RESUMO
Advances in burn management over the past 2 decades have resulted in improved survival and reduced morbidity. The treatment of a single patient following a 90% total body surface area injury illustrates the intensity of labour and coordinated hospital care required for such catastrophically injured patients. Data were extracted from the medical records and from personal recollections of the individual members of the multidisciplinary team as well as from the patient. The clinical course and management of complications are described chronologically as a series of overlapping phases from admission to discharge.
RESUMO
INTRODUCTION: We describe a semi-open approach to percutaneous tracheostomy as an effective and potentially safer alternative to open tracheostomy or percutaneous techniques in burn patients. METHODS: We identified patients who underwent the modified technique from 2005 to 2007. Our method used a 2-3 cm incision and limited dissection to the pretracheal fascia. A needle was used to enter the trachea and insert a guidewire. The trachea was then dilated using a 'Blue Rhino' dilator. The remainder of the procedure was performed according to standard technique. RESULTS: 39 patients were identified. 30 of these cases were performed at the bedside. The average time to tracheostomy was 19 days. The average total body surface area involved was 42%. 51% of patients had burns of the neck. Five patients had burns over the stomal site. Of these five, three required autografting prior to tracheostomy. There were no deaths related to the procedure and the only complication was intraoperative hemorrhage in one patient, which was readily controlled. CONCLUSION: The semi-open modification of the percutaneous tracheostomy combines the convenience and minimally invasive advantages of the percutaneous technique with the better surgical control of the airway afforded by the traditional open technique.
