2011 OPEN FORUM Abstracts
EFFECTS OF TIDAL VOLUME AND PEEP ON MORTALITY IN PEDIATRIC PATIENTS WITH INHALATION INJURY.
Ronald Mlcak, Oscar E. Suman, David N. Herndon; Shriners Hospitals for Children, Galveston, TX
BACKGROUND: Despite advances in critical care, inhalation injury continues to be a major source of morbidity and mortality in burn patients and often requires mechanical ventilation. The ARDS net study has shown a significant decrease in mortality when low tidal volumes are used for the treatment of ARDS. Whether the results hold true for patients of inhalation injury has yet to be studied. The purpose of the study was to determine the effects of tidal volume and PEEP on mortality in pediatric patients with inhalation injury over a two decade time period. METHODS: 769 severely burned pediatric patients with inhalation injury were retrospectively studies from 1986 to June 2007. Patients were stratified into two decades; 1986-1996 vs. 1997-2007. Mean initial tidal volumes used in the first decade were 14 +/- 0.9 ml/kg vs. 9 +/- 2 ml/kg in the second decade. Outcome variables included ventilator days, PEEP levels, incidence of pneumonia, incidence of atelectasis, and mortality. Data are reported as mean +/- SD. Significance was accepted at p < 0.05. RESULTS: Age and burn size were similar in both groups. Mean ventilator days in the 1986-1996 decade were 5.7 +/- 4 vs. 9.0 +/- 3 in the 1997-2007 decade (p < 0.05). The average highest PEEP level used from 1986-1996 was 6.7 +/- 1 vs. 9.1 +/- 2 in the 1997-2007 decade (p < 0.05). The incidence of pneumonia in the 1986-1996 decade was 25 % vs. 29 % in the 1997-2007 decade (p < 0.05). The incidence of atelectasis was 42 % in the 1986-1996 decade vs. 64 % in the 1997-2007 decade (p < 0.05). The inhalation injury mortality rate was 13.5 +/- 8 % in the 1986-1996 decade vs. 14.7 +/- 7 % in the 1997-2007 decade. CONCLUSION: Results indicate that the tidal volume and PEEP levels used to treat pediatric patients with inhalation injury had no significant effect on mortality. However lower tidal volumes were associated with a significant increase in ventilator days, incidence of pneumonia and atelectasis.
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