The Science Journal of the American Association for Respiratory Care

2008 OPEN FORUM Abstracts

THE ACUITY OF BURN INJURY PATIENTS DURING THE 2007 SAN DIEGO COUNTY WILDFIRES

Marcia Teal1, Julie M. Emerick1, Rick Ford1



Background: In October of 2007, the UCSD Regional Burn Center received word that the first victim of the Harris Wildfires was on their way. In total more than 50 victims of the fires were treated by our Burn Center, 23 were admitted and 6 of these were firefighters. During the first day alone the Burn Intensive Care Unit cared for 14 patients. Of these admissions, 7 were intubated and ventilated. Initially 3 of these ventilated patients were on volume control ventilation and the other 4 were set up on Airway Pressure Release Ventilation (APRV) ventilation. Within 24 hours all 7 intubated patients were placed on APRV. The ability of the Respiratory Care Department to safely care for these patients during this crisis required a clear understanding of the acuity of these patients in order to direct limited resources where needed most. We describe the acuity of patients and the impact they had, so that other centers can better anticipate what to expect if in a similar situation.

Methods: A retrospective review of ventilator settings and ABG analysis was obtained for the duration of all ventilated burn victims. Specifically, Total Body Surface Area percentage (%TBSA) burn injury, PEEP High's , P/F ratios and ventilator days were collected.

Results: Of the seven ventilated burn patients, the average TBSA burn injury was 28.7% (high= 60%/low= 2%) For patients on APRV, average PEEP High settings were 26.3 cm H20 (high= 34cm H20/ low= 21cm H20). P/F ratios averaged 297mm Hg (high=502 mm Hg/low=172mm Hg). The total average ventilator days were 28.4 (high=45/low=14.

Conclusion: These findings suggest that in the face of inhalation injury with large fluid shifts and high acuity, that patients could be supported with early application of APRV. The average ventilating pressures were also kept to a minimum when employing this mode. Our ability to assess acuity, anticipate needs, select appropriate technology, and deploy scarce resources where needed resulted in a triage response to this local disaster that was well organized with constant communication. Despite our staff being affected by evacuations and concern for their own friends and family members, we were able to give exceptional care to all of our patients affected by the 2007 wildfires.