Is high PEEP low volume ventilation in burn patients beneficial?: A retrospective study of 61 patients

In burn care lung damage by inhalation injury is a major cause of mortality in burn patients. In the field of intensive care medicine ventilation strategies to reduce lung injury caused by ventilation are under investigation. The promising results of the application of pressure controlled high PEEP...

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Bibliographic Details
Published in:Burns 2004-06, Vol.30 (4), p.368-373
Main Authors: Wolter, T.P, Fuchs, P.C, Horvat, N, Pallua, N
Format: Article
Language:English
Subjects:
Adult
Burn patients
Burns, Inhalation - therapy
Critical Care - methods
Female
Hospital Mortality
Humans
Inhalation injury
Injury Severity Score
Lung Diseases - etiology
Male
Middle Aged
Open lung concept
Oxygen - blood
Partial Pressure
PEEP
Positive-Pressure Respiration - adverse effects
Positive-Pressure Respiration - methods
Retrospective Studies
Retrospective study
Scoring systems
Treatment Outcome
Ventilation strategies
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Summary:In burn care lung damage by inhalation injury is a major cause of mortality in burn patients. In the field of intensive care medicine ventilation strategies to reduce lung injury caused by ventilation are under investigation. The promising results of the application of pressure controlled high PEEP low volume (HPLV) ventilation prompted us to use this ventilation strategy in our burn ICU. To establish whether this ventilation regime is beneficial the charts of 61 consecutive patients needing artificial respiration were reviewed. A scoring system for PEEP level and tidal volume was developed and treatment groups with high PEEP and low volume and low PEEP high volume regimes were compared. No statistically significant differences could be found when comparing treatment versus mortality, the number of pulmonary complications or incidence of pneumothoraces. However, the trend showed a benefit in mortality for patients with an ABSI scoring up to 9, but at the same time pulmonary complications increase. The Horovitz oxygenation index showed no advantage for the HPLV Group. In a separate analysis we found a significant correlation between absolute PEEP and mortality. The correlation between PEEP level and mortality is a dynamic factor predicting outcome, This not been described yet and can be an addition to the static ABSI score. Differences between ventilation strategies were not as evident as expected in this retrospective study, so prospective randomized studies are needed.
ISSN:0305-4179
1879-1409
DOI:10.1016/j.burns.2003.12.010