Forced vital capacity assessment for risk stratification of blunt chest trauma patients in emergency settings: A preliminary study

Carrié, C.; Stecken, Laurent; Scotto, Marion; Durand, Marion; Masson, F.; Revel, Philippe; Biais, Matthieu

doi:10.1016/j.accpm.2016.12.004

Cited by 11 publications

(13 citation statements)

References 17 publications

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“…While assessment of pulmonary function on admission makes intuitive sense as a gauge of pain control and the ability to perform pulmonary hygiene, such evaluation has not been shown to correlate with improved outcomes. 5,12 However, other factors, such as age, pain scale, number, and anatomic location of ribs fractured, and the presence or absence of pulmonary contusions and flail chest, may identify those at highest risk for respiratory failure who warrant interventions such as ICU admission and early epidural catheter placement. 1,2,8,10 In our study cohort, 91.7% of patients with ERF were triaged appropriately to the ICU from the ED.…”

Section: Discussionmentioning

confidence: 99%

“…1,2 This recognition has led to the development of screening measures and clinical pathways in an attempt to improve outcomes by the early identification and aggressive treatment of high-risk patients. [3][4][5] The mainstays of interventions include initial triage to the intensive care unit (ICU) or to a specialized patient care area, aggressive pain control, early physiotherapy, and lung inflation protocols. 4,6,7 Despite early implementation of targeted therapies, respiratory failure requiring mechanical ventilation has been reported to occur in 7-32% of patients after blunt chest trauma.…”

Section: Introductionmentioning

confidence: 99%

“…3,6 Early assessment of pulmonary function, such as use of serial measurements of vital capacity, has not been shown to reliably predict respiratory complications after blunt chest trauma. 5,12 Multiple scoring systems have also been developed to identify high-risk patients; nonetheless, even these approaches may fail to predict 20% of respiratory failure events after blunt chest trauma. 10,11,13 Of significance, delayed complications have been described as adverse events that occur a week or more after initial injury.…”

Section: Introductionmentioning

confidence: 99%

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Delayed Respiratory Failure After Blunt Chest Trauma

Martin

Lü

Inouye

et al. 2020

The American Surgeon

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Background Patient factors associated with delayed respiratory failure (DRF) after blunt chest trauma are not well documented. Earlier identification and closer monitoring may improve outcomes for these patients. The purpose of this study was to identify the prevalence and clinical predictors of DRF in patients after blunt chest trauma. Materials and Methods A retrospective review of adult patients admitted to a Level 1 trauma center after blunt chest trauma between January 1, 2009 and December 31, 2013, was conducted. Patients with early respiratory failure were compared to patients with DRF using Fisher’s exact tests, chi square, and Student’s t-tests. A P-value of <.05 was considered significant. Results 1299 patients had blunt chest trauma and at least 1 rib fracture, of which 830 met inclusion criteria. 5.8% of patients progressed to respiratory failure. Respiratory failure was delayed in 25% of these patients. DRF patients had significantly lower ISS (16.5 vs. 22.7, P = .04), more bilateral rib fractures (66.7% vs. 28.7%, P = .02) and fewer pulmonary contusions (16.7% vs. 50.0%, P = .04). Discussion Injury patterns, including bilateral rib fractures without pulmonary contusions and low but severe Injury Severity Score burden, may help identify high-risk patients who may benefit from closer monitoring and more aggressive therapy.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Delayed Respiratory Failure After Blunt Chest Trauma

Martin

Lü

Inouye

et al. 2020

The American Surgeon

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“…In a recent preliminary study published in 2018, it is suggested that, in emergency settings, a serial evaluation of forced vital capacity (FVC) could be a reliable marker of trauma severity as well as a reliable method to assess the effectiveness of its management: a persistently low FVC might in fact advise against ward admission and advocate for more aggressive treatment, especially in patients with increased risk of complications (10).…”

Section: Anatomymentioning

confidence: 99%

Chest wall pain management after chest wall trauma

Lovisari¹,

Favarato²,

Giovannini³

et al. 2020

J Vis Surg

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Blunt chest trauma is defined as a high energy injury to the thorax and its structures, and it is usually a strong indicator of severe injury. Its clinical presentation can vary from rib fractures to pneumothorax, hemothorax, lung and soft tissue contusion; these lesions and consequential pain predispose to respiratory failure by compromising respiratory mechanics and by exacerbating pre-existing lung disease.This picture can lead to a number of complications, such as pneumonia or ARDS, that have a significant impact on patients' morbidity and mortality. One of the cornerstones of blunt chest trauma management is providing early and effective analgesia: pain control improves respiratory mechanics, reduces possible complications and allows effective and aggressive physiotherapy. In literature, there are few clinical trials comparing different analgesic techniques for pain relief in blunt thoracic trauma; our review aims to detail the clinical implication, adequacy and possible complications of different analgesic approaches commonly used in thoracic trauma management, such as epidural anesthesia, regional anesthesia, endovenous and intrathecal analgesia. This review is also focused on management and prevention of chronic pain. Pain management, lung toilet, aggressive respiratory therapy and early mobilization are key to a successful patient recovery. In selected patients, operative fixation may lead to better outcomes although further research is needed to clearly identify the category of patients and the ideal timing for surgical intervention. Chronic pain develops in up to 50% of the patients after a thoracic trauma. A multimodal approach tackling both its somatic and neuropathic component is essential to chronic pain prevention. Early and effective pain control demonstrated to have a pivotal role on patient recovery. While endovenous analgesia constitutes the method of choice for intensive care unit (ICU) sedated patients, regional unilateral analgesia should be considered in awake and spontaneously breathing patients. The approach of choice should be tailored on the single patient and, if possible, a multimodal strategy should be established.

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“…FVC and forced expiratory volume per second (FEV 1 ) were measured using a hand-held spirometer (Spirobank TM , MIR Laboratory, Rome, Italy). 20 Each respiratory maneuver was repeated three times and only the best performance was recorded. Respiratory disability was defined by one or more of the following: NYHA 5 score ≥ 2, SpO 2 ≤ 92% or FVC ≤ 80% at rest.…”

Section: Data Collection and Outcomesmentioning

confidence: 99%