Association of inhalation injury with ventilator-associated pneumonia and clinical outcomes in critically ill patients with burns: A retrospective study

Objective To evaluate the impact of inhalation injury on the outcomes of patients with burns, especially ventilator-associated pneumonia (VAP) and mortality. Methods Single-center retrospective study of patients admitted to the intensive care unit (ICU) with burn injuries. Data were obtained from medical records. The primary outcome was VAP incidence in patients with or without inhalation injury. Secondary outcomes included need and duration of mechanical ventilation (MV), incidence of acute respiratory distress syndrome (ARDS), rates of reintubation and tracheostomy, need for vasopressors and renal replacement therapy (RRT), length of ICU and hospital stay, hospital mortality, and comparison between survivors and non-survivors. Results From January 2017 to December 2023, 242 patients with a median burn surface area of 23% (15%-37%) were included. The incidence of inhalation injury was 9.9% ( n = 24). The overall incidence of VAP was 23%. VAP incidence was significantly higher in patients with inhalation injury than in those without inhalation injury (RR 2.1, CI 1.9–3.8) ( p < 0.012). After adjustment for age, burn surface area, and duration of MV, the RR remained significant (2.1, CI 1.2–3.7) ( p = 0.009). Patients with inhalation injury had higher rates of reintubation (12.5% vs. 2.8%, p = 0.048) and tracheostomy (54.2% vs. 21.6%, p < 0.001). The incidence of inhalation injury was similar in survivors and non-survivors (11.2% vs. 5.6%, p = 0.305), but non-survivors had a higher burn surface area than survivors (40% vs. 20%, p < 0.01). Conclusion The incidence of VAP was higher in patients with inhalation injury than in those without inhalation injury; however, the mortality was similar.