Home Oxygen Therapy Related Burns: An Outcome Comparison based on Location of Intubation

Research Article

Austin J Emergency & Crit Care Med. 2017; 4(2): 1057.

Home Oxygen Therapy Related Burns: An Outcome Comparison based on Location of Intubation

Meyerson J¹, Coffey RA² and Jones LM²*

¹Department of Plastic Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA

²Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA

*Corresponding author: Jones LM, Department of Surgery, The Ohio State University Wexner Medical Center, 410 W. 10th Avenue, N744 Doan Hall, Columbus, OH 43210, USA

Received: April 04, 2017; Accepted: May 05, 2017; Published: May 12, 2017

Abstract

Introduction: Burns resulting from home oxygen therapy often result in the patient being intubated without clear indications of airway injury or compromise. This study compares two groups of patients with home oxygen therapy related burns based upon the location of intubation: at a verified burn center and prior to admission to the burn center.

Methods: A retrospective study of all patients admitted with home oxygen burns to our burn center from 2006-2015 was performed. Data collected included intubation status, intubation location, indications for intubation, and bronchoscopy findings. Outcomes included ICU length of stay, hospital length of stay, ventilator days and cost.

Results: A total of 78 patients were divided into intubated and nonintubated: 37% of patients were intubated with 69% intubated prior to transfer to the burn center. The intubated group had significantly longer lengths of hospital stay (p<0.0001), longer ICU stays (p<0.0001), more ventilator days (p<0.001) and higher costs (p<0.0001). No patient in either group demonstrated inhalation injury on bronchoscopy. The location of intubation demonstrated an increase of 8% per year toward intubation prior to admission to the burn center (p<0.05) with the largest increase from 2010-2015 (p<0.05).

Conclusion: In the last decade, there has been an increasing number of home oxygen burn patients being intubated at outside hospitals or by EMS prior to arrival at the burn center. Indications and algorithms for intubation of these patients need to be developed. Community education for non-burn center personnel should be implemented to provide best practices for this patient population.

Keywords: Home Oxygen Therapy; Burn Injury; Intubation

Introduction

Long term oxygen therapy has become an integral part of the treatment of hypoxemia related to chronic obstructive pulmonary disease. Home oxygen therapy (HOT) use has increased greatly over the past10 years with approximately 1.5 million people in the United States currently receiving home oxygen therapy [1]. When combined with fuel and an ignition source, home oxygen therapy can lead to fires and cause severe burns and even death. HOT-related burns have been increasing at 14% per year from 2002-2011 [2]. While the total body surface area (TBSA) of these injuries may be small and involve only the face, patients with these types of injuries are often assumed to have concomitant inhalation injuries. Thus, patients may be intubated as a precaution which itself may lead to unintended consequences. Several studies have documented the hospital courses of patients with HOT-related injuries noting increased length of stay, complications, and cost [3-10]. Previous research has not solely focused on the trends and outcomes of HOT-related burn patients based upon the location of intubation. The purpose of this study is to compare two groups of patients with HOT-related injuries based upon the location of intubation: those patients intubated at our verified burn center and those intubated prior to admission to the burn center. Outcomes to be investigated included total length of stay, intensive care unit (ICU) length of stay, number of ventilator days, hospital costs, complications, indications for intubation and if bronchoscopy was used in the management of these patients.

Materials and Methods

A retrospective chart review was performed of all HOT-related burns admitted to our verified burn center from 2006-2015. Eligible hospitalized adult patients were identified using the burn quality database. Data elements included place of intubation: at our burn center, at an outside hospital or by emergency medical services; evidence of inhalation injury; method of inhalation injury diagnosis; mortality; TBSA burned; complications during hospital stay; sex; age; hospital charges; length of stay; ventilator days until extubation and length of ICU stay. Data was obtained through medical chart review. All hospital charges were adjusted for inflation to 2015 United States (U.S.) Dollars.

Patients were divided into two groups for analysis, those patients with HOT-related burns that were either intubated versus not intubated. Patients who were intubated were further stratified into patients that underwent intubation at our burn center and those who were intubated at an outside hospital or by emergency medical services. Data was analyzed with the SPSS statistical program (IBM Inc. Armonk, NY). Categorical data were compared using Chi squared test and continuous data were compared using student’s t-test. A p-value of less than 0.05 was considered statistically significance.

Results

A total of 78 patients were eligible for inclusion into the study. All patients had ignition from cigarette smoking. Subjects were grouped into intubated and non-intubated patients. There were no statistical differences in patient demographics based upon intubation status. In total, 29 patients (37.0%) presenting with HOT-related burn injuries were intubated. Of those that underwent intubation, 20 patients (69.0%) were intubated prior to transfer to our burn center by either an outside hospital or emergency medical services (OSH) with the remaining 9 patients (31.0%) intubated at our institution (BC). The mean TBSA for intubated patients was 3.3% (range 0.5-20%) and for non-intubated patients was 1.7% (range 0.5-10%) (p<0.05).

Comparing patients undergoing intubation versus nonintubation, the intubation group had on average a longer hospital length of stay of 9.4 days versus 2.6 days (p<0.0001), longer ICU length of stay of 6.1 days versus 0.5 days (p<0.0001) and a greater number of days on a ventilator 5 days versus 0.0 days (p<0.001) (Table 1). Outcome measures did not significantly differ between initial location of intubation (BC versus OSH). Six of the 29 (20.7%) intubated patients had bronchoscopy performed, and no patient in our study demonstrated inhalation injury on exam. The most common complications from intubation resulted in ventilator acquired pneumonia (n=4) and tracheostomy (n=2). No airway complications were noted for patients that were not intubated. There was one patient mortality; however, this subject sustained a TBSA of 80% with ignition of clothing after the HOT-related burn. This patient was excluded from statistical analysis.