Eastman Alexander L, Arnoldo Brett A, Hunt John L, Purdue Gary F
Division of Burns, Trauma and Critical Care, Department of Surgery, The University of Texas Southwestern Medical Center, MC 9158, Dallas, Texas 75390-9158, USA.
J Burn Care Res. 2010 Sep-Oct;31(5):701-5. doi: 10.1097/BCR.0b013e3181eebe4f.
Despite the traditional teaching of early and aggressive airway management in thermally injured patients, paramedics and medical providers outside of burn centers receive little formal training in this difficult skill set. However, the initial airway management of these patients is often performed by these preburn center providers (PBCPs). The purpose of this study was to evaluate the authors' experience with patients intubated by PBCPs and subsequently managed at the authors' center. A retrospective review of a level I burn center database was undertaken. All records of patients arriving intubated were reviewed. From January 1982 to June 2005, 11,143 patients were admitted to the regional burn center; 11.4% (n = 1,272) were intubated before arrival. In this group, mean age was 37.1 years, mean burn size was 35.3% TBSA, and mean length of hospital stay was 27.0 days. Approximately 26.3% were suspected of having an inhalation injury, and this was confirmed by either bronchoscopy or clinical course in 88.6% of this subgroup. Mortality in patients arriving intubated was 30.8%, and these were excluded from the rest of the analysis. In the surviving 879 intubated patients, reasons reported by PBCPs for intubation included "airway swelling" in 34.1%, "prophylaxis" in 27.9%, and "ventilation or oxygenation needs" in 13.2%. Of these patients, 16.3% arrived directly from the scene, with the remainder arriving from another hospital facility. Of all survivors who arrived intubated, 11.9% were extubated on the day of admission, 21.3% were extubated on the first postburn day (PBD), and 8.2% were extubated on the second PBD. No patients who were extubated on PBD1 or PBD2 had to be reintubated. A significant number of burn patients have their initial airway management by PBCPs. Of these, a significant number are extubated soon after arrival at the burn center without adverse sequelae. Rationale for their initial intubation varies, but education is warranted in the prehospital community to reduce unnecessary intubation of the burn patient.
尽管传统上教导要对热烧伤患者尽早进行积极的气道管理，但烧伤中心以外的护理人员和医疗人员在这项高难度技能方面接受的正规培训很少。然而，这些患者的初始气道管理往往由这些烧伤中心前的医疗人员（PBCPs）进行。本研究的目的是评估作者对由PBCPs插管并随后在作者所在中心接受治疗的患者的经验。对一级烧伤中心数据库进行了回顾性研究。对所有插管入院患者的记录进行了审查。从1982年1月至2005年6月，11143例患者被收入该地区烧伤中心；11.4%（n = 1272）在入院前已插管。在这组患者中，平均年龄为37.1岁，平均烧伤面积为35.3%TBSA，平均住院时间为27.0天。约26.3%的患者被怀疑有吸入性损伤，其中88.6%的亚组通过支气管镜检查或临床病程得到证实。插管入院患者的死亡率为30.8%，这些患者被排除在其余分析之外。在879例存活的插管患者中，PBCPs报告的插管原因包括“气道肿胀”占34.1%，“预防”占27.9%，“通气或氧合需求”占13.2%。在这些患者中，16.3%直接从现场送来，其余患者从其他医院送来。在所有插管入院的幸存者中，11.9%在入院当天拔管，21.3%在烧伤后第一天（PBD）拔管，8.2%在烧伤后第二天拔管。在PBD1或PBD2拔管的患者中，没有患者需要重新插管。大量烧伤患者由PBCPs进行初始气道管理。其中，相当一部分患者在到达烧伤中心后不久即拔管，且无不良后果。他们初始插管的理由各不相同，但院前社区有必要进行培训，以减少对烧伤患者不必要的插管。
