Skip to main content
SpringerLink
Log in
Book cover

Handbook of Burns pp 173–190Cite as

Respiratory management

  • Chapter

  • 3338 Accesses

Abstract

Respiratory therapy begins with ensuring that the burn patient has a protected and stable airway. Failure to recognize the potential for airway obstruction, or impending airway obstruction may result in lethal consequences for the burn patient. Classically, airway obstruction in burn victims rapidly progresses from mild pharyngeal edema to complete upper airway obstruction [1].

This is a preview of subscription content, log in via an institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   119.00
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   159.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Mlcak RP, Suman OE, Herndon DN (2007) Respiratory management of inhalation injury. Burns 33: 2–13

    Article  PubMed  Google Scholar 

  2. Cha S, Kim CH, Lee JH et al (2007) Isolated smoke inhalation injuries: acute respiratory dysfunction, clinical outcomes, and short term evolution of pulmonary functions with the effects of steroids. Burns 33: 200–208

    Article  PubMed  Google Scholar 

  3. Modnani DD, Steele NP, de Vries E (2006) Factors that predict the need for intubation in patients with smoke inhalation injury. Ear, Nose Throat J 85: 278–280

    Google Scholar 

  4. Goh SH, Tiah L, Lim HC et al (2006) Disaster preparedness: Experience from a smoke inhalation mass casualty incident. Eur J Emerg Med 13: 330–334

    Article  PubMed  Google Scholar 

  5. Whited RE (1984) A prospective study of laryngotracheal sequelae in long-term intubation. Laryngoscope 94: 367–370

    Article  PubMed  CAS  Google Scholar 

  6. Stauffer J, Olson D, Petty T (1981) Complications and consequences of endotraeal intubation and tracheostomy: a prospective study of 150 critically ill adult patients. Am J Med 70: 65–76

    Article  PubMed  CAS  Google Scholar 

  7. Eckhauser FE, Billote J, Burke, JF et al (1974) Tracheostomy complicating massive burn injury: a plea for conservatism. Am J Surg 127: 418–423

    Article  PubMed  CAS  Google Scholar 

  8. Moylan JA, West JT, Nash G et al (1972) Tracheostomy in thermally injure patients: a review of 5 years’ experience. Am Surg 38: 119–123.

    PubMed  Google Scholar 

  9. Majeski JA, MacMillan BG (1978) Tracheoinnominate artery erosion in a burned child. J Trauma 18: 137–139

    Article  PubMed  CAS  Google Scholar 

  10. Mulder DS, Rubush JL (1969) Complications of tracheostomy: relationship to long term ventilation assistance. J Trauma 9: 389–402

    Article  PubMed  CAS  Google Scholar 

  11. Jones WG, Madden M, Finkelstein J et al (1989) Tracheostomies in burn patients. Ann Surg 209: 471–474

    Article  PubMed  CAS  Google Scholar 

  12. Gaissert HA, Lofgren RH, Grillo HC (1993) Upper airway compromise after inhalation injury: complex strictures of the larynx and trachea and their management. Ann Surg 218: 672–678

    Article  PubMed  CAS  Google Scholar 

  13. Lund T, Goodwin CW, McManus WF et al (1985) Upper airway sequelae in burn patients requiring endotracheal intubation or tracheostomy. Ann Surg 201: 374–382

    Article  PubMed  CAS  Google Scholar 

  14. Sellers B, Davis B, Larkin PW et al (1997) Early prediction of prolonged ventilator dependence in thermally injured patients. J Trauma, Injury, Infection & Critical Care 43: 899–903

    Article  CAS  Google Scholar 

  15. Saffle JR, Morris SE, Edelman L (2002) Early tracheostomy does not improve outcome in burn patients. J Burn Care Rehabil 23: 431–438

    Article  PubMed  Google Scholar 

  16. Palmieri TL, Jackson W, Greenhalgh DG (2002) Benefits of early tracheostomy in severely burned children. Crit Care Med 30: 922–924

    Article  PubMed  Google Scholar 

  17. Mlcak RP, Herndon DN (2007) Respiratory care. In: Herndon DN (ed) Total burn care. Saunders Elsevier, pp 281–291

    Google Scholar 

  18. Enkhbaatar P, Traber DL (2004) Pathophysiology of acute lung injuryh in combined burn and smoke inhalation injury. Clin Sci (Lond) 197: 137–143

    Google Scholar 

  19. Murakami K, Traber DL (2003) Pathophysiological basis of smoke inhalation injury. New Physiol Sci 18: 125–129

    CAS  Google Scholar 

  20. Miller AC, Rivero A, Ziad S et al (2009) Influence of nebulized unfractionated heparin and N-acetylcysteine in acute lung injury after smoke inhalation. J Burn Care Res 30: 249–256

    Article  PubMed  Google Scholar 

  21. DeMaestro R, Thaw L, Bjork T et al (1980) Free radicals and mediators of tissue injury. Acta Physiol Scan 192[Suppl]: S23–57

    Google Scholar 

  22. Parker IC, Martin DI, Rutilig G et al (1983) Prevention of free radical mediated vascular permeability increases in lung using superoxide dismutase. Chest 83: 528–535

    Article  Google Scholar 

  23. Cuzzocrea S, Mazzon E, Dugol L et al (2001) Protrective effects of NAC on lung injury and red blood cell modification induced by carrageenan in the rate. FASEB J 15: 1187–1200

    Article  PubMed  CAS  Google Scholar 

  24. Cox C, Zwischenberger J, Traber D et al (1993) Heparin improves oxygenation and minimizes barotrauma after severe smoke inhalation in an ovine model. SGO 176: 339–349

    PubMed  CAS  Google Scholar 

  25. Brown M, Desai M, Traber LD et al (1988) Dimethylsulfoxide with heparin in the treatment of smoke inhalation injury. J Burn Care Rehabil 9: 22–25

    Article  PubMed  CAS  Google Scholar 

  26. Desai MH, Mlcak R, Richardson J et al (1998) Reduction in mortality in pediatric patients with inhalation injury with aerosolized heparin/Acetylcysteine therapy. J Burn Care and Rehabilitation 19: 210–212

    Article  CAS  Google Scholar 

  27. Holt J, Soffle JR, Morris SE (2008) Use of inhaled heparin/N-acetylcysteine in inhalation injury: Does it help? J Burn Care Res 29: 192–195

    PubMed  Google Scholar 

  28. Slutsky AS (2001) Basic Science in ventilator induced lung injury. Am J Respir Crit Care Med 163: 599–600

    PubMed  CAS  Google Scholar 

  29. Dreyfuss D, Saumon G (1998) Ventilator induced lung injury: lessons from experimental studies. Am J Respir Crit Care Med 157: 294–323

    PubMed  CAS  Google Scholar 

  30. Gattinoni L, Caironi P, Pelosi P et al (2001) What has computed tomography taught us about ARDS? Am J Respir Crit Care Med 164: 1701–1711

    PubMed  CAS  Google Scholar 

  31. Gattinoni L, Presenti A (2005) The concept of “baby lung”. Intensive Care Med 31: 776–784

    Article  PubMed  Google Scholar 

  32. Gattinoni L, D’Andrea L, Pelosi P et al (1993) Regional effects and mechanism of positive end expiratory pressure in early adult respiratory distress syndrome. JAMA 269: 2122–2127

    Article  PubMed  CAS  Google Scholar 

  33. Crotti S, Mascheroni D, Caironi P et al (2001) Recruitment and de-recruitment during acute respiratory failure: a clinical study. Am J Respir Crit Care Med 164: 131–40

    PubMed  CAS  Google Scholar 

  34. Gattinoni L, Caironi P, Crressoni M et al (2006) Lung recruitment in patients with the acute respiratory distress syndrome. N Engl J Med 354: 1775–1786

    Article  PubMed  CAS  Google Scholar 

  35. ARDS Network Investigators (2000) Ventilation with lower tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med 342: 1301–1308

    Article  Google Scholar 

  36. Amato MB, Barbas CS, Medieros DM et al (1998) Effect of a protective ventilation strategy on mortality in ARDS. N Engl J Med 338: 347–354

    Article  PubMed  CAS  Google Scholar 

  37. Brochard L, Roudot-Toraval F, Roupie E (1998) Tidal volume reduction for prevention of VILI in ARDS. Am J Respir Crit Care Med 158: 1831–1838

    PubMed  CAS  Google Scholar 

  38. Stewart TE, Meade MO, Cook DJ et al (2000) Evaluation of a strategy to prevent barotraumas in patients at high risk for ARDS: pressure and limited volume ventilation group. N Engl J Med 342: 1301–1308

    Article  Google Scholar 

  39. Brower RG, Shanholz CB, Fessler HE et al (1999) Prospective randomized controlled trial comparing traditional vs. reduced tidal volumes for ALI or ARDS. Crit Care Med 27: 1492–1498

    Article  PubMed  CAS  Google Scholar 

  40. Dries DJ (2009) Key questions in ventilator management of the burn injured patient — Part 1. J Burn Care Res 30: 128–138

    Article  PubMed  Google Scholar 

  41. Dries DJ (1995) Permissive hypercapnia. J Trauma 39: 984–989

    Article  PubMed  CAS  Google Scholar 

  42. Navelesi P, Maggiore SM (2006) Positive end expiratory pressure. In: Tobin MJ (ed) Principles and practice of mechanical ventilation, 2nd edn. McGraw-Hill, New York, pp 273–325

    Google Scholar 

  43. Brower RG, Lanken PN, MacIntyre N et al (2004) The National Heart Lung and Blood Institute ARDS Clinical Trials Network. Higher vs lower positive end expiratory pressures in patients with the acute respiratory distress syndrome. N Engl J Med 351: 327–336

    Article  PubMed  Google Scholar 

  44. Villar J, Kacmarek RM, Perez-Mendez L et al (2006) High positive end expiratory pressure, low tidal volumd ventilation strategy improves outcome in persistant acute respiratory distress syndrome. A randomized controlled trial. Crit Care Med 34: 1311–1318

    Article  PubMed  Google Scholar 

  45. Mercat A, Richard JC, Vielle B et al (2008) Positive end expiratory pressure settings in adults with acute lung injury and acute respiratory distress syndrome: a randomized controlled trial. JAMA 299: 646–655

    Article  PubMed  CAS  Google Scholar 

  46. Meade MO, Cook DJ, Guyatt GH (2008) Lung Open Ventilation Study Investigators: Ventilation strategy using low tidal volumes, recruitment maneuvers, and high positive end-expiratory pressures for acute lung injury and acute respiratory distress syndrome. A randomized controlled trial. JAMA 299: 637–645

    Article  PubMed  CAS  Google Scholar 

  47. Gattinoni L, Caironi P (2008) Refining ventilatory treatments for acute lung injury and acute respiratory distress syndrome. JAMA 299: 691–693

    Article  PubMed  CAS  Google Scholar 

  48. Talmor D, Sarge T, Malhotra A et al (2008) Mechanical ventilation guided by esophagel pressure in acute lung injury. N Engl J Med 359: 2095–2104

    Article  PubMed  CAS  Google Scholar 

  49. Cioffi WG, deLemos RA, Coalson JJ et al (1993) Decreased pulmonary damage in primates with inhalation injury treated with high frequency ventilation. Ann Surg 218: 328–337

    Article  PubMed  CAS  Google Scholar 

  50. Cioffi WG, Graves TA, McManus WF et al (1989) High frequency percussive ventilation in patients with inhalation injury. J Trauma 29: 350–354

    Article  PubMed  CAS  Google Scholar 

  51. Reper P, DanKaert R, vanHille F et al (1998) The usefulness of combined high frequency percussive ventilation during acute respiratory failure after smoke inhalation. Burns 24: 34–38

    Article  PubMed  CAS  Google Scholar 

  52. Cioffi WG, Rue LW, Graves TA et al (1991) Prophylactic use of high frequency percussive ventilation in patients with inhalation injury. Ann Surg 213: 575–582

    Article  PubMed  Google Scholar 

  53. Cortella J, Mlack R, Herndon Dl (1999) High frequency percussive ventilation in pediatric patients with inhalation injury. J Burn Care Rehabil 20: 2–5

    Google Scholar 

  54. Rue LW, Cioffi WG, Madon AD et al (1993) Improved survival of patients with inhalation injury. Arch Surg 128: 772–780

    Article  PubMed  Google Scholar 

  55. Rodeberg DA, Maschinot NE, Housinger TA et al (1992) Decreased pulmonary barotraumas with the use of volumetric diffusive respiration in pediatric patients with burns. J Burn Care Rehabil 13: 506–511

    Article  PubMed  CAS  Google Scholar 

  56. Carmen B, Cahill T, Worden G et al (2002) A prospective randomized comparison of the volume diffusive respirator vs convential ventilation for ventilation of burned children. J Burn Care Rehabil 23: 444–448

    Article  Google Scholar 

  57. Reper P, Wibaux O, VanLaeke D et al (2002) High frequency percussive ventilation and conventional ventilation after smoke inhalation: a randomized study. Burns 28: 503–508

    Article  PubMed  CAS  Google Scholar 

  58. Hall J, Hunt JL, Arnoldo BD et al (2007) Use of high frequency percussive ventilation in inhalation injuries. J Burn Care Res 28: 396–400

    Article  PubMed  Google Scholar 

  59. Furguson ND, Stewart TE (2002) New therapies for adults with acute lung injury: high frequency oscillatory ventilation. Crit Care Clin 18: 1–23

    Article  Google Scholar 

  60. Derdak S (2003) High-frequency oscillatory ventilation for acute respiration distress syndrome in adult patients. Crit Care Med 31:S317–323

    Article  PubMed  Google Scholar 

  61. Suzuki H, Papazoglou K, Bryan AC (1992) Relationship between PaO2 and lung volume during high frequency oscillatory ventilation. Acta Paediatr Jpn 34: 494–500

    Article  PubMed  CAS  Google Scholar 

  62. Kolton M, Cattran CB, Kent G, Volgyesi G, Froese AB, Bryan AC (1982) Oxygenation during high-frequency ventilation compared with conventional mechanical ventilation in two models of lung injury. Anesth Analg 61: 323–332

    Article  PubMed  CAS  Google Scholar 

  63. Hamilton PP, Onayemi A, Smyth JA et al (1983) Comparison of conventional and high-frequency oscillatory ventilation: oxygenation and lung pathology. J Appl Physiol 55: 131–138

    PubMed  CAS  Google Scholar 

  64. McCulloch PR, Fordert PG, Froese AB (1988) Lung volume maintenance prevents lung injury during high frequency oscillatory ventilation in surfactant-deficient rabbits. Am Rev Respir Dis 137: 1185–1192

    PubMed  CAS  Google Scholar 

  65. Bond DM, Froese AB (1993) Volume recruitment maneuvers are less deleterious than persistent low lung volumes in the atelectasis-prone rabbit lung during high-frequency oscillation. Crit Care Med 21: 402–412

    Article  PubMed  CAS  Google Scholar 

  66. Rotta AT, Gunnarsson B, Fuhrman BP, Hernan LJ, Steinhorn DM (2001) Comparison of lung protective ventilation strategies in a rabbit model of acute lung injury. Crit Care Med 29: 2176–2184

    Article  PubMed  CAS  Google Scholar 

  67. Imai Y, Nakagawa S, Ito Y, Kawano T, Slutsky AS, Miyasaka K (2001) Comparison of lung protection strategies using conventional and high-frequency oscillatory ventilation. J Appl Physiol 91: 1836–1844

    PubMed  CAS  Google Scholar 

  68. Froese AB (1997) High-frequency oscillatory ventilation for adult respiratory distress syndrome: let’s get it right this time. Crit Care Med 25: 906–908

    Article  PubMed  CAS  Google Scholar 

  69. Fort P, Farmer C, Westerman J et al (1997) High-frequency oscillatory ventilation for adult respiratory distress syndrome-a pilot study. Crit Care Med 25: 937–947

    Article  PubMed  CAS  Google Scholar 

  70. Mehta S, Lapinksy SE, Hallett DC et al (2001) A prospective trial of respiratory distress syndrome. Crit Care Med 29: 1360–1369

    Article  PubMed  CAS  Google Scholar 

  71. Andersen FA, Gurrormsen AB, Flaatten HK (2002) High frequency oscillatory ventilation in adjult patients with acute respiratory distress syndrome-a retrospective study. Acta Anaesthesiol Scan 46: 1082–1088

    Article  CAS  Google Scholar 

  72. Mehta S, Granton J, MacDonald RJ et al (2004) High frequency oscillatory ventilation in adjults: the Toronto experience. Chest 126: 518–527

    Article  PubMed  Google Scholar 

  73. Claridge JA, Hostetter RG, Lowson SM, Young JS (1999) High frequency oscillatory ventilation can be effective as rescue therapy for refractory acute lung dysfunction. Am Surg 65: 1092–1096

    PubMed  CAS  Google Scholar 

  74. David M, Weiler N, Heinrichs W et al (2003) High-frequency oscillatory ventilation in adult acute respiratory distress syndrome. Intensive Care Med 29: 1656–1665

    Article  PubMed  Google Scholar 

  75. Derdak S, Mehta S, Stewart TE et al (2002) High frequency oscillatory ventilation for acute respiratory distress syndrome: a randomized controlled trial. Am J Respir Crit Care Med 166: 801–808

    Article  PubMed  Google Scholar 

  76. Bollen CW, van Well GT, Sherry T et al (2005) High frequency oscillatory ventilation compared with conventional mechanical ventilation in adult respiratory distress syndrome: a randomized controlled trial. Crit Care 9:R430–439

    Article  PubMed  Google Scholar 

  77. Cartotto R, Ellis S, Gomez M, Cooper A, Smith T (2004) High frequency oscillatory ventilation in burn patients with the acute respiratory distress syndrome. Burns 30: 453–463

    Article  PubMed  Google Scholar 

  78. Cartotto R, Ellis S, Smith T (2005) Use of high frequency oscillatory ventilation in burn patients. Crit Care Med 33:S175–181

    Article  PubMed  Google Scholar 

  79. Cartotto R, Walia G, Ellis S et al (2009) Oscillation after inhalation: high frequency oscillatory ventilation in burn patients with the acute respiratory distress syndrome and co-existing smoke inhalation injury. J Burn Care Res 30: 119–127

    Article  PubMed  Google Scholar 

  80. Habashi NM (2005) Other approaches to open lung ventilation: airway pressure release ventilation. Crit Care Med 33: 5228–2540

    Article  Google Scholar 

  81. Seymour CW, Frazer M, Reilly PM et al (2007) Airway pressure release and biphasic intermittent positive airway pressure ventilation: are they ready for primetime? J Trauma 62: 1298–1309

    Article  PubMed  Google Scholar 

  82. Dries DJ (2009) Key questions in ventilator management of the burn injured patient — Part 2. J Burn Care Res 30: 211–220

    Article  PubMed  Google Scholar 

  83. Byerly FL, Shapiro ML, Short A et al (2005) Airway pressure release ventilation is the management of inhalation injuries. J Burn Care Rehabil 26: S93 (abstract)

    Article  Google Scholar 

  84. Santucci S, Gobara S, Santos C et al (2003) Infections in a burn intensive care unit: experience of seven years. J Hosp Infec 53: 6–13

    Article  CAS  Google Scholar 

  85. Wibbenmeyer L, Danks R, Faucher L et al (2006) Prospective analysis of resistance in a burn population. J Burn Care Res 27: 152–160

    Article  PubMed  Google Scholar 

  86. Chastre J, Fagon JY (2006) Ventilator Associated pneumonia. Am J Respir Crit Care Med 34: 1414–1519

    Google Scholar 

  87. Mosier MJ, Pham TN (2009) American Burn Association Practice Guidelines for prevention, diagnosis, and treatment of ventilator associated pneumonia in burn patients. J Burn Care Res 30: 910–928

    PubMed  Google Scholar 

  88. Chim H, Tan B, Son C (2007) Five year review of infections in a burn intensive care unit: high incidence of Acinetobacter baumanii in a tropical climate. Burns 33: 1008–1014

    Article  PubMed  Google Scholar 

  89. Croce M, Fabian T, Mueller E et al (2004) The appropriate diagnostic threshold for ventilator-associated pneumonia using quantitative cultures. J Trauma 56: 931–934

    Article  PubMed  Google Scholar 

  90. Minei JP, Nathan AB, Eest M et al (2006) Injury and the host response to injury large scar collaborative research program investigators. Inflammation and the host response to injury, a large scale collaborative project; patient-oriented research care — standard operating procedures for clinical care II. Guidelines for prevention, diagnosis, and treatment of VAP in the trauma patient. J Trauma 60: 1106–1113

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Ross Tilley Burn Centre at Sunnybrook Health Sciences Centre, Department of Surgery, University of Toronto, Rm D712 2075 Bayview Ave., Toronto, ON, Canada, M4N 3M5

    Robert Cartotto M.D., FRCS(C) (Associate Professor)

Authors
  1. Robert Cartotto M.D., FRCS(C)
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Robert Cartotto M.D., FRCS(C) .

Editor information

Editors and Affiliations

  1. Sunnybrook Health Sciences Centre, Department of Surgery, Division of Plastic Surgery, University of Toronto, Sunnybrook Research Institute, Toronto, ON, Canada

    Marc G. Jeschke M.D., Ph.D.

  2. Plastische, Aesthetische und Rekonstruktive Chirurgie, Landesklinikum Wiener Neustadt, Wiener Neustadt, Austria

    Lars-Peter Kamolz M.D., M.Sc.

  3. Department of Hand and Plastic Surgery and Intensive Care, Linköping University Hospital, Linköping, Sweden

    Folke Sjöberg M.D., Ph.D.

  4. Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden

    Folke Sjöberg M.D., Ph.D.

  5. Brooke Army Medical Center, Fort Sam Houston, TX, USA

    Steven E. Wolf M.D.

Rights and permissions

Reprints and permissions

Copyright information

© 2012 Springer-Verlag/Wien

About this chapter

Cite this chapter

Cartotto, R. (2012). Respiratory management. In: Jeschke, M.G., Kamolz, LP., Sjöberg, F., Wolf, S.E. (eds) Handbook of Burns. Springer, Vienna. https://doi.org/10.1007/978-3-7091-0348-7_12

Download citation

  • DOI: https://doi.org/10.1007/978-3-7091-0348-7_12

  • Publisher Name: Springer, Vienna

  • Print ISBN: 978-3-7091-0347-0

  • Online ISBN: 978-3-7091-0348-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation