Tracheostomies in burn patients

• Published in: Annals of surgery Vol. 209; no. 4; pp. 471 - 474
• Main Authors: JONES, W. G, MADDEN, M, FINKELSTEIN, J, YURT, R. W, GOODWIN, C. W
• Format: Conference Proceeding Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott 01-04-1989
• Subjects: Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Burns - surgery; Burns, Inhalation - mortality; Burns, Inhalation - surgery; Emergency and intensive respiratory care; Female; Humans; Intensive care medicine; Intubation, Intratracheal; Male; Medical sciences; Middle Aged; Tracheal Stenosis - etiology; Tracheoesophageal Fistula - etiology; Tracheostomy - adverse effects; Burn; Human; Tracheotomy
• ISSN: 0003-4932; 1528-1140
• DOI: 10.1097/00000658-198904000-00013

The use of tracheostomies in burned patients with inhalation injuries is now reserved for specific indications rather than as prophylactic airway management. A 5-year burn center experience with tracheostomies used in this fashion is presented. Ninety-nine tracheostomies were performed in 3246 patients who had indications of prolonged respiratory failure or acute loss of airway. Although colonization of the sputum was universal, neither rates of pulmonary sepsis nor mortality were significantly increased in patients who underwent tracheostomies. Twenty-eight patients developed late upper airway sequelae, including tracheal stenosis (TS), tracheoesophageal fistula (TEF), and tracheoarterial fistula (TAF). Duration of intubation correlated only with development of TAF, whereas patients in whom TEF developed were significantly older and more likely to have evidence of tracheal necrosis at the time of tracheostomy. The pathogenesis of upper airway sequelae in these patients as divergent responses to the combined insults of inhalation injury, infection, and intubation is considered.