Mechanical Ventilation Strategies in the Critically Ill Burn Patient: A Practical Review for Clinicians

Abstract

Burn patients are a unique population when considering strategies for ventilatory support. Frequent surgical operations, inhalation injury, pneumonia, and long durations of mechanical ventilation add to the challenging physiology of severe burn injury. We aim to provide a practical and evidence-based review of mechanical ventilation strategies for the critically ill burn patient that is tailored to the bedside clinician.

Mechanical Ventilation in the Burn Patient

“…However, there are some concerns about using this mode, specifically in burn patients. According to some animal studies, the APRV-treated population developed ARDS faster than the conventional ventilation population [20]. In contrast, a retrospective study performed by Foster et al on burn patients suggests that APRV is a safe ventilation model for these patients [24].…”

“…HFPV has not been shown to reduce mortality when compared to low-tidal volume. Still, it improves oxygenation and the number of available alveolar units, so it is now used regularly in burn centers in the United States [20].…”

“…One of the most convenient advantages is the amount of sedation required to maintain this mode. Although in some patients with ARDS, we require a RASS of −3 or −4, this mode requires a RASS of −2, and it is also compatible with prone positioning, which preserves reflexes, favors spontaneous breathing, and reduces the risk for VAP [20,22]. We could theoretically use this mode in patients with low compliance and poor oxygenation, such as severely burned patients [23].…”

“…When managing this mode, we must be mindful of some precautions, such as patients with underlying comorbidities who do not tolerate low sedation, commonly neurologically critical patients [21], as well as patients generating auto-PEEP and air trapping [20].…”

Acute Respiratory Distress Syndrome, Mechanical Ventilation, and Inhalation Injury in Burn Patients

“…A variety of unconventional modes of MV, including high-frequency percussive ventilation (HFPV), high-frequency oscillatory ventilation (HFOV), or airway-pressure-release ventilation (APRV), are used in some burn centers for patients with ARDS. 44 …”