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

Burns & Trauma 2021年第1期9卷 47-57页

作者： Gerie J.Glas Janneke Horn Markus W.Hollmann Benedikt Preckel Kirsten Colpaert Manu Malbrain Ary Serpa Neto Karim Asehnoune Marcello Gamma de Abreu Ignacio Martin-Loeches Paolo Pelosi folke sjoerg Jan M.Binnekade Berry Cleffken Nicole P.Juffermans Paul Knape Bert G.Loef David P.Mackie Perenlei Enkhbaatar Nadia Depetris Anders Perner Eva Herrero Lucia Cachafeiro Marc Jeschke Jeffrey Lipman Matthieu Legrand Johannes Horter Athina Lavrentieva Alex Kazemi Anne Berit Guttormsen Frederik Huss Mark Kol Helen Wong Therese Starr Luc De Crop Wilson de Oliveira Filho Joa Manoel Silva Junior Cintia M.C.Grion Marjorie Burnett Frederik Mondrup Francois Ravat Mathieu Fontaine Renan Le Floch Mathieu Jeanne Morgane Bacus Maite Chaussard Marcus Lehnhardt Bassem Daniel Mikhail Jochen Gille Aidan Sharkey Nicole Trommel Auke C.Reidinga Nadine Vieleers Anna Tilsley Henning Onarheim Maria Teresa Bouza Alexander Agrifoglio Filip Fredén Tina Palmieri Lynda E.Painting Marcus J.Schultz LAMiNAR investigators Academic Medical Center University of AmsterdamAmsterdamAZ 1105The Netherlands Department of Anaesthesia and Intensive Therapy Medical University of Lublin Aleje Racklawickie 1–20-059 Lublin–Poland AZ JAN PALFIJN GENT Watersportlaan 5–9000 Gent–Belgium ABC Medical School SaPauloBangúSP 5001Brazil Service d’Anesthésie Réanimation Chirurgicale Nantes 44093France University Hospital Carl Gustav Carus Dresden 01307Germany St James University Hospital Dublin D08 NHY1Ireland University of Genoa GenoaGE 16128Italy Linkoing University Hospital Linkoing 58185Sweden Maasstad Hospital RotterdamDZ 3079The Netherlands Red Cross Hospital BeverwijkLE 1942The Netherlands Martini Hospital GroningenNT 9728The Netherlands University of Texas Medical Branch GalvestonTX 77555USA Turin CTO Burn Center TurinTO 10126Italy Rigshospitalet Copenhagen 2100Denmark La Paz University Hospital Madrid 28046Spain Ross Tilley Burn Centre Sunnybrook Health Sciences CentreToronto M4N 3M5Canada Royal Brisbane and Women’s Hospital Queensland UniversityHerstonQLD 4029Australia Australian and New Zealand Intensive Care Research Centre.Monash University MelbourneVIC 3004Australia GH St-Louis-Lariboisière APHPParis 75010France BG Klinik Ludwigshafen Ludwigshafen 67071Germany Papanikoalou Hospital Thessaloniki 54621Greece Middlemore Hospital OtahuhuAuckland 2025New Zealand Haukeland University Hospital Bergen 5021Norway Uppsala University Hospital Uppsala 75185Sweden Concord Repatriation General Hospital NSW University of SydneyConcord 2139Australia Ziekenhuis Netwerk Antwerpen-Stuivenberg Antwerpen 2060Belgium Universidade de Sao Paulo Sao Paulo 01246-903Brazil Universidade Estadual de Londrina Londrina 86057-970Brazil Sunnybrook Health Sciences Centre Toronto M4N 3M5Canada CHU Lyon St Luc Lyon 69007France CHU Nantes Service dánesthesie reanimation chirugicale Nantes 44093France Hopital Roger Salengro CHRU LilleLille 59037France Saint-Louis Hospital Paris 75010France BG University Hospital Bergmannsheil Bo

Background:It is unknown whether lung-protective ventilation is applied in burn patients and whether they benefit from *** 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 *** 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 *** association between V_(T) and VFD-28 was analyzed using a competing risk *** settings were presented for all patients,focusing on the first day of *** also compared ventilation settings between patients with and without inhalation ***:A total of 160 patients from 28 ICUs in 16 countries were *** 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 cmH_(2)O;80%of patients had maximum airway pressures<30 cmH_(2)***: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 *** of low V_(T) was not associated with a reduction in *** registration:*** *** of registration:9 December 2014.

关键词： Mechanical ventilation Inhalation trauma Lung-protective Critical care

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