Namdar Thomas, Stollwerck Peter Leonard, Stang Felix Hagen, Klotz Karl-Friedrich, Lange Thomas, Mailänder Peter, Siemers Frank
Department of Plastic Surgery, Hand Surgery, Burn Unit, University Hospital Schleswig-Holstein, Campus Lübeck, 23538 Lübeck, Germany.
Ger Med Sci. 2010 Jun 7;8:Doc10. doi: 10.3205/000099.
In patients with major burn injuries mechanical ventilation is often required for longer periods. Tracheostomy (TS) plays an integral role in airway management. We investigated the effect of TS on ventilation parameters within 8 hours after TS.
A retrospective analysis of severely burned patients admitted to the burn unit of a German University Hospital was performed. Ventilation parameters 8 hours before and after TS were registered.
A retrospective analysis of 20 patients which received surgical TS was performed. Mean age was 52+/-19 years. Mean abbreviated burned severity index (ABSI) was 8.3+/-2.2. A mechanical ventilation was required for 14.3+/-4.8 days. TS was performed on day 7+/-4. Inspiratory oxygen concentration (FiO(2)) (p<0.001), peak inspiratory pressure (p<0.001), positive end-expiratory pressure (p=0.003) and pulmonary resistance (p<0.001) were reduced significantly after TS. The arterial partial pressure of oxygen/FiO(2)-ratio increased significantly after TS (p<0.001).
We demonstrate that TS reduces invasiveness of ventilation in severely burned patients and by this can optimize lung protective ventilation strategy.
大面积烧伤患者通常需要较长时间的机械通气。气管切开术（TS）在气道管理中起着不可或缺的作用。我们研究了气管切开术后8小时内TS对通气参数的影响。
对一所德国大学医院烧伤科收治的严重烧伤患者进行回顾性分析。记录气管切开术前8小时和术后8小时的通气参数。
对20例行手术气管切开术的患者进行回顾性分析。平均年龄为52±19岁。平均简化烧伤严重程度指数（ABSI）为8.3±2.2。机械通气需要14.3±4.8天。气管切开术在第7±4天进行。气管切开术后，吸入氧浓度（FiO₂）（p<0.001）、吸气峰压（p<0.001）、呼气末正压（p=0.003）和肺阻力（p<0.001）显著降低。气管切开术后动脉血氧分压/FiO₂比值显著升高（p<0.001）。
我们证明气管切开术降低了严重烧伤患者通气的侵入性，从而可以优化肺保护性通气策略。
