- Author
-
G.J. Glas
- Title
- Respiratory care of critically ill burn patients
- Subtitle
- Mechanical ventilation and pulmonary coagulopathy
- Supervisors
- Co-supervisors
- Award date
- 26 May 2021
- Number of pages
- 209
- ISBN
- 9789083149608
- Document type
- PhD thesis
- Faculty
- Faculty of Medicine (AMC-UvA)
- Abstract
-
Burn patients are at high risk for lung injury and subsequent respiratory failure, often requiring mechanical ventilation (MV). Coagulopathy is frequently seen, particularly following severe burn or inhalation trauma and may result in the formation of pulmonary casts which contribute to respiratory dysfunction. While MV may be lifesaving, it could also severely harm lungs. To limit so called ‘ventilator–induced lung injury’ (VILI), ‘lung–protective’ ventilation strategies have become standard care in the nonburn intensive care unit (ICU) population. Whether lung–protective ventilation is practiced in burn patients is unknown.
Optimization of MV strategies and attenuation of pulmonary coagulopathy may shorten the duration of MV and improve the outcome of burn patients. This thesis comprises studies focusing on these two aspects of the respiratory care of burn patients.
The first part of this thesis focused on MV practices. The general aim was to assess current MV practices. To achieve this we performed a systematic review which described changes in MV practices over time and summarized the reported VILI. To gain further insight in the current ventilation practices we performed an international prospective observational cohort study, which also aimed to determine associations between ventilator settings and clinical outcomes.
The second part of this thesis focused on pulmonary coagulopathy. We aimed to determine the association between nebulized anticoagulants and outcomes of ventilated ICU–patients through an individual patient data metaanalysis and initiated a multicenter randomized controlled trial investigating feasibility, efficacy and safety of nebulized heparin versus placebo in patients with inhalation trauma. - Persistent Identifier
- https://hdl.handle.net/11245.1/88cac16e-eb65-45c1-94d2-e94389aa5ecd
- Downloads
-
Thesis (complete)
Front matter
Chapter 1: General introduction and outline of this thesis
Chapter 2: Changes in ventilator settings and ventilator-induced lung injury in burn patients : A systematic review
Chapter 3: Ventilation practices in burn patients: An international prospective observational cohort study
Chapter 4: Coagulopathy and its management in patients with severe burns
Chapter 5: Individual patient data metaanalysis: Nebulized heparin for patients under mechanical ventilation
Chapter 6: HEPBURN: Investigating the efficacy and safety of nebulized heparin versus placebo in burn patients with inhalation trauma: Study protocol for a multicenter randomized controlled trial
Chapter 7: Nebulized heparin in burn patients with inhalation trauma: Safety and feasibility
Chapter 8: Summary
Chapter 9: General discussion and future perspectives
Chapter 10: Nederlandse samenvatting
Contributing authors and affiliations; Publications; PhD portfolio; Curriculum vitae; Acknowledgements
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