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

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(V_(T))was defined as V_(T)≤8 mL/kg predicted body weight(PBW).Levels of positive end-expiratory pressure(PEEP)and maximum airway pressures were collected.The association between V_(T) 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 V_(T) was used in 74%of patients,median V_(T) 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 V_(T)(p=0.98).All patients were ventilated with PEEP levels≥5 cmH_(2)O;80%of patients had maximum airway pressures<30 cmH_(2)O.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 V_(T) was not associated with a reduction in VFD-28.Trial registration:Clinicaltrials.gov NCT02312869.Date of registration:9 December 2014.