Respiratory management

lished by the American Burn Association, recommends the following [86]:

(a) Prevention

Minimize the duration of intubation and mechanical ventilation through the use of weaning protocols, daily sedation, interruption, and daily spontaneous breathing trials.

Use of specialized endotracheal such as silver impregnated tubes, or tubes which allow continuous suction of subglottic secretions should be considered.

Patients should be placed in a semirecumbent position, especially if being enterally fed.

A post pyloric feeding tube is desirable to reduce gastroesophageal regurgitation and aspiration. If fed by the post pyloric route, gastric stress ulcer prophylaxis is recommended.

Routine use of prophylactic antibiotics is not recommended due to the risk of selection of endemic multi resistant organism in a burn unit setting.

Oral chlorhexidine to decrease oropharyngeal colonization is an effective and recommended VAP prevention strategy.

Adoption of strict infection control measures including hand washing, contact barrier precautions, and patient/staff co-horting is advisable.

(b) Treatment

Initiate early broad-spectrum antibiotic therapy based on timing of VAP onset, and local burn unit specific patterns of likely organisms and resistance profiles, as soon as the diagnosis of VAP is made.

De-escalation, or narrowing of the broad-spec- trum antibiotic coverage once quantitative cultures are available, is recommended.

Antibiotic rotation schedules should be considered, if possible, tailored to an individual burn unit’s endemic bacterial and resistance patterns.

An 8-day course of specific antibiotic treatment is usually adequate for most VAP’s, except for methacillin-resistant Staphylococcus aureus and gram negative bacilli (e. g. Acinetobacter or Pseudomonas), which may require a longer duration of treatment (15 days).

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Correspondence: R. Cartotto M.D., FRCS(C), Ross Tilley Burn Centre at Sunnybrook Health Sciences Centre, Associate Professor, Department of Surgery, University of Toronto, Rm

[88]Chim H, Tan B, Son C (2007) Five year review of infecD712 2075 Bayview Ave. Toronto, ON, Canada M4N 3M5, E-

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