Patients with extensive burns, facial and airway compromise represent a
challenge in terms of endotracheal tube fixation and therefore the
maintenance of a safe airway pathway. Both in intensive care units as
well as in the operating room accidental extubation may occur.
The literature reports an increased frequency of these events in
patients with extensive burns.
This paper describes a minimally invasive method of endotracheal tube
fixation in patients with extensive facial burns that was recently
developed in our hospital facing the need to solve this problem.
We report the case of a eight years old boy with airway burn and face
injuries that prevent normal endotracheal tube fixation. The patient
was admitted with endotracheal tube fixed to the gums with an
interdental suture, unfortunately the suture tears 5 times in 7 days. Due to this, we search for an alternative method.
Through an interconsultation with a dentist the patient is asess and
together we decided to apply a splint fixation with wire-composite to the
upper incisors. The procedure is performed at the bedside in ICU,
adapting our equipment and achieving to set our splint simply and firmly between the upper incisors. Then wire is tied to the endotracheal tube with 2-0 silk suture. The patient does not require other fixations methods to fix the tube.
When the mechanical ventilations devises are removed the device can be used on the following endotracheal intubation procedures under anesthesia.
Once discharged the patient the fixed wire can be removed in the dental clinic
smoothly and without any sequel to the teeth.
The procedure was performed easily and with no complications. Was so
widely accepted by the ICU team, anesthesia equipment and burn
surgeons that was used immediately in the next similar patient admitted to
the ICU of the Hospital. The second patient, like the former kept the
splint on during his treatment, He didn´t present any complications and the splint was removed at discharge.
This method was easy to implement and highly secure. Avoid
repeated gum tears with consequent deterioration of periodontal
attachment, pain and risk associated bacteremia. It is simpler and
lower cost than other published methods and allowed not only to secure
the endotracheal tube, but also allow to heal the gums and facilitate oral hygiene.
For these reasons we believe that this endotracheal fixation method should be considered in cases that can be performed electively when requested to a dentist.
We need to consider that the Hospital Roberto del Rio is the only paediatric centre that offers emergency dental care permanently and that we will continue to receive this type of patient as we are referral center for burned children. |
