Ventilation practices in burn patients - an international prospective observational cohort study

Gerie Glas; Janneke Horn; Markus W. Hollmann; Benedikt Preckel; Kirsten Colpaert; Manu Malbrain; Ary Serpa Neto; Karim Asehnoune; Marcello Gamma De Abreu; Ignacio Martin-Loeches; Paolo Pelosi; Folke Sjöberg; Jan M. Binnekade; Berry Cleffken; Nicole P. Juffermans; Paul Knape; Bert G. Loef; David P. Mackie; Perenlei Enkhbaatar; Nadia Depetris; Anders Perner; Eva Herrero; Lucia Cachafeiro; Marc Jeschke; Jeffrey Lipman; Matthieu Legrand; Johannes Horter; Athina Lavrentieva; Alex Kazemi; Anne Berit Guttormsen; Frederik Huss; Mark Kol; Helen Wong; Therese Starr; Luc De Crop; Wilson De Oliveira Filho; João Manoel Silva Junior; Cintia M.C. Grion; Marjorie Burnett; Frederik Mondrup; Francois Ravat; Mathieu Fontaine; Renan Le Floch; Mathieu Jeanne; Morgane Bacus; Maïté Chaussard; Marcus Lehnhardt; Bassem Daniel Mikhail; Jochen Gille; Aidan Sharkey; Nicole Trommel; Auke C. Reidinga; Nadine Vieleers; Anna Tilsley; Henning Onarheim; Maria Teresa Bouza; Alexander Agrifoglio; Filip Fredén; Tina Palmieri; Lynda E. Painting; Marcus J Schultz; LAMiNAR investigators

doi:10.1093/burnst/tkab034

Ventilation practices in burn patients - an international prospective observational cohort study

Gerie Glas, Janneke Horn, Markus W. Hollmann, Benedikt Preckel, Kirsten Colpaert, Manu Malbrain, Ary Serpa Neto, Karim Asehnoune, Marcello Gamma De Abreu, Ignacio Martin-Loeches, Paolo Pelosi, Folke Sjöberg, Jan M. Binnekade, Berry Cleffken, Nicole P. Juffermans, Paul Knape, Bert G. Loef, David P. Mackie, Perenlei Enkhbaatar, Nadia DepetrisAnders Perner, Eva Herrero, Lucia Cachafeiro, Marc Jeschke, Jeffrey Lipman, Matthieu Legrand, Johannes Horter, Athina Lavrentieva, Alex Kazemi, Anne Berit Guttormsen, Frederik Huss, Mark Kol, Helen Wong, Therese Starr, Luc De Crop, Wilson De Oliveira Filho, João Manoel Silva Junior, Cintia M.C. Grion, Marjorie Burnett, Frederik Mondrup, Francois Ravat, Mathieu Fontaine, Renan Le Floch, Mathieu Jeanne, Morgane Bacus, Maïté Chaussard, Marcus Lehnhardt, Bassem Daniel Mikhail, Jochen Gille, Aidan Sharkey, Nicole Trommel, Auke C. Reidinga, Nadine Vieleers, Anna Tilsley, Henning Onarheim, Maria Teresa Bouza, Alexander Agrifoglio, Filip Fredén, Tina Palmieri, Lynda E. Painting, Marcus J Schultz, LAMiNAR investigators

Research output: Contribution to journal › Article › Research › peer-review

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Abstract

Background: It is unknown whether lung-protective ventilation is applied in burn patients and whether they benefit from it. This study aimed to determine ventilation practices in burn intensive care units (ICUs) and investigate the association between lung-protective ventilation and the number of ventilator-free days and alive at day 28 (VFD-28). Methods: This is an international prospective observational cohort study including adult burn patients requiring mechanical ventilation. Low tidal volume (VT) was defined as VT ≤ 8 mL/kg predicted body weight (PBW). Levels of positive end-expiratory pressure (PEEP) and maximum airway pressures were collected. The association between VT and VFD-28 was analyzed using a competing risk model. Ventilation settings were presented for all patients, focusing on the first day of ventilation. We also compared ventilation settings between patients with and without inhalation trauma. Results: A total of 160 patients from 28 ICUs in 16 countries were included. Low VT was used in 74% of patients, median VT size was 7.3 [interquartile range (IQR) 6.2-8.3] mL/kg PBW and did not differ between patients with and without inhalation trauma (p = 0.58). Median VFD-28 was 17 (IQR 0-26), without a difference between ventilation with low or high VT (p = 0.98). All patients were ventilated with PEEP levels ≥5 cmH2O; 80% of patients had maximum airway pressures <30 cmH2O. Conclusion: In this international cohort study we found that lung-protective ventilation is used in the majority of burn patients, irrespective of the presence of inhalation trauma. Use of low VT was not associated with a reduction in VFD-28.

Original language	English
Pages (from-to)	698-710
Number of pages	13
Journal	Burns & Trauma
Volume	9
DOIs	https://doi.org/10.1093/burnst/tkab034
Publication status	Published - 2021

Keywords

Critical care
Inhalation trauma
Lung-protective
Mechanical ventilation

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10.1093/burnst/tkab034Licence: CC BY

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Glas, G., Horn, J., Hollmann, M. W., Preckel, B., Colpaert, K., Malbrain, M., Neto, A. S., Asehnoune, K., De Abreu, M. G., Martin-Loeches, I., Pelosi, P., Sjöberg, F., Binnekade, J. M., Cleffken, B., Juffermans, N. P., Knape, P., Loef, B. G., Mackie, D. P., Enkhbaatar, P., ... LAMiNAR investigators (2021). Ventilation practices in burn patients - an international prospective observational cohort study. Burns & Trauma, 9, 698-710. https://doi.org/10.1093/burnst/tkab034

@article{c67a4411508d4f6f92276cbfc69c0aa7,

title = "Ventilation practices in burn patients - an international prospective observational cohort study",

abstract = "Background: It is unknown whether lung-protective ventilation is applied in burn patients and whether they benefit from it. This study aimed to determine ventilation practices in burn intensive care units (ICUs) and investigate the association between lung-protective ventilation and the number of ventilator-free days and alive at day 28 (VFD-28). Methods: This is an international prospective observational cohort study including adult burn patients requiring mechanical ventilation. Low tidal volume (VT) was defined as VT ≤ 8 mL/kg predicted body weight (PBW). Levels of positive end-expiratory pressure (PEEP) and maximum airway pressures were collected. The association between VT and VFD-28 was analyzed using a competing risk model. Ventilation settings were presented for all patients, focusing on the first day of ventilation. We also compared ventilation settings between patients with and without inhalation trauma. Results: A total of 160 patients from 28 ICUs in 16 countries were included. Low VT was used in 74\% of patients, median VT size was 7.3 [interquartile range (IQR) 6.2-8.3] mL/kg PBW and did not differ between patients with and without inhalation trauma (p = 0.58). Median VFD-28 was 17 (IQR 0-26), without a difference between ventilation with low or high VT (p = 0.98). All patients were ventilated with PEEP levels ≥5 cmH2O; 80\% of patients had maximum airway pressures <30 cmH2O. Conclusion: In this international cohort study we found that lung-protective ventilation is used in the majority of burn patients, irrespective of the presence of inhalation trauma. Use of low VT was not associated with a reduction in VFD-28.",

keywords = "Critical care, Inhalation trauma, Lung-protective, Mechanical ventilation",

author = "Gerie Glas and Janneke Horn and Hollmann, \{Markus W.\} and Benedikt Preckel and Kirsten Colpaert and Manu Malbrain and Neto, \{Ary Serpa\} and Karim Asehnoune and \{De Abreu\}, \{Marcello Gamma\} and Ignacio Martin-Loeches and Paolo Pelosi and Folke Sj{\"o}berg and Binnekade, \{Jan M.\} and Berry Cleffken and Juffermans, \{Nicole P.\} and Paul Knape and Loef, \{Bert G.\} and Mackie, \{David P.\} and Perenlei Enkhbaatar and Nadia Depetris and Anders Perner and Eva Herrero and Lucia Cachafeiro and Marc Jeschke and Jeffrey Lipman and Matthieu Legrand and Johannes Horter and Athina Lavrentieva and Alex Kazemi and Guttormsen, \{Anne Berit\} and Frederik Huss and Mark Kol and Helen Wong and Therese Starr and \{De Crop\}, Luc and \{De Oliveira Filho\}, Wilson and \{Manoel Silva Junior\}, Jo{\~a}o and Grion, \{Cintia M.C.\} and Marjorie Burnett and Frederik Mondrup and Francois Ravat and Mathieu Fontaine and Floch, \{Renan Le\} and Mathieu Jeanne and Morgane Bacus and Ma{\"i}t{\'e} Chaussard and Marcus Lehnhardt and Mikhail, \{Bassem Daniel\} and Jochen Gille and Aidan Sharkey and Nicole Trommel and Reidinga, \{Auke C.\} and Nadine Vieleers and Anna Tilsley and Henning Onarheim and Bouza, \{Maria Teresa\} and Alexander Agrifoglio and Filip Fred{\'e}n and Tina Palmieri and Painting, \{Lynda E.\} and Schultz, \{Marcus J\} and \{LAMiNAR investigators\}",

note = "Publisher Copyright: {\textcopyright} 2021 The Author(s).",

year = "2021",

doi = "10.1093/burnst/tkab034",

language = "English",

volume = "9",

pages = "698--710",

journal = "Burns \& Trauma",

issn = "2321-3876",

publisher = "Oxford University Press",

}

Glas, G, Horn, J, Hollmann, MW, Preckel, B, Colpaert, K, Malbrain, M, Neto, AS, Asehnoune, K, De Abreu, MG, Martin-Loeches, I, Pelosi, P, Sjöberg, F, Binnekade, JM, Cleffken, B, Juffermans, NP, Knape, P, Loef, BG, Mackie, DP, Enkhbaatar, P, Depetris, N, Perner, A, Herrero, E, Cachafeiro, L, Jeschke, M, Lipman, J, Legrand, M, Horter, J, Lavrentieva, A, Kazemi, A, Guttormsen, AB, Huss, F, Kol, M, Wong, H, Starr, T, De Crop, L, De Oliveira Filho, W, Manoel Silva Junior, J, Grion, CMC, Burnett, M, Mondrup, F, Ravat, F, Fontaine, M, Floch, RL, Jeanne, M, Bacus, M, Chaussard, M, Lehnhardt, M, Mikhail, BD, Gille, J, Sharkey, A, Trommel, N, Reidinga, AC, Vieleers, N, Tilsley, A, Onarheim, H, Bouza, MT, Agrifoglio, A, Fredén, F, Palmieri, T, Painting, LE, Schultz, MJ & LAMiNAR investigators 2021, 'Ventilation practices in burn patients - an international prospective observational cohort study', Burns & Trauma, vol. 9, pp. 698-710. https://doi.org/10.1093/burnst/tkab034

TY - JOUR

T1 - Ventilation practices in burn patients - an international prospective observational cohort study

AU - Glas, Gerie

AU - Horn, Janneke

AU - Hollmann, Markus W.

AU - Preckel, Benedikt

AU - Colpaert, Kirsten

AU - Malbrain, Manu

AU - Neto, Ary Serpa

AU - Asehnoune, Karim

AU - De Abreu, Marcello Gamma

AU - Martin-Loeches, Ignacio

AU - Pelosi, Paolo

AU - Sjöberg, Folke

AU - Binnekade, Jan M.

AU - Cleffken, Berry

AU - Juffermans, Nicole P.

AU - Knape, Paul

AU - Loef, Bert G.

AU - Mackie, David P.

AU - Enkhbaatar, Perenlei

AU - Depetris, Nadia

AU - Perner, Anders

AU - Herrero, Eva

AU - Cachafeiro, Lucia

AU - Jeschke, Marc

AU - Lipman, Jeffrey

AU - Legrand, Matthieu

AU - Horter, Johannes

AU - Lavrentieva, Athina

AU - Kazemi, Alex

AU - Guttormsen, Anne Berit

AU - Huss, Frederik

AU - Kol, Mark

AU - Wong, Helen

AU - Starr, Therese

AU - De Crop, Luc

AU - De Oliveira Filho, Wilson

AU - Manoel Silva Junior, João

AU - Grion, Cintia M.C.

AU - Burnett, Marjorie

AU - Mondrup, Frederik

AU - Ravat, Francois

AU - Fontaine, Mathieu

AU - Floch, Renan Le

AU - Jeanne, Mathieu

AU - Bacus, Morgane

AU - Chaussard, Maïté

AU - Lehnhardt, Marcus

AU - Mikhail, Bassem Daniel

AU - Gille, Jochen

AU - Sharkey, Aidan

AU - Trommel, Nicole

AU - Reidinga, Auke C.

AU - Vieleers, Nadine

AU - Tilsley, Anna

AU - Onarheim, Henning

AU - Bouza, Maria Teresa

AU - Agrifoglio, Alexander

AU - Fredén, Filip

AU - Palmieri, Tina

AU - Painting, Lynda E.

AU - Schultz, Marcus J

AU - LAMiNAR investigators

PY - 2021

Y1 - 2021

N2 - Background: It is unknown whether lung-protective ventilation is applied in burn patients and whether they benefit from it. This study aimed to determine ventilation practices in burn intensive care units (ICUs) and investigate the association between lung-protective ventilation and the number of ventilator-free days and alive at day 28 (VFD-28). Methods: This is an international prospective observational cohort study including adult burn patients requiring mechanical ventilation. Low tidal volume (VT) was defined as VT ≤ 8 mL/kg predicted body weight (PBW). Levels of positive end-expiratory pressure (PEEP) and maximum airway pressures were collected. The association between VT and VFD-28 was analyzed using a competing risk model. Ventilation settings were presented for all patients, focusing on the first day of ventilation. We also compared ventilation settings between patients with and without inhalation trauma. Results: A total of 160 patients from 28 ICUs in 16 countries were included. Low VT was used in 74% of patients, median VT size was 7.3 [interquartile range (IQR) 6.2-8.3] mL/kg PBW and did not differ between patients with and without inhalation trauma (p = 0.58). Median VFD-28 was 17 (IQR 0-26), without a difference between ventilation with low or high VT (p = 0.98). All patients were ventilated with PEEP levels ≥5 cmH2O; 80% of patients had maximum airway pressures <30 cmH2O. Conclusion: In this international cohort study we found that lung-protective ventilation is used in the majority of burn patients, irrespective of the presence of inhalation trauma. Use of low VT was not associated with a reduction in VFD-28.

AB - Background: It is unknown whether lung-protective ventilation is applied in burn patients and whether they benefit from it. This study aimed to determine ventilation practices in burn intensive care units (ICUs) and investigate the association between lung-protective ventilation and the number of ventilator-free days and alive at day 28 (VFD-28). Methods: This is an international prospective observational cohort study including adult burn patients requiring mechanical ventilation. Low tidal volume (VT) was defined as VT ≤ 8 mL/kg predicted body weight (PBW). Levels of positive end-expiratory pressure (PEEP) and maximum airway pressures were collected. The association between VT and VFD-28 was analyzed using a competing risk model. Ventilation settings were presented for all patients, focusing on the first day of ventilation. We also compared ventilation settings between patients with and without inhalation trauma. Results: A total of 160 patients from 28 ICUs in 16 countries were included. Low VT was used in 74% of patients, median VT size was 7.3 [interquartile range (IQR) 6.2-8.3] mL/kg PBW and did not differ between patients with and without inhalation trauma (p = 0.58). Median VFD-28 was 17 (IQR 0-26), without a difference between ventilation with low or high VT (p = 0.98). All patients were ventilated with PEEP levels ≥5 cmH2O; 80% of patients had maximum airway pressures <30 cmH2O. Conclusion: In this international cohort study we found that lung-protective ventilation is used in the majority of burn patients, irrespective of the presence of inhalation trauma. Use of low VT was not associated with a reduction in VFD-28.

KW - Critical care

KW - Inhalation trauma

KW - Lung-protective

KW - Mechanical ventilation

UR - https://www.scopus.com/pages/publications/85143991138

U2 - 10.1093/burnst/tkab034

DO - 10.1093/burnst/tkab034

M3 - Article

C2 - 34926707

AN - SCOPUS:85143991138

SN - 2321-3876

VL - 9

SP - 698

EP - 710

JO - Burns & Trauma

JF - Burns & Trauma

ER -

Ventilation practices in burn patients - an international prospective observational cohort study

Abstract

Keywords

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