Citation

Younan D, Griffin R, Thompson M, Swain T, Honkanen M, Crosby JC, Ellis CV, Pittet JF, Kerby JD. Shock 2016; 47(1): 107-110.

Affiliation

*Department of Surgery, Division of Acute Care Surgery, University of Alabama in Birmingham, Birmingham, Alabama. †Department of Emergency Medicine, University of Alabama in Birmingham, Birmingham, Alabama. ‡Department of Epidemiology, University of Alabama in Birmingham, Birmingham, Alabama. §Department of Anesthesiology, University of Alabama in Birmingham, Birmingham, Alabama.

Copyright

(Copyright © 2016, The Shock Society, Publisher Lippincott Williams and Wilkins)

DOI

10.1097/SHK.0000000000000738

PMID

27559698

Abstract

OBJECTIVE: Coagulopathy is known to be associated with burn injury. Our group has showed that, in spinal cord injury patients, coagulopathy is associated with an increase in VAP. We hypothesized that the same association exists between coagulopathic burn patients and ventilator associated events.

METHODS: Patients admitted for burn care between January 1, 2011 and December 31, 2015 who required mechanical ventilation were included in the study. Ventilator-associated events (VAEs) as defined by the Center for Disease Control were categorized as no event, ventilator-associated condition, infection-related ventilator-associated complication, and possible VAP. Demographic, injury characteristics were compared among four INR categories using analysis of variance and chi-square tests.

RESULTS: Four hundred and four patients were admitted for burn care, of which 263 met the inclusion criteria. 111 had normal INR, 59 had a slightly elevated INR (1.2-1.4), 33 had a moderately elevated INR (1.4-1.6), and 60 had a severely elevated INR (>1.6). Those with moderately and severely elevated INR were ventilated for a longer period (p = 0.0034), had more days in the ICU (p = 0.0010), and had longer hospital stay (p = 0.0016). After adjusting for inhalation injury and TBSA, patients with severely elevated INR were over 4 times as likely to have any VAE (OR: 4.16, 95%CI: 1.33-13.05) and 4.5 times as likely to develop IVAC or PVAP combined (OR: 4.59, 1.35-15.67).

CONCLUSIONS: Early coagulopathy is associated with a significantly increased incidence of VAEs in burn patients. While additional studies need to be conducted to verify these findings, early recognition and treatment could decrease VAEs.

Language: en