Journal of burn care & research : official publication of the American Burn Association
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Practice Guideline
American Burn Association Practice guidelines for prevention, diagnosis, and treatment of ventilator-associated pneumonia (VAP) in burn patients.
The purpose of this guideline is to review the available published literature on ventilator-associated pneumonia (VAP) as it pertains to the burn patient. It provides an evidence-based recommendation for the prevention, diagnosis, and treatment of VAP in adult burn patients. This guideline is designed to assist all healthcare providers caring for adult burn patients with suspected VAP. Summary recommendations were made using the following grading scale: grade A--supported by at least one well-designed prospective trial with clear-cut results; grade B--supported by several small prospective trials with a similar conclusion; and grade C--supported by a single small prospective trial, retrospective analyses, cases studies, and expert opinions based on investigators' practices.
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There are no guidelines to determine when bronchoscopy is appropriate in patients with inhalation injury complicated by pneumonia. We reviewed the National Burn Repository from 1998 to 2007 to determine if there is any difference in outcome in burn patients with inhalation injury and pneumonia who did and did not undergo bronchoscopy. Three hundred fifty-five patients with pneumonia did not undergo bronchoscopy, 173 patients underwent one bronchoscopy, and 96 patients underwent more than one bronchoscopy. ⋯ This benefit can be seen in a decreased duration of mechanical ventilation, decreased length of intensive care unit stay, and decreased overall hospital cost. In addition, there was a trend toward an improvement in mortality. The aggressive use of bronchoscopy after inhalation injury may be justified.