ABSTRACT
Airway management in both acute and reconstructive burn patients can be a major challenge for evaluation, intubation, and securing the airway in the setting of altered airway structure. Airway evaluation in both acute and reconstructive patients includes examination for evidence of laryngeal and supraglottic edema and structural changes due to trauma and/or scarring that will impact the successful approach to acquiring an airway for surgical procedures and medical recovery. The approach to acquiring a successful airway is rarely standard laryngoscopy and often requires fiberoptic bronchoscopy and a variety of airway manipulation techniques. Tracheostomy should be reserved for those with classic requirements of ventilatory and/or mechanical failure or severe upper airway burns. Even securing an airway for surgical procedures, especially with patients suffering injuries involving the head and neck, can be nonstandard and requires creative and flexible approaches to be successful. After much trial and error over the past 30 years in a large burn center, our multidisciplinary team has learned many valuable lessons. This review will focus on our current approach to safe airway management in acute and reconstructive burn patients.
Subject(s)
Adrenal Gland Neoplasms , Adrenalectomy/methods , Adrenergic alpha-Antagonists , Antihypertensive Agents , Dizziness , Dopamine/blood , Hypertension , Pheochromocytoma , Preoperative Care/methods , Adrenal Gland Neoplasms/blood , Adrenal Gland Neoplasms/pathology , Adrenal Gland Neoplasms/surgery , Adrenergic alpha-Antagonists/administration & dosage , Adrenergic alpha-Antagonists/adverse effects , Antihypertensive Agents/administration & dosage , Antihypertensive Agents/adverse effects , Antihypertensive Agents/classification , Dizziness/diagnosis , Dizziness/etiology , Dizziness/physiopathology , Dizziness/prevention & control , Humans , Hypertension/drug therapy , Hypertension/etiology , Hypertension/physiopathology , Male , Middle Aged , Patient Selection , Pheochromocytoma/diagnosis , Pheochromocytoma/metabolism , Pheochromocytoma/physiopathology , Pheochromocytoma/surgery , Treatment OutcomeABSTRACT
The aim of this study was to evaluate cardiac function and clinical outcomes in perioperative pediatric burn patients. Transesophageal echocardiography data were collected on 40 patients from 2004 to 2007. Of the 40 patients who received exams, a complete set of cardiac parameters and outcome variables was obtained in 26 patients. The mean age of the patients was 9.7 ± 0.9 years, and the mean TBSA burn size was 64 ± 3%. Patients were divided into two groups based on systolic function. One group represented patients with ejection fractions of >50% and the other ≤50%. Clinical variables were then compared among the groups. In our cohort, systolic dysfunction was observed in 62% of patients (EF ≤ 50%). Systolic dysfunction was associated with a statistically significant increase in number of surgeries, ventilator days, and length of stay in the intensive care unit. The length of stay in patients with preserved systolic function and those with systolic dysfunction was 34.3 ± 3.3 days and 67.2 ± 4.0 days, respectively. Diastolic function measurements were obtained in 65%, and 88% had evidence of diastolic dysfunction. Diastolic dysfunction was not associated with any statistically significant correlations. This study lends evidence to the well-supported basic science models showing cardiac dysfunction after burns. Additionally, it shows that cardiac dysfunction can have clinical consequences. To our knowledge, this is the first study that shows the clinical sequelae of systolic dysfunction in the perioperative pediatric burn population.
