Non-invasive positive pressure ventilation in burns

Introduction

Acute respiratory failure is a common complication of severely burn-injured patients. Non-invasive positive pressure ventilation (NIPPV) has been used with success in hypercapnic and hypoxaemic acute respiratory failure. However, the outcome of NIPPV with burn patients is less well documented. The purpose of this study is to report our experience with NIPPV in a series of burn-injured patients.

Methods

The records of all burn patients from July 2008 to September 2009, in whom NIPPV was used in the intensive burn care unit, were reviewed. The criteria for selecting patients for NIPPV included a combination of the following factors: patients with acute respiratory failure, haemodynamically stable, conscious and cooperative with their treatment. There had to be no need for endotracheal intubation.

Results

Thirty-one patients were treated with NIPPV. Nineteen were female. Mean age was 44.22 years, mean total body surface area (TBSA) was 38.37%. NIPPV was used to treat hypoxia in 21 patients, hypercapnia in four patients and both of them in six patients. The mean PaO₂/FiO₂ ratio before NIPPV was 188.53. NIPPV was used to treat ARDS in 12 patients, pneumonia in eight patients, atelectasis in six patients and cardiogenic oedema in five patients. The mean PaO₂/FiO₂ ratio after NIPPV was 256.43. Intubation was successfully avoided in 12 out of the 31 (38.7%) patients. All of these patients progressed to self-ventilation status following NIPPV.

Conclusions

The use of NIPPV with burn-injured patients is, as yet, unclear because little work has been documented. In our experience, the use of NIPPV can lead to avoid the need for endotracheal intubation and mechanical ventilation.