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. 2021 Dec 16:9:tkab034.
doi: 10.1093/burnst/tkab034. eCollection 2021.

Ventilation practices in burn patients-an international prospective observational cohort study

Marcus J Schultz  1 , Janneke Horn  1 , Markus W Hollmann  1 , Benedikt Preckel  1 , Gerie J Glas  1 , Kirsten Colpaert  2 , Manu Malbrain  3 , Ary Serpa Neto  4 , Karim Asehnoune  5 , Marcello Gamma de Abreu  6 , Ignacio Martin-Loeches  7 , Paolo Pelosi  8 , Folke Sjöberg  9 , Jan M Binnekade  1 , Berry Cleffken  10 , Nicole P Juffermans  1 , Paul Knape  11 , Bert G Loef  12 , David P Mackie  11 , Perenlei Enkhbaatar  13 , Nadia Depetris  14 , Anders Perner  15 , Eva Herrero  16 , Lucia Cachafeiro  16 , Marc Jeschke  17 , Jeffrey Lipman  18 , Matthieu Legrand  19 , Johannes Horter  20 , Athina Lavrentieva  21 , Gerie Glas  1 , Alex Kazemi  22 , Anne Berit Guttormsen  23 , Frederik Huss  24 , Mark Kol  25 , Helen Wong  25 , Therese Starr  18 , Luc De Crop  2 , Wilson de Oliveira Filho  26 , João Manoel Silva Junior  27 , Cintia M C Grion  28 , Marc G Jeschke  29 , Marjorie Burnett  29 , Frederik Mondrup  15 , Francois Ravat  30 , Mathieu Fontaine  30 , Karim Asehoune  31 , Renan Le Floch  31 , Mathieu Jeanne  32 , Morgane Bacus  32 , Maïté Chaussard  33 , Marcus Lehnhardt  34 , Bassem Daniel Mikhail  34 , Jochen Gille  35 , Aidan Sharkey  7 , Nicole Trommel  10 , Auke C Reidinga  12 , Nadine Vieleers  11 , Anna Tilsley  22 , Henning Onarheim  23 , Maria Teresa Bouza  36 , Alexander Agrifoglio  16 , Filip Fredén  24 , Tina Palmieri  37 , Lynda E Painting  37 ; LAMiNAR investigators
Affiliations

Ventilation practices in burn patients-an international prospective observational cohort study

Marcus J Schultz et al. Burns Trauma. .

Abstract

Background: It is unknown whether lung-protective ventilation is applied in burn patients and whether they benefit from it. This study aimed to determine ventilation practices in burn intensive care units (ICUs) and investigate the association between lung-protective ventilation and the number of ventilator-free days and alive at day 28 (VFD-28).

Methods: This is an international prospective observational cohort study including adult burn patients requiring mechanical ventilation. Low tidal volume (V T) was defined as V T ≤ 8 mL/kg predicted body weight (PBW). Levels of positive end-expiratory pressure (PEEP) and maximum airway pressures were collected. The association between V T and VFD-28 was analyzed using a competing risk model. Ventilation settings were presented for all patients, focusing on the first day of ventilation. We also compared ventilation settings between patients with and without inhalation trauma.

Results: A total of 160 patients from 28 ICUs in 16 countries were included. Low V T was used in 74% of patients, median V T size was 7.3 [interquartile range (IQR) 6.2-8.3] mL/kg PBW and did not differ between patients with and without inhalation trauma (p = 0.58). Median VFD-28 was 17 (IQR 0-26), without a difference between ventilation with low or high V T (p = 0.98). All patients were ventilated with PEEP levels ≥5 cmH2O; 80% of patients had maximum airway pressures <30 cmH2O.

Conclusion: In this international cohort study we found that lung-protective ventilation is used in the majority of burn patients, irrespective of the presence of inhalation trauma. Use of low V T was not associated with a reduction in VFD-28.

Trial registration: Clinicaltrials.gov NCT02312869. Date of registration: 9 December 2014.

Keywords: Critical care; Inhalation trauma; Lung-protective; Mechanical ventilation.

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Figures

Figure 1.
Figure 1.
Ventilator settings on the first day of ventilation of patients with and without inhalation trauma. Cumulative frequency distributions from the following parameters measured on the first day of mechanical ventilation: (a) VT, (b) maximum airway pressure, (c) PEEP, (d) driving pressure. Vertical dotted lines: predefined cut-off values for each variable. Horizontal dotted lines: proportion of patients reaching the cut-offs. Driving pressure: plateau (or peak) pressure minus PEEP. VT tidal volume, PEEP positive end-expiratory pressure, PBW predicted body weight
Figure 2.
Figure 2.
Distribution of ventilatory parameters on the first day of mechanical ventilation. Distribution of positive end-expiratory pressure (PEEP), inspired fraction of oxygen (FiO2), respiratory rate and maximum airway pressure vs tidal volume (VT). Dotted lines (horizontal and vertical) represent cut-off values for each variable. (a) PEEP, (b) FiO2, (c) respiratory rate, (d) maximum airway pressure
Figure 3.
Figure 3.
Cumulative incidence curves for ventilation status of patients ventilated with low vs high tidal volume size at day 28 and day 90. Sub-distribution hazard ratio: the magnitude is affected by both time to extubation and probability of death; calculated using the Cox proportional hazard model. (a) Ventilation status at day 28, (b) ventilation status at day 90. VT tidal volume
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