Early tracheostomy and active exercise programmes in adult intensive care patients with severe burns.

BACKGROUND: Tracheostomy is a strategy often employed in patients requiring prolonged intubation in ICU settings. Evidence suggests that earlier tracheostomy and early active exercise are associated with better patient centered outcomes. Severe burn patients often require prolonged ventilatory support due to their critical condition, complex sedation management and multiple operating room visits. It is still unclear the optimal timing for tracheostomy in this population. METHODS: We conducted a service evaluation where we compared Early Tracheostomy (≤10 days) with Late Tracheostomy (>10 days) in 41 severely burned patients that required prolonged respiratory support. RESULTS: Early Tracheostomy cohort was associated with fewer days of mechanical ventilation (16 vs 33, p = 0.001), shorter hospital length of stay (65 vs 88 days, p = 0.018), earlier first day of active exercise (day 8 vs day 25, p < 0.0001) and higher Functional Assessment for Burns scores upon discharge (32 vs 28, p = 0.016). CONCLUSION: Early tracheostomy in patients with severe burns is associated with earlier active exercise, fewer days of ventilation, shorter length of hospital stay and better physical functional independence upon discharge from hospital.

Abdominal compartment syndrome in burns patients: Introduction of an evidence-based management guideline and algorithm.

ABSTRACT: Abdominal compartment syndrome is a serious potential complication of burn injury, and carries high morbidity and mortality. Although there are generalised published guidelines on managing the condition, to date no management algorithm has yet been published tailored specifically to the burn injury patient. We set out to examine the literature on the subject in order to produce an evidence based management guideline, with the aim of improving outcomes for these patients. The guideline covers early detection and assessment of the condition as well as optimum medical, surgical and postoperative management. We believe that this guideline provides a much needed benchmark for managing burns patients with raised intra-abdominal pressure, as well as providing a template for further research and improvements in care.