501 The Role of a Tracheostomy in the Critically Ill Burn Patient

Abstract Introduction Tracheostomy is a commonly performed procedure in critically ill patients requiring prolonged mechanical ventilation. However, nationwide practice patterns for the role of tracheostomy burn have not been well described. Methods A 25-question Qualtrics online survey was distributed by American Burn Association (ABA) to their physician members. Questions pertained practitioner demographics, indications, type performed, and timing procedure. The questionnaire further ascertained how presence inhalation injury Total Body Surface Area (TBSA) influence tracheostomy; if concurrent percutaneous endoscopic gastrostomy (PEG) tubes were whether enteral feeds held prior tracheostomy. Results Thirty-seven surgeons responded worked primarily at ABA verified academic centers. Open more frequently than (73% vs 27%). Eighty-three percent deferred concomitant PEG despite healthy overlying skin due belief that patient would eventually pass swallow evaluation (74%). Tube routinely 67% surgeons, most 6 or 8 hours prior. common indication Fifty-four perform through open uninfected 2nd degree neck burns. As 3rd burns, 35% will only after excision grafting. For ventilation had no standard time frame regardless TBSA. mechanically ventilated with >20% TBSA burns (excluding burns), 40% early (0-7 days) 24% delayed (8+days). inhalational injuries < 20%, frame, 16% 49% Conclusions national tendency toward tracheostomy, deferring PEG, holding tube 6-8 identified. Patients seem undergo earlier frequently, whereas those 20% Although appears impact evidence based guidelines are lacking guide clinical additional studies needed. Applicability Research Practice Survey results infer favoring consideration