Complications

Pulmonary infections following inhalation injury are common. The risk of developing pneumonia without evidence of inhalation injury is 8 to 10 per cent. With inhalation injury diagnosed by xenon scan only, the incidence of pneumonia increases to 20 per cent and, with bronchoscopic evidence of inhalation injury, it climbs to

50 per cent. Not surprisingly, increasing extent of burn also correlates with increased rates of pneumonia ( Shirani...ei.a/: 1987). Once the diagnosis of pneumonia or tracheobronchitis is made, antibiotic therapy directed at the predominant organism in the sputum culture is begun. Antibiotics with a broad spectrum of activity are avoided unless required by the resistance pattern of the infecting organism.

Inhalation injury can also be the cause of mechanical complications. In those patients who require high airway pressures to maintain acceptable ventilation and oxygenation, barotrauma can result in pneumothorax, pneumomediastinum, subcutaneous emphysema, or pneumoperitoneum. The complications of prolonged intubation or tracheostomy, such as tracheal stenosis, tracheo-esophageal fistula, and laryngeal polyps, are very difficult to treat, and so prevention should be the first line of defense. Stabilization of the endotracheal or tracheostomy tube, maintenance of cuff pressures at a minimum to prevent air leak, and prompt weaning to extubation should be the standard of care for intubated patients. Tracheostomy has been reported to be required in 3 per cent of burn patients, and is indicated to improve endobronchial toilet in patients with tenacious secretions and for the comfort of patients who require long-term intubation. Although there is a wide range of opinion concerning the timing of tracheostomy, we consider tracheostomy, other than that required for early airway control, for any patient who will require continued endotracheal intubation after 2 weeks of mechanical ventilation.

Sleep Apnea

Sleep Apnea

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