Early tracheostomy and active exercise programmes in adult intensive care patients with severe burns |
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| Institution: | 1. St Andrews Centre for Plastic Surgery and Burns, Broomfield Hospital, Chelmsford, Essex CM1 7ET, United Kingdom;2. Centre for Neuroscience, Surgery and Trauma, Blizard Institute, Queen Mary University of London, United Kingdom;1. Burn and Regenerative Medicine Research Center, Guilan University of Medical Sciences, Rasht, Iran;2. Department of Mechanical Engineering, School of Engineering, Aalto University, Espoo, Finland;3. Department of Medical Physics, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran;4. Health Information Management Research Center, Kashan University of Medical Sciences, Kashan, Iran;1. Department of Burns and Plastic Surgery, Yongchuan Hospital of Chongqing Medical University, Chongqing 402160, PR China;2. Central Laboratory, Yongchuan Hospital of Chongqing Medical University, Chongqing 402160, PR China;1. Burn and Regenerative Medicine Research Center, Guilan University of Medical Sciences, Rasht, Iran;2. Department of Corrective Exercise and Sport Injury, Faculty of Sport Sciences, University of Guilan, Rasht, Iran;3. Department of Psychology, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran;4. Department of Medical Physics, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran;5. Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran;6. Quchan School of Nursing, Mashhad University of Medical Sciences, Mashhad, Iran;1. School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, 4072, Australia;2. The Royal Brisbane & Women’s Hospital, Queensland Health, Butterfield Street, Brisbane, Queensland, 4029, Australia;3. School of Health and Behavioural Sciences, University of the Sunshine Coast, Sippy Downs, Queensland, 4556, Australia;4. School of Medicine, The University of Queensland, Brisbane, Queensland, 4072, Australia;1. Department of Plastic, Reconstructive & Aesthetic Surgery, Burn Unit, Klinikum Nuremberg Hospital, Paracelsus Medical University (PMU), Breslauer Str. 201, 90471 Nuremberg, Germany;2. ZEW – Leibniz Centre for European Economic Research, L7 1, 68161 Mannheim, Germany;3. German Society for Burn Treatment (DGV), Committee of the German Burn Registry, Luisenstrasse 58–59, 11, 10117 Berlin, Germany;1. Department of Burns and Plastic Surgery, City Hospital Campus, Nottingham University Hospitals NHS Trust, Hucknall Road, Nottingham NG5 1PB, United Kingdom;2. The University of Nottingham Medical School, Nottingham NG7 2UH, United Kingdom;3. Postgraduate Medical Education Centre, City Hospital Campus, Nottingham University, Hospitals NHS Trust, Nottingham NG5 1PB, United Kingdom |
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| Abstract: | BackgroundTracheostomy is a strategy often employed in patients requiring prolonged intubation in ICU settings. Evidence suggests that earlier tracheostomy and early active exercise are associated with better patient centered outcomes. Severe burn patients often require prolonged ventilatory support due to their critical condition, complex sedation management and multiple operating room visits. It is still unclear the optimal timing for tracheostomy in this population.MethodsWe conducted a service evaluation where we compared Early Tracheostomy (≤10 days) with Late Tracheostomy (>10 days) in 41 severely burned patients that required prolonged respiratory support.ResultsEarly Tracheostomy cohort was associated with fewer days of mechanical ventilation (16 vs 33, p = 0.001), shorter hospital length of stay (65 vs 88 days, p = 0.018), earlier first day of active exercise (day 8 vs day 25, p < 0.0001) and higher Functional Assessment for Burns scores upon discharge (32 vs 28, p = 0.016).ConclusionEarly tracheostomy in patients with severe burns is associated with earlier active exercise, fewer days of ventilation, shorter length of hospital stay and better physical functional independence upon discharge from hospital. |
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| Keywords: | Burns Intensive care Tracheostomy Physiotherapy Active exercise |
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