Control/Tracking Number: 13-A-47-ABA
Activity: Abstract Submission
Current Date/Time: 9/21/2012 2:30:29 PM
Intubation After Home-Oxygen Therapy Related Burns: Costs and Comparisons
Author Block: F. Shihadeh, BS, R. Coffey, MSN, CNP, B. Blay, None, N. Arradaza, MS, G.
Phillips, MAS, S. F. Miller, MD, L. M. Jones, MD
The Ohio State University Wexner Medical Center, Columbus, OH
Abstract:
Introduction: Home oxygen therapy (HOT) has become an integral part of the treatment of many
diseases but misuse can lead to burns. While the total body surface area (TBSA) of these injuries
may be small and involve only the face, patients with HOT-related injuries are suspect for the
presence of inhalation injuries, prompting intubation. The purpose of this study is to compare two
groups of patients with HOT-related injuries (intubated and not intubated), including total length of
stay, ICU length of stay, ventilator days, hospital costs, complications, morbidity/mortality,
indications for intubation and if/how bronchoscopy was used in the management of these
patients.
Methods: A retrospective chart review of all HOT-related burns admitted to our institution
between January 1, 2006 and February 29, 2012 was conducted. Demographic data, TBSA,
intubation, inhalation injury and outcome data including discharge disposition and charges were
collected.
Results: Of the 47 patients admitted for HOT-related injuries, 18 (38%) underwent intubation.
Both groups were similar in mean pH, PCO2, pO2, mean % TBSA and complication rate.
Intubated patients, however, had an increased median length of stay (LOS) (6.0 vs. 2.5 days),
ICU stay (2 vs. 0 days), increased median hospital cost ($36,219 vs. $9,623), were more likely to
be discharged to an extended care facility or another service and were most likely to have facial
burns (83.3% vs. 71.4%) compared to non-intubated patients. Among all the patients, a greater
proportion of the burns were on the nose, followed by the cheeks and forehead. Cigarette
smoking was overwhelmingly the most frequent method of ignition source (73.4%). Of the 18
intubated patients, only one underwent bronchoscopy to confirm inhalation injuries. The
indications for intubation were difficult to cull from the patient reports, as 8/18 (44%) were
intubated prior to arriving at our hospital. None of the patients died.
Conclusions: Despite minimal cutaneous injuries, patients with HOT injuries may undergo
intubation, which lead to greater costs and LOS in the hospital. Intubating patients, however, did
not seem to affect the complication or survival rate compared with non-intubated patients. With
concerns for inhalation injuries, bronchoscopy is usually done to confirm the need for intubation
yet intubation was performed often without bronchoscopy and without clearly elucidated
indications. It is important for burn centers to develop best practice algorithms for intubation or
maintaining mechanical ventilation in patients with HOT-related injuries.
Applicability of Research to Practice: The development and evaluation of algorithms for
intubation practices and airway management for patients with HOT injuries will improve care and
decrease health care costs.
External Funding: None
:
Author Disclosure Information: F. Shihadeh, None..
R. Coffey, None..
B. Blay, None..
N. Arradaza, None..
G. Phillips, None..
S. F. Miller, None..
L. M. Jones, None.
Presentation Preference (Complete): No Preference
Category (Complete): Critical Care - Inhalation
Award Information (Complete):
Select an award to apply for here:
Moyer Award
Status: Complete