Extracorporeal membrane oxygenation for acute respiratory distress syndrome in burn patients:a case series and literature update

Background:Acute respiratory distress syndrome(ARDS)has a reported incidence of 34–43%in ventilated burn patients and is associated with a mortality of 59%in the severe form.The use and experience with extracorporeal membrane oxygenation(ECMO)in burn patients developing ARDS are still limited.We present our results and discuss the significance of ECMO in treating burn patients.Methods:A retrospective analysis of burn patients treated with ECMO for ARDS between January 2017 and January 2019 was performed.Demographic,clinical,and outcome data were collected and analyzed.Results:Eight burn patients were treated at our institution with ECMO in the designated time period.Of these,all but one patient had inhalation injury,burn percentage of TBSA was 37±23%,ABSI score was 8.4±2,and R-Bauxscore was 98±21.Seven patients developed severe ARDS and one patient moderate ARDS according to the Berlin classification with a PaO_(2)/FiO_(2) ratio upon initiation of ECMO therapy of 62±22 mmHg.ECMO duration was 388±283 h.Three patients died from severe sepsis while five patients survived to hospital discharge.Conclusions:ECMO is a viable therapy option in burn patients developing severe ARDS and can contribute to survival rates similar to ECMO therapy in non-burn-associated severe ARDS.Consequently,patients with severe respiratory insufficiency with unsuccessful conventional treatment and suspected worsening should be transferred to burn units with the possibility of ECMO treatment to improve outcome.

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.