Dr Matthew Davies¹, Dr Sepehr Lajevardi^1,2, Dr Anand Deva¹, Dr  Peter Maitz²

¹Macquarie University Hospital, Macquarie University , Australia, ²Concord Repatriation Hospital, Concord, Australia

Abstract:

Background

Airway management can be one of the most critical but varied steps in early burn care. The NSW ACI burn transfer guidelines indicate the criteria for consideration of intubation when there is clinical evidence or suspicion of an inhalational injury. Given some patients have prolonged transfers in NSW, they may develop airway compromise prior to arrival in a burns unit.

Objectives

The aim of this study was to assess the standard of airway management in patients transferred to a specialised burns centre in NSW.

Methods

Prospective data was collated for all burns patients transferred to Concord Hospital, NSW from 2009 to 2013. This included airway management advice by the burns team, outcome measures and was compared to guidelines.

Findings and Conclusions

Of the 334 patients identified, 13.5% required intubation either prior to transfer (Group 1: 62.2%) or after transfer (Group 2: 37.8%). In total, 96.4% of group 1 and 94.1% of group 2 met intubation criteria on arrival. There was a significant difference in TBSA (16.1% group 1 and 27.4% group 2; p<0.05), likely explained by some inhalation only (0%TBSA) and small TBSA head/neck only burns which may have skewed the data. Outcomes varied by mortality rate (0% vs 17.6%; p<0.05) and duration of intubation (3.5 vs 7.9 days; p<0.05). The groups did not vary significantly in rates of early extubation, ICU LOS and hospital LOS.

This study demonstrates that the statewide intubation criteria offers a benefit to reduced mortality and duration of intubation when used appropriately.

Biography:

Matthew Davies is an uncredited plastics registrar in Sydney with a keen interest in research and academic surgery.