The addition of these to ABA criteria created the Denver criteria, which exhibited an increased sensitivity for long-term intubations (95%), but decreased specificity (24%). Traditional criteria associated with long-term intubation included suspected smoke inhalation (OR 2.45 ), and singed facial hair (OR 2.53 ). Sensitivity of ABA criteria for long-term intubation was 77% and specificity 46%. Long-term intubation was strongly associated with ABA criteria (77.5%) compared to traditional criteria (22.5%) (p<0.001). Of 218 patients, 151 had long-term and 67 had short-term intubations. Those with ≥26 VFD were deemed unnecessary short-term intubations. Patients with <26days free from mechanical ventilation (ventilator-free days (VFD)) out of 28, were deemed indicated long-term intubations.
Criteria for intubation were defined as traditional criteria (suspected smoke inhalation, oropharynx soot, hoarseness, dysphagia, singed facial hair, oral edema, oral burn, non-full thickness facial burns), or ABA criteria as defined by the 2011 ABA guidelines (full thickness facial burns, stridor, respiratory distress, swelling on laryngoscopy, upper airway trauma, altered mentation, hypoxia/hypercarbia, hemodynamic instability). This was a retrospective review of intubated adults admitted to our center with thermal burns 2008-2013. We sought to determine the clinical criteria that predict intubations with benefit. Recent studies demonstrate that burn patients are undergoing unnecessary intubations.
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