock (OR 10.662; 3.623-31.375; p < 0.001), and oral oedema (OR 0.590; 0.368-0.944; p = 0.028). Shock (SE 21.2 %, SP 99.0 %) and FTFB (SE 24.6 %, SP 95.4 %) were the most sensitive and specific CF for detecting PMV, with high PPV (96.7 % and 87.8 %) but low NPV (48.1 % and 48.3 %), respectively. In patients with TBSA < 20 %, NPV increased to 60.6 % for shock and 61.2 % for FTFB.

STMV for prophylactic reasons is frequent in burn patients in our country and may represent potentially unnecessary intubations. PMV was associated with higher TBSA, age, FTFB, and shock. FTFB and shock showed the best overall diagnostic performance for detecting PMV, with moderate NPV in patients with TBSA < 20 %. New protocols should be established in our region for airway management of burn patients.