Intubation and extubation criteria of patients with burn injury at the Royal Adelaide Hospital.

Dr Lachlan Kerr1

1Central Adelaide Local Health Network, , Australia

Abstract:

PURPOSE OF STUDY: Despite criteria to guide intubation from the ABA, concerns remain regarding over-intubation of burns patients. Complications arise as a result of intubation including VAP (Elliot et al. 2015). This study reviewed indications for intubation against ABA and Denver Criteria, duration of intubation, and complications arising from intubation of burns patients treated at the Royal Adelaide Hospital (RAH) between 2017-2020.

METHODS: Adult burns patients admitted under the RAH burns unit between 2017-2020, and intubated on arrival or pre-hospital were found through the BRANZ database. Case notes were reviewed, and patient demographics, VAP rates, burn characteristics and rates of bronchoscopy/nasoendoscopy were extracted. Indications for intubation were compared to the ABA and Denver criteria.

RESULTS: 62 patients were included. The average age was 47.9 (17-84), 45 (74%) were male, and the average TBSA was 17.8% (range 0-80%). 91% and 74% of patients met ABA and Denver criteria, respectively. 58% of patients were intubated pre-RAH, 61% of these in the pre-hospital setting. VAP developed in 22.5% of patients, 93% of whom were intubated for >48 hours. 36 (52%) patients were extubated within 48 hours. 58% of patients underwent either nasoendoscopy or bronchoscopy.

CONCLUSIONS: Most adult patients with burns admitted to the RAH are intubated per published criteria. However, over half of patients were extubated within 48 hours suggesting potentially avoidable intubation. This study supports the sentiment that current intubation criteria may over-estimate the risk of airway compromise (Dingle et al. 2021). Early nasoendoscopy/bronchoscopy may be useful in determining those patients who can be extubated <48 hours.

REFERENCES: Elliott, D, Elliott, R, Burrell A, Harrigan, P, Murgo, M, Rolls, K & Sibbritt, D 2015, ‘Incidence of ventilator-associated pneumonia in Australasian intensive care units: use of a consensus-developed clinical surveillance checklist in a multisite prospective audit’, BMJ Open, vol. 5, e008924.doi:10.1136/bmjopen-2015-008924
Dingle, L, Wain, R, Bishop, S, Soueid, A & Sheikh, 2021, ’Intubation in burns patients: a 5-year review of the Manchester regional burns centre experience’, Burns, vol. 47, no. 3, pp. 576-586.


Biography:

Dr. Lachlan Kerr is a current junior doctor working with interests in Intensive care and Anesthetics, areas in which he aims to specialise.

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