Effects of airway management team in the treatment of severely mass burn patients combined with inhalation injury

Objective To explore and analyze the effects of airway management team (AMT) in the treatment of severely mass burn patients combined with inhalation injury. Methods The clinical data of 58 severely burned patients combined with inhalation injury hospitalized in our unit from January 2012 to August 2014, conforming to the inclusion criteria, were retrospectively analyzed. According to whether airway management was implemented by AMT or not, patients hospitalized from January 2012 to July 2014 were divided into control group (n=27), while patients in Kunshan factory aluminum dust explosion accident hospitalized on 2nd August 2014 were divided into observation group (n=31). Patients in control group received regular airway nursing carried out by nurses on duty, while patients in observation group received specialized airway concentration nursing implemented by AMT. The concrete implementation included overall assessment of patients′ airway, elaborate airway care, and controlled management of mechanical ventilation. Arterial blood gas indexes and oxygenation index of patients in the two groups on post injury day (PID) 1, 7, and 14 were compared. Sputum viscosity, ventilator-associated pneumonia (VAP) occurrence rate, and ventilation time of patients in the two groups in post injury week(s) 1, 2, and 3 after admission were monitored and recorded. Survival rates of patients in the two groups were compared. Data were processed with analysis of variance for repeated measurement, t test and Bonferroni correction, chi-square test, and Wilcoxon rank sum test. Results (1) There were no statistically significant differences in pH value, arterial partial pressure of oxygen (PaO₂), arterial partial pressure of carbon dioxide (PaCO₂), arterial oxygen saturation (SaO₂), and oxygenation index of patients in the two groups on PID 1 (t=0.595, -0.166, 1.518, -0.828, 0.458, P>0.05). The pH values of patients in observation group on PID 7 and 14 were 7.327±0.050 and 7.367±0.043, respectively, significantly better than those in control group (7.304±0.021 and 7.390±0.029, respectively, t=-2.385, 2.391, P<0.05). The PaO₂ values of patients in observation group on PID 7 and 14 were (95.1±6.7) and (106.3±7.8) mmHg (1 mmHg=0.133 kPa), respectively, significantly higher than those in control group [(91.6±5.7) and (102.0±8.3) mmHg, respectively, t=-2.109, -2.059, P<0.05]. The PaCO₂ values of patients in observation group on PID 7 and 14 were (41±4) and (40±4) mmHg, respectively, significantly lower than those in control group [(43±5) and (43±4) mmHg, respectively, t=2.220, 2.304, P<0.05]. The SaO₂ values of patients in observation group on PID 7 and 14 were 0.95±0.04 and 0.96±0.04, respectively, significantly higher than those in control group (0.93±0.05 and 0.94±0.05, respectively, t=-2.201, -2.016, P<0.05). The oxygenation indexes of patients in observation group on PID 7 and 14 were (286±18) and (329±20) mmHg, significantly higher than those in control group [(277±14) and (306±58) mmHg, respectively, t=-2.263, -2.022, P<0.05]. (2) Sputum viscosity of patients in observation group in post injury week(s) 1, 2, and 3 were superior to that in control group (Z=-2.096, -2.076, -2.033, P<0.05). (3) VAP occurrence rate of patients in observation group was lower than that in control group, and time of mechanical ventilation of patients in observation group was shorter than that in control group (χ²=4.244, t=2.425, P<0.05). (4) Survival rate of patients in observation group was higher than that in control group (χ²=4.244, P<0.05). Conclusions The special intensive care of airway management by AMT can effectively improve the oxygenation status of severely burned patients combined with inhalation injury, alleviate the sputum viscosity, reduce the occurrence of VAP, and shorten the time of mechanical ventilation, thus benefits the treatment of severely mass burn patients combined with inhalation injury.