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Early prediction of prolonged ventilator dependence in thermally injured patients
B J Sellers1, B L Davis, P W Larkin
1Intermountain Burn Center and the Department of Surgery, University of Utah, Salt Lake City 84132, USA.
Insights
Predicting prolonged ventilator dependence (PVD) in burn patients early can help identify candidates for early tracheostomy. This study developed a predictive equation using objective clinical factors for better resource utilization.
Area of Science:
- Medical research
- Trauma and critical care
- Burn patient management
Background:
- Prolonged ventilator dependence (PVD) is a concern in intensive care settings.
- Early tracheostomy may improve outcomes and resource use in trauma/ICU patients.
- Predictive criteria for PVD in burn patients are needed.
Purpose of the Study:
- To develop and validate criteria for predicting prolonged ventilator dependence (PVD) in burn patients.
- To identify burn patients likely to require mechanical ventilation for over 14 days.
- To inform decisions regarding early tracheostomy in burn care.
Main Methods:
- Retrospective review of burn patients (age >= 16) requiring mechanical ventilation for >= 3 days (1990-1994).
- Logistic regression analysis to create a predictive equation for PVD using full-thickness burn size, age, inhalation injury, and PaO2/FiO2 ratio on day 3.
- Validation of the equation using data from 1995.
Main Results:
- The predictive equation demonstrated good accuracy in identifying PVD.
- An 82% prediction accuracy for PVD was observed in the initial cohort (1990-1994).
- The equation achieved 90% accuracy when tested on a subsequent cohort (1995).
Conclusions:
- Objective clinical variables can predict PVD in burn patients during the early postburn period.
- The developed predictive model can aid in selecting patients for early tracheostomy studies.
- Early identification of PVD risk can optimize resource allocation and patient management strategies.
Background:
Recent studies suggest that when prolonged ventilator dependence (PVD) can be predicted in trauma or intensive care unit patients, early tracheostomy may reduce hospital stay and improve utilization of resources. This study was performed to develop criteria predictive of PVD (> 14 days) in burn patients.
Methods:
We reviewed burn patients aged > or =16 years admitted between 1990 and 1994 who required ventilator support for > or =3 days. Using the variables full-thickness burn size, age, inhalation injury, and worst PaO2/FiO2 on ventilator day 3, an equation predicting PVD was created using logistic regression. The equation was tested by applying it to 1995 patients.
Results:
When a probability of >0.5 was considered predictive of PVD, the equation correctly predicted PVD in 82% of 1990 to 1994 patients (n = 110) and 90% of 1995 patients (n = 29).
Conclusion:
PVD in burn patients can be predicted using objective variables in the early postburn period. Predictions can be used to select patients for prospective studies of early tracheostomy.