PubMed · 15534462
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Reginald L Richard. OT/PT.. https://doi.org/10.1097/00004630-200411000-00015
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BACKGROUND: Patients with major burn injuries frequently develop acute respiratory distress syndrome (ARDS). High-frequency oscillatory ventilation (HFOV) has been used successfully in our regional burn center since 1999 for the management of oxygenation failure secondary to ARDS and as a method of intraoperative ventilation to allow surgical burn wound excision to proceed, despite the presence of severe ARDS. OBJECTIVE: The objective of this article is to review the use of HFOV in burn patients, with an emphasis on the indications and selection criteria for the initiation of HFOV, special considerations for patients with smoke inhalation injury, and our approach to intra-operative HFOV. SETTING: Adult regional burn center in a university-affiliated tertiary care hospital. RESULTS: We have now used HFOV in 36 severely burned patients, 33% of whom had an associated smoke inhalation injury. HFOV produced significant improvements in oxygenation among burn patients with oxygenation failure secondary to ARDS. HFOV produced a slower and less robust reversal of oxygenation failure in those with smoke inhalation compared with patients with burns alone. HFOV has been used intraoperatively for 33 procedures in 18 patients without complications. CONCLUSION: HFOV has been an indispensable ventilation modality in our burn center, and has played an important role in reversing oxygenation failure in patients with ARDS and in facilitating early excision and closure of the burn wound in these patients.
The purpose of this investigation was to examine burn-patient referral patterns and severity of burn distribution, as well as to determine the impact these patterns may have on the education of surgeons in training. Data from the 1998-1999 National Inpatient Sample (NIS) and the Michigan Hospital Association (MHA) were analyzed based upon burn diagnostic-related groups (DRGs; 504-511) and their referral distribution was documented. Providers were segregated into high-volume hospitals (HVHs) treating >100 patients per year, moderate-volume hospitals treating 25 to 99 patients per year, and low-volume hospitals (LVHs) treating <25 patients per year. Surgical training programs were identified within the state of Michigan and examined for an educational affiliation with a burn center. Across the United States, 47.5% of burn patients receive care at HVHs. Patients with the highest severity (ie, DRGs 504 and 505) were usually (77%) treated in HVHs. Within the state of Michigan, 4 HVHs were identified, which represent 50.8% of the total burn admissions. At least 1 HVH received over 80% of its admissions from adjacent or distant counties and subsequently represented a higher proportion of higher-severity burn DRG admissions. Twenty-three percent of general surgical programs within the state of Michigan do not have a formal burn rotation or affiliation with a regional burn center for educational training. Several programs have affiliations with low-volume burn providers. The most severe burns are reaching high-volume centers, but many burns continue to remain within LVHs. A wide variation in patient distribution occurs throughout the United States. Matching the patient and resident distribution is essential for effective training of surgical residents.
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