BACKGROUND It is unknown whether lung-protective ventilation is applied in burn patients and whether they benefit from it. This study aimed to determine ventilation practices in burn intensive care units (ICUs) and investigate the association between lung-protective ventilation and the number of ventilator-free days and alive at day 28 (VFD-28). METHODS This is an international prospective observational cohort study including adult burn patients requiring mechanical ventilation. Low tidal volume (V T) was defined as V T ≤ 8 mL/kg predicted body weight (PBW). Levels of positive end-expiratory pressure (PEEP) and maximum airway pressures were collected. The association between V T and VFD-28 was analyzed using a competing risk model. Ventilation settings were presented for all patients, focusing on the first day of ventilation. We also compared ventilation settings between patients with and without inhalation trauma. RESULTS A total of 160 patients from 28 ICUs in 16 countries were included. Low V T was used in 74% of patients, median V T size was 7.3 [interquartile range (IQR) 6.2-8.3] mL/kg PBW and did not differ between patients with and without inhalation trauma (p = 0.58). Median VFD-28 was 17 (IQR 0-26), without a difference between ventilation with low or high V T (p = 0.98). All patients were ventilated with PEEP levels ≥5 cmH2O; 80% of patients had maximum airway pressures <30 cmH2O. CONCLUSION In this international cohort study we found that lung-protective ventilation is used in the majority of burn patients, irrespective of the presence of inhalation trauma. Use of low V T was not associated with a reduction in VFD-28. TRIAL REGISTRATION Clinicaltrials.gov NCT02312869. Date of registration: 9 December 2014.

中文翻译：

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烧伤患者的通气实践——一项国际前瞻性观察性队列研究。

背景 目前尚不清楚烧伤患者是否应用肺保护性通气以及是否从中受益。本研究旨在确定烧伤重症监护病房 (ICU) 的通气实践，并调查肺保护性通气与第 28 天无呼吸机天数和存活天数 (VFD-28) 之间的关联。方法 这是一项国际前瞻性观察性队列研究，包括需要机械通气的成人烧伤患者。低潮气量 (VT) 定义为 VT ≤ 8 mL/kg 预测体重 (PBW)。收集呼气末正压 (PEEP) 水平和最大气道压力。使用竞争风险模型分析 VT 和 VFD-28 之间的关联。为所有患者提供了通气设置，重点是通气的第一天。我们还比较了有和没有吸入性创伤的患者之间的通气设置。结果共纳入来自 16 个国家 28 个 ICU 的 160 名患者。74% 的患者使用了低 VT，中位 VT 大小为 7.3 [四分位距 (IQR) 6.2-8.3] mL/kg PBW，在有和没有吸入性创伤的患者之间没有差异 (p = 0.58)。中位 VFD-28 为 17 (IQR 0-26)，低 VT 和高 VT 通气之间没有差异 (p = 0.98)。所有患者均通气，PEEP 水平≥5 cmH2O；80% 的患者最大气道压力 <30 cmH2O。结论 在这项国际队列研究中，我们发现大多数烧伤患者使用肺保护性通气，无论是否存在吸入性创伤。使用低 VT 与 VFD-28 的降低无关。试验注册 临床试验。政府 NCT02312869。注册日期：2014 年 12 月 9 日。