Intra-oral fixation of the endotracheal tube in a major paediatric burns patient – An interdisciplinary solution

Dr Lachlan Farmer1, Dr Lloyd Hurrel2, Dr Sam Gue2, Ms Linda Quinn1, Dr Rebecca Cooksey1, Dr Amy Jeeves1, Dr  Darren Molony1, Dr Michelle  Lodge1, Mr Bernard Carney1

1Department of Paediatric Burns Surgery – Women’s And Children’s Hospital Adelaide, 2Department of Paediatric Dentistry – Women’s and Children’s Hospital

Abstract:
Introduction

Secure fixation of the endotracheal tube (ETT) is of critical importance in burn patients, particularly those where the burn involves the chest, head and neck.  Securing the ETT safely and without secondary morbidity can be difficult in this cohort. The need for a secure, long lasting solution to this problem was highlighted in a recent major paediatric burn within our institution.

Discussion

Great attention is given to the need for early intubation in severe burns involving the head, neck and chest. In these patients, a delay in intubation can be life threatening due to increasing oedema of the upper airway and rigidity of the burn eschar making both positioning and ventilation difficult.

With this in mind, care must be taken to ensure the endotracheal tubes (ETT) are not accidentally dislodged. Many routine fixation devices such as ties and tapes are not well suited to patients with facial burns due to a number of factors, namely: oedema related changes in neck and face circumference causing inappropriate tension in the tie, the need for topical application of wound care products to the burnt face disturbing the tapes ability to adhere,  and, patient transfer, pressure area care, and the performance of mouth care placing the ETT as high risk of dislodgement.  Through our multidisciplinary approach to the management of paediatric burn patients we were able to develop a method using tailored dental blocks to secure an ETT, circumventing many of the issues previously encountered.  Our methods and learning points are highlighted.

Biography:
Dr Lachlan Farmer is an unaccredited registrar in the Department of Plastic & Reconstructive Surgery. He endeavors to undertake advanced training in Plastic, Reconstructive and Burns Surgery.

About ANZBA

ANZBA is a not for profit organisation and the peak body for health professionals responsible for the care of the burn injured in Australia and New Zealand. ANZBA encourages higher standards of care through education, performance monitoring and research.

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