Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
European Journal of Trauma and Emergency Surgery
Published in: European Journal of Trauma and Emergency Surgery 1/2020

01-02-2020 | Thoracic Trauma | Original Article

Does lack of thoracic trauma attenuate the severity of pulmonary failure? An 8-year analysis of critically injured patients

Authors: Xin Huang, Louis J. Magnotti, Timothy C. Fabian, Martin A. Croce, John P. Sharpe

Published in: European Journal of Trauma and Emergency Surgery | Issue 1/2020

Login to get access

Abstract

Purpose

Patients with thoracic trauma are presumed to be at higher risk for pulmonary dysfunction, but adult respiratory distress syndrome (ARDS) may develop in any patient, regardless of associated chest injury. This study evaluated the impact of thoracic trauma and pulmonary failure on outcomes in trauma patients admitted to the intensive-care unit (ICU).

Methods

All trauma patients admitted to the ICU over an 8-year period were identified. Patients that died within 48 h of arrival were excluded. Patients were stratified by baseline characteristics, injury severity, development of ARDS, and infectious complications. Multiple logistic regression was used to determine variables significantly associated with the development of ARDS.

Results

10,362 patients were identified. After exclusions, 4898 (50%) patients had chest injury and 4975 (50%) did not. 200 (2%) patients developed ARDS (3.6% of patients with chest injury and 0.5% of patients without chest injury). Patients with ARDS were more likely to have chest injury than those without ARDS (87% vs 49%, p < 0.001). However, of the patients without chest injury, the development of ARDS still led to a significant increase in mortality compared to those patients without ARDS (58% vs 5%, p < 0.001). Multiple logistic regression found ventilator-associated pneumonia (VAP) to be the only independent predictor for the development of ARDS in ICU patients without chest injury.

Conclusions

ARDS development was more common in patients with thoracic trauma. Nevertheless, the development of ARDS in patients without chest injury was associated with a tenfold higher risk of death. The presence of VAP was found to be the only potentially preventable and treatable risk factor for the development of ARDS in ICU patients without chest injury.
Literature
1.
Ashbaugh DG, Bigelow DB, Petty TL, Levine BE. Acute respiratory distress in adults. Lancet. 1967;2:319–23.CrossRef
2.
Fahr M, Jones G, O’Neal H, Duchesne J, Tatum D. Acute respiratory distress syndrome incidence, but not mortality, has decreased nationwide: a national trauma data bank study. Am Surg. 2017;83(4):323–31.PubMed
3.
Croce MA, Fabian TC, Davis KA, Gavin TJ. Early and late acute respiratory distress syndrome: two distinct clinical entities. J Trauma. 1999;46(3):361–6 (discussion 366–8).CrossRef
4.
Milberg JA, Davis DR, Steinberg KP, Hudson LD. Improved survival of patients with acute respiratory distress syndrome (ARDS): 1983–1993. JAMA. 1995;273:306–9.CrossRef
5.
Eberhard LW, Morabito DJ, Matthay MA, Mackersie RC, Campbell AR, Marks JD, Alonso JA, Pittet JF. Initial severity of metabolic acidosis predicts the development of acute lung injury in severely traumatized patients. Crit Care Med. 2000;28:125–31.CrossRef
6.
Salim A, Martin M, Constantinou C, Sangthong B, Brown C, Kasotakis G, Demetriades D, Belzberg H. Acute respiratory distress syndrome in the trauma intensive care unit: morbid but not mortal. Arch Surg. 2006;141:655–8.CrossRef
7.
Haider AH, Gupta S, Zogg CK, Kisat MT, Schupper A, Efron DT, Haut ER, Obirieze AC, Schneider EB, Pronvost PJ, et al. Beyond incidence: costs of complications in trauma and what it means for those who pay. Surgery. 2015;158:96–103.CrossRef
8.
Treggiari MM, Hudson LD, Martin DP, Weiss NS, Caldwell E, Rubenfeld G. Effect of acute lung injury and acute respiratory distress syndrome on outcome in critically ill trauma patients. Crit Care Med. 2004;32:327–31.CrossRef
9.
Miller PR, Croce MA, Bee TK, Qaisi WG, Smith CP, Collins GL, Fabian TC. ARDS after pulmonary contusion: accurate measurement of contusion volume identifies high-risk patients. J Trauma. 2001;51(2):223–8 (discussion 229–30).CrossRef
10.
Miller PR, Croce MA, Kilgo PD, Scott J, Fabian TC. Acute respiratory distress syndrome in blunt trauma: identification of independent risk factors. Am Surg. 2002;68(10):845–50 (discussion 850-1).PubMed
11.
Cooke CR, Kahn JM, Caldwell E, Okamoto VN, Heckbert SR, Hudson LD, Rubenfeld GD. Predictors of hospital mortality in a population-based cohort of patients with acute lung injury. Crit Care Med. 2008;36(5):1412–20.CrossRef
12.
Luo L, Shaver CM, Zhao Z, Koyama T, Calfee CS, Bastarache JA, Ware LB. Clinical predictors of hospital mortality differ between direct and indirect ARDS. Chest. 2017;151(4):755–63.CrossRef
13.
Bellani G, Laffey JG, Pham T, Fan E, Brochard L, Esteban A, Gattinoni L, van Haren F, Larsson A, McAuley DF, et al. Epidemiology, pattern of care, and mortality for patients with acute respiratory distress syndrome in intensive care units in 50 countries. JAMA. 2016;315(8):788–800.CrossRef
14.
Poole GV, Ward EF, Griswold JA, Muakkassa FF, Hsu HS. Complications of pelvic fractures from blunt trauma. Am Surg. 1992;58:225–31.PubMed
15.
Rubenfeld GD, Caldwell E, Peabody E, Weaver J, Martin DP, Neff M, Stern EJ, Hudson LD. Incidence and outcomes of acute lung injury. N Engl J Med. 2005;353:1685–93.CrossRef
16.
Calfee CS, Eisner MD, Ware LB, Thompson BT, Parsons PE, Wheeler AP, Korpak A, Matthay MA. Trauma-associated lung injury differs clinically and biologically from acute lung injury due to other clinical disorders. Crit Care Med. 2007;35(10):2243–50.CrossRef
17.
DiRusso SM, Nelson LD, Safcsak K, Miller RS. Survival in patients with severe adult respiratory distress syndrome treated with high-level positive end-expiratory pressure. Crit Care Med. 1995;23:1485–96.CrossRef
18.
Sutyak JP, Wohltmann CD, Larson J. Pulmonary contusions and critical care management in thoracic trauma. Thorac Surg Clin. 2007;17(1):11–23.CrossRef
19.
Croce MA, Fabian TC, Schurr MJ, Boscarino R, Pritchard FE, Minard G, Patton JH Jr, Kudsk KA. Using bronchoalveolar lavage to distinguish nosocomial pneumonia from systemic inflammatory response syndrome: a prospective analysis. J Trauma. 1995;39(6):1134–9 (discussion 1139-40).CrossRef
20.
Magnotti LJ, Schroeppel TJ, Fabian TC, Clement LP, Swanson JM, Fischer PE, Bee TK, Maish GO 3rd, Minard G, Zarzaur BL, Croce MA. Reduction in inadequate empiric antibiotic therapy for ventilator-associated pneumonia: impact of a unit-specific treatment pathway. Am Surg. 2008;74(6):516–22 (discussion 522-3).PubMed
21.
Sharpe JP, Magnotti LJ, Weinberg JA, Swanson JM, Wood GC, Fabian TC, Croce MA. Impact of pathogen-directed antimicrobial therapy for ventilator-associated pneumonia in trauma patients on charges and recurrence. J Am Coll Surg. 2015;220(4):489–95.CrossRef
22.
ARDS Definition Task Force. Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E, Fan E, Camporota L, Slutsky AS. Acute respiratory distress syndrome: the Berlin Definition. JAMA 2012; 307(23):2526–33.
23.
Bernard GR, Artigas A, Brigham KL, Carlet J, Falke K, Hudson L, Lamy M, Legall JR, Morris A, Spragg R, et al: The American-European Consensus Conference on ARDS: definitions, mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med. 1994; 149(3 pt 1):818–824.CrossRef
Metadata
Title
Does lack of thoracic trauma attenuate the severity of pulmonary failure? An 8-year analysis of critically injured patients
Authors
Xin Huang
Louis J. Magnotti
Timothy C. Fabian
Martin A. Croce
John P. Sharpe
Publication date
01-02-2020
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Trauma and Emergency Surgery / Issue 1/2020
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI
https://doi.org/10.1007/s00068-019-01081-w

Other articles of this Issue 1/2020

European Journal of Trauma and Emergency Surgery 1/2020 Go to the issue

Original Article

Intramedullary screw fixation for simple displaced olecranon fractures

Guideline

Surgeon-performed point-of-care ultrasound for acute cholecystitis: indications and limitations: a European Society for Trauma and Emergency Surgery (ESTES) consensus statement

Original Article

Digital templating without a calibration marker is accurate at predicting implant size for hip hemiarthroplasty

Editorial

Focus on chest trauma: implications from clinical and experimental studies

Original Article

Accuracy of navigated and conventional iliosacral screw placement in B- and C-type pelvic ring fractures

Original Article

Microparticles profiling in trauma patients: high level of microparticles induce activation of platelets in vitro