Effects of tracheostomies on infection and airway complications in pediatric burn patients

Considerable controversy exists as to whether tracheostomy is ever indicate d in burn patients, New advents in the treatment of inhalation injury have improved survival, making the use of tracheostomy more usual. The purpose o f this study was to analyze the outcome of tracheostomies, and the effect o f time on complications. Patients requiring ventilatory support and tracheostomies were studied. Dem ographic data. hospital course, ventilatory parameters and complications we re analyzed. Two hundred ninety patients required ventilation and 36 trache ostomy. Mean percentage of TBSA burned was 59% +/- 4. Ninety percent of the se patients presented with inhalation injury. Mortality in tracheostomy pat ients was 25 and 16% in all ventilated patients. Thirty-Five percent of the patients developed lute complications. Patients who had their airway conve rted to tracheostomy before day 10 postinjury had a significantly lower inc idence of subglottic stenosis, and patients who required airway pressures o ver 50 cm H2O for more than 10 days had a significantly higher incidence of tracheomalacia. Pneumonia occurred at similar incidence in ventilated and tracheostomy patients. The mortality and late complications of pediatric burn patient with tracheo stomy has decreased over the last decade. They do not present with higher i ncidence of pneumonia. Maintenance of airway pressures below 50 cm H2O and conversion of the artificial airway to tracheostomy before day 10 postinjur y may be advisable in patients requiring long term ventilation to prevent l ate complications. (C) 2000 Elsevier Science Ltd and ISBL. All rights reser ved.