VENTILATORY MANAGEMENT OF THE PULMONARY BURN

Summary Ventilatory management begins with a consideration of the requirements for gas exchange. The impaired ventilatory apparatus may adequately cope with resting demands for gas exchange, but may be unable to meet the requirements of increased metabolism. Resting hypermetabolism may be particularly severe in the burn patient. This hypermetabolism with its increased rates of gas exchange places severe prolonged demands on ventilation. Measurements of blood gas tensions and gas exchange describe the balance between cardiopulmonary supply and tissue need for gas exchange. This balance becomes more evident when gas tension and gas exchange are considered respectively as intensive and extensive properties of the same system. The hazard to the burn patient of elevation in gas exchange, cardiac output and heat loss may be unsuspected when only measuring intensive variables such as gas tensions. The specificity of the failure of oxygenation as the ultimate functional lesion of the pulmonary burn has been described. Asepsis, chest physiotherapy, airway humidification and quantitation of ventilator and oxygen therapy have been emphasized in the successful management of the severe pulmonary burn.