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Rivista di Anestesia, Rianimazione, Terapia Antalgica e Terapia Intensiva
Minerva Anestesiologica 2017 Apr 11
Copyright © 2017 EDIZIONI MINERVA MEDICA
Thoracic trauma and acute respiratory distress syndrome in polytraumatized patients admitted to a level I trauma center: a retrospective analysis
Thomas HAIDER, Gabriel HALAT, Thomas HEINZ, Stefan HAJDU, Lukas L. NEGRIN ✉
Department of Trauma Surgery, Medical University of Vienna, Vienna, Austria
BACKGROUND: Although thoracic trauma has often been associated with the development of ARDS in general, its impact on ARDS in combination with severe concomitant injuries has still to be elucidated. Therefore, the objective of this study was to determine the frequency of thoracic trauma and ARDS in polytraumatized patients, and to evaluate the impact of thoracic trauma on the occurrence and the onset of ARDS.
METHODS: Included in this retrospective cohort study were all polytraumatized patients over 18 years of age, with an injury severity score (ISS) of at least 16, who were admitted to our level I trauma center over a three-year time period.
RESULTS: Two hundred and eighty-eight patients met the inclusion criteria. 54.9% suffered from thoracic trauma, 51.7% developed ARDS, 21.5% pneumonia and 0.7% pulmonary embolism. Independent of the ISS, the presence of thoracic trauma increased the odds of ARDS occurrence (OR, 2.242; 95%CI, 1.381-3.640; p<0.001) and resulted in a significantly earlier onset of ARDS (median, day 2 vs. day 3; p<0.01). Of those patients suffering from ARDS, ventilation time and length of stay at the ICU were longer if a concomitant thoracic injury was present (p<0.001). In general, ARDS was diagnosed prior to pneumonia and was therefore identified as its risk factor (OR, 11.033; 95%CI, 4.812-25.299; p<0.001). Finally, an overall mortality rate of 21.2% was observed, which was neither affected by thoracic trauma nor ARDS.
CONCLUSIONS: Thoracic trauma was identified as major risk factor for ARDS occurrence and earlier onset in polytrauma victims.
KEY WORDS: Polytrauma - Thoracic trauma - ARDS - Pulmonary complications - Blunt chest trauma - Acute lung injury