Department of Surgery, Loyola University Medical Center, Maywood, Illinois.
Division of Trauma, Burn, and Surgical Care, Brigham and Women's Hospital, Boston, Massachusetts.
J Surg Res. 2023 Nov;291:221-230. doi: 10.1016/j.jss.2023.06.005. Epub 2023 Jul 14.
Upper airway management is crucial to burn care. Endotracheal intubation is often performed in the setting of inhalation injury, burns of the face and neck, or large burns requiring significant resuscitation. Tracheostomy may be necessary in patients requiring prolonged ventilatory support. This study compares long-term, patient-reported outcomes in burn patients with and without tracheostomy.
Data from the Burn Model System Database, collected from 2013 to 2020, were analyzed. Demographic and clinical data were compared between those with and without tracheostomy. The following patient-reported outcomes, collected at 6-, 12-, and 24-mo follow-up, were analyzed: Veterans RAND 12-Item Health Survey (VR-12), Satisfaction with Life, Community Integration Questionnaire, Patient-Reported Outcomes Measurement Information System 29-Item Profile Measure, employment status, and days to return to work. Regression models and propensity-matched analyses were used to assess the associations between tracheostomy and each outcome.
Of 714 patients included in this study, 5.5% received a tracheostomy. Mixed model regression analyses demonstrated that only VR-12 Physical Component Summary scores at 24-mo follow-up were significantly worse among those requiring tracheostomy. Tracheostomy was not associated with VR-12 Mental Component Summary, Satisfaction with Life, Community Integration Questionnaire, or Patient-Reported Outcomes Measurement Information System 29-Item Profile Measure scores. Likewise, tracheostomy was not found to be independently associated with employment status or days to return to work.
This preliminary exploration suggests that physical and psychosocial recovery, as well as the ability to regain employment, are no worse in burn patients requiring tracheostomy. Future investigations of larger scale are still needed to assess center- and provider-level influences, as well as the influences of various hallmarks of injury severity. Nonetheless, this work should better inform goals of care discussions with patients and families regarding the use of tracheostomy in burn injury.
上呼吸道管理对烧伤护理至关重要。在吸入性损伤、面颈部烧伤或需要大量复苏的大面积烧伤的情况下，通常需要进行气管插管。需要长时间通气支持的患者可能需要进行气管切开术。本研究比较了有和无气管切开术的烧伤患者的长期、患者报告的结局。
分析了 2013 年至 2020 年期间从烧伤模型系统数据库中收集的数据。比较了有和无气管切开术的患者之间的人口统计学和临床数据。分析了以下在 6、12 和 24 个月随访时收集的患者报告的结局：退伍军人 RAND 12 项健康调查（VR-12）、生活满意度、社区融入问卷、患者报告的结局测量信息系统 29 项简表测量、就业状况和重返工作岗位的天数。使用回归模型和倾向匹配分析来评估气管切开术与每种结局之间的关联。
在本研究纳入的 714 名患者中，5.5%接受了气管切开术。混合模型回归分析表明，仅在 24 个月随访时，需要气管切开术的患者的 VR-12 生理成分综合评分显著更差。气管切开术与 VR-12 心理成分综合评分、生活满意度、社区融入问卷或患者报告的结局测量信息系统 29 项简表测量评分无关。同样，气管切开术与就业状况或重返工作岗位的天数无关。
本初步探索表明，需要气管切开术的烧伤患者在身体和心理社会恢复以及重新就业能力方面并无更差的结局。仍需要更大规模的未来研究来评估中心和提供者层面的影响，以及各种损伤严重程度的标志的影响。尽管如此，这项工作应该能够更好地为与患者和家属就烧伤中使用气管切开术进行的护理目标讨论提供信息。
