710 Use of Airway Pressure Relief Ventilation (APRV) in Burn Patients with and Without Inhalation Injury

• Published in: Journal of burn care & research 2020-03, Vol.41 (Supplement_1), p.S186-S187
• Main Authors: Foster, Kevin N, Buchanan, Dylon, Durr, Timothy, Richey, Karen J
• Format: Article
• Language: English
• ISSN: 1559-047X; 1559-0488
• DOI: 10.1093/jbcr/iraa024.296

Abstract Introduction Burn patients often require ventilator management because of large % TBSA injury, the presence of inhalation injury, and/or other factors. Airway pressure relief ventilation (APRV) offers several advantages over conventional ventilation modes including improved alveolar recruitment, better oxygenation and hemodynamics, preservation of spontaneous breathing, and possibly less ventilator-induced lung injury. This study reviews the use of APRV as the primary ventilator mode in burn patients with and without inhalation injury. Methods A retrospective chart review of patients admitted to the burn center and requiring APRV ventilation over a ten year period was performed. Data collected included demographic data, burn injury data, ventilator settings, arterial blood gas data, and development of ventilator-associated pneumonia (VAP). Results There were 411 patients identified over the ten year period. Mean age was 46 years, and mean % TBSA burned was 33. Seventy-three percent were male. One-half (51%) of patients had an inhalation injury. Mean hospital length of stay was 32 days with 22 mean ventilator days. Average number of surgeries was 4.4 per patient. Mean high pressure (P high) was 23 mm Hg. Mean FiO2 was 88% on post-injury day (PID) 1, 65% on day PID 2, and 45% thereafter. Mean P/F ratio was 333. Mean pH was 7.40, mean pCO2 was 40 mmHg, and mean HCO3 was 25 mm Hg. Forty-six percent of patients met criteria for diagnosis of VAP. Conclusions These data demonstrate that burn patients requiring mechanical ventilation can be safely and effectively managed with APRV. Oxygenation, carbon dioxide removal, normal acid-base status, and excellent P/F ratios were maintained with relatively low ventilator settings such as peak airway pressure and FiO2. Patients were able to breathe spontaneously when able and were easily liberated form the ventilator at the appropriate time. Applicability of Research to Practice This study defines an unconventional and potentially improved ventilator mode use in burn patients.