Abstract
Introduction: Tracheostomy is one of the most frequent surgical procedures in critical care patients. Tracheostomy in burn injury patients is, however, very specific topic.
The purpose of our research is the evaluation of such topic. Methods: We conducted a retrospective study of patients hospitalized at ICU of Department of Burn Injuries at University Hospital Královské Vinohrady and Third Faculty of Medicine, Charles University in Prague between 1. 1. 2012 - 31. 12. 2017, who underwent tracheostomy performed by an otorhinolaryngologist. 47 patients were enrolled to the study.
We evaluated the complications of tracheostomy and its correlation to the factors of the site of the burn injury, timing of tracheostomy and experience of the surgeon. Results: There was no significant difference between the group with burn injury in the neck region versus burn injury outside the neck in terms of surgical complications, stoma infections, postoperative pneumonia, colonization of the respiratory tract mucosa by multi-resistant bacteria nor mortality.
Regarding the timing of tracheostomy, we found higher occurrence of multi resistant nosocomial bacteria in lower respiratory tract in the late tracheostomy group (p=0.07). Although the overall complications rate was higher in tracheostomies performer by resident otorhinolaryngologists, the difference was not statistically significant.
Conclusion: Tracheostomy in burn injury is a specific topic given the patient's primary illness. The management usually follows the international societies' guidelines.
The most controversial long-term airway management is in the presence of burn trauma directly in the neck region. According to our study results, there was no higher incidence of complications in such patients though.
Timing of tracheostomy may play role in multi-resistant bacteria colonization of the lower respiratory tract. The choice of a level of experience of a surgeon to be performing tracheostomy in burn injury should be carefully considered.