Severe thoracic trauma – still an independent predictor for death in multiple injured patients?

Grubmüller, Michael; Kerschbaum, Maximilian; Diepold, Eva; Angerpointner, Katharina; Nerlich, Michael; Ernstberger, Antonio

doi:10.1186/s13049-017-0469-7

Cited by 32 publications

(47 citation statements)

References 35 publications

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“…A recently performed prospective study by Grubmüller et al investigated the impact of severe chest trauma on severely injured patients, showing a significantly increased rate of in-hospital complications like organ failure and respiratory failure [18]. Consistent with that analysis, the presented study found increased incidence of MODS (p < 0.001; r = 0.849).…”

supporting

confidence: 86%

Impact of Chest Trauma and Overweight on Mortality and Outcome in Severely Injured Patients

Eckhardt

Horst

Störmann

et al. 2020

JCM

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The morbidity and mortality of severely injured patients are commonly affected by multiple factors. Especially, severe chest trauma has been shown to be a significant factor in considering outcome. Contemporaneously, weight-associated endocrinological, haematological, and metabolic deviations from the norm seem to have an impact on the posttraumatic course. Therefore, the aim of this study was to determine the influence of body weight on severely injured patients by emphasizing chest trauma. A total of 338 severely injured patients were included. Multivariate regression analyses were performed on patients with severe chest trauma (AIS ≥ 3) and patients with minor chest trauma (AIS < 3). The influence of body weight on in-hospital mortality was evaluated. Of all the patients, 70.4% were male, the median age was 52 years (IQR 36–68), the overall Injury Severity Score (ISS) was 24 points (IQR 17–29), and a median BMI of 25.1 points (IQR 23–28) was determined. In general, chest trauma was associated with prolonged ventilation, prolonged ICU treatment, and increased mortality. For overweight patients with severe chest trauma, an independent survival benefit was found (OR 0.158; p = 0.037). Overweight seems to have an impact on the mortality of severely injured patients with combined chest trauma. Potentially, a nutritive advantage or still-unknown immunological aspects in these patients affecting the intensive treatment course could be argued.

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supporting

confidence: 86%

Impact of Chest Trauma and Overweight on Mortality and Outcome in Severely Injured Patients

Eckhardt

Horst

Störmann

et al. 2020

JCM

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“…Our reported patients suffering from thoracic trauma and clavicle fracture showed a prolonged period of ICU stay (mean 9.4 days) and intubation time (mean 7.4 days) compared to published multiply-injured patients without thoracic trauma (ICU: 8.1 days, intubation time: 3.9 days) [3]. Yet, our ndings are comparable with previously published data on patients with thoracic trauma (ICU: 11 days, intubation time: 7 days [34]; ICU: 12 days, intubation time: 7 days [14]).…”

Section: Discussionsupporting

confidence: 85%

“…Similar to previously published data on thoracic trauma, motorcycle crashes could be identi ed as the most frequent injury mechanism for developing a severe thoracic trauma with a clavicle fracture [11,14,29,30].…”

Section: Discussionsupporting

confidence: 71%

“…Despite advances in ventilatory management like lung-protective, non-invasive ventilation protocols, patients with thoracic trauma often require prolonged ventilatory support and protracted ICU and hospital stays [12][13][14]. Since clavicular injuries represent a severe loss of integrity of the chest and upper quarter of the body, disorders in breathing mechanics can occur [15].…”

Section: Introductionmentioning

confidence: 99%

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Surgical Stabilization of Clavicle Fractures Reduces Organ Failure Rates in Multiply-injured Patients with Thoracic Trauma: An Analysis Based on the TraumaRegister DGU®.

Eberbach

Lefering

Hager³

et al. 2020

Preprint

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Introduction: Thoracic trauma has decisive influence on the outcome of multiply-injured patients and is often associated with clavicle fractures. The affected patients are prone to lung dysfunction and multiple organ failure. The aim of this study is to investigate the influence of surgical stabilization of clavicle fractures in patients with thoracic trauma on specific outcome parameters.Methods: A multi-center, retrospective analysis of patient records documented in the TraumaRegister DGU® between 2009 and 2015 was performed. The inclusion criteria were multiply-injured patients with thoracic trauma and associated clavicle fracture, maximum AIS severity ≥ 3 and admission to the intensive care unit. The influence of operative vs. non-operative clavicular fracture treatment and timing of surgery on lung failure, multiple organ failure, sepsis, length of ICU stay, intubation time and length of hospital stay was assessed by regression analysis.Results: A total of 3,209 patients were included in the analysis. In 1,362 patients (42%) the clavicle fracture was treated operatively after 7.1 ± 5.3 days. Surgically treated patients had a significant reduction in lung failure (p = 0.013, OR = 0.74), multiple organ failure (p = 0.001, OR = 0.64), intubation time (p = 0.004; -1.81 days) and length of hospital stay (p = 0.014; -1.51 days) compared to non-operative treatment. Moreover, surgical fixation of the clavicle within five days following hospital admission significantly reduced the rates of lung failure (p = 0.01, OR = 0.62), multiple organ failure (p = 0.01, OR = 0.59) and length of hospital stay (p = 0.01; -2.1 days).Conclusions: Based on our results, multiply-injured patients with thoracic trauma and concomitant clavicle fracture seem to benefit significantly from surgical stabilization of a clavicle fracture, especially when surgery is performed within the first five days after hospital admission.

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“…It has been reported in some studies that mechanical ventilation time and pulmonary complication rates increase in the presence of flail chest along with pulmonary contusion after thoracic trauma (14). ARDS is one of the complications which may develop as a result of these pathologies (15).…”

Section: Discussionmentioning

confidence: 99%

The Success of ECMO in Flail Chest and ARDS Following Thoracic Gunshot Wound

Uzundere¹,

Kaçar²,

Yektaş³

2019

tybd

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ÖZ Konvansiyonel yönetimin başarısız olduğu şiddetli akut respiratuvar distres sendromu (ARDS) olan hastalarda ekstrakorporeal membran oksijenasyonu (ECMO) son seçenek olarak kullanılabilir. En iyi sonuçlar travma sonrası şiddetli ARDS olan hastalarda elde edilmektedir. Yaralanan akciğerler ECMO tedavisi ile tamamen iyileşebilir. Acil operasyona alınan hastaya akciğerindeki morfolojik varyasyon ve yaygın kontüzyon nedeniyle pnömonektomi yapılamadı. Kotlarda büyük bir hasarı olan hastada yelken göğüs mevcuttu. Kemik dokuda büyük kayıp mevcut olduğundan kotlara çelik plak koyulamadı. Hastanın fraktüre kosta uçları kesildikten sonra dual mesh ile açık olan göğüs duvarı onarıldı ve üzeri serratus ve latissimus dorsi kaslarıyla kapatıldı. Yelken göğüs düzeltilemedi. Yoğun bakım takibinde akut respiratuvar distres sendromu gelişen hastada konvansiyonel yönetimle başarı sağlanamadı ve akciğerlerin iyileşmesine imkan sağlamak amacıyla ECMO kullanıldı. Hastaya uygulanan ECMO tedavisi 7 gün sürdü ve herhangi bir komplikasyon olmaksızın tamamlandı. Hasta 29 gün sonra servise transfer edildi. Bu olgu sunumunda ateşli silah ile ciddi toraks yaralanması sonucu acil servise getilen 44 yaşında erkek hastada konvansiyonel yönetimle başarı sağlanamadığından akciğerlerin iyileşmesine imkan sağlayan hayat kurtarıcı bir tedavi olarak ECMO'nun kullanımını bildiriyoruz.ABSTRACT Extracorporeal membrane oxygenation (ECMO) may be the last option in patients with severe acute respiratory distress syndrome (ARDS) in whom conventional methods have failed. The best results are obtained in patients with severe ARDS after trauma. Injured lungs can recover completely with ECMO therapy. A 44-year-old male patient was brought to the emergency department after sustaining severe thoracic gunshot injury. The patient was rushed into emergency surgery; however, pneumonectomy could not be performed due to morphological variation and widespread contusion in the lungs. The patient had flail chest with extensive damage of the ribs. Titanium plates could not be placed, as there was a major loss in the bone tissue. After cutting the fractured rib ends, the open chest wall was repaired with dual mesh and covered with serratus and latissimus dorsi muscles. However, the flail chest could not be corrected. During the follow-up in the intensive care unit, the patient developed ARDS and conventional therapies were unsuccessful. Thus, ECMO was used to allow lung healing. ECMO treatment was continued for seven days and was completed without any complications. The patient was transferred to the regular ward after 29 days. ECMO can be used as a life-saving treatment that allows lung healing in case conventional treatment methods have failed.

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Severe thoracic trauma – still an independent predictor for death in multiple injured patients?

Cited by 32 publications

References 35 publications

Impact of Chest Trauma and Overweight on Mortality and Outcome in Severely Injured Patients

Impact of Chest Trauma and Overweight on Mortality and Outcome in Severely Injured Patients

Surgical Stabilization of Clavicle Fractures Reduces Organ Failure Rates in Multiply-injured Patients with Thoracic Trauma: An Analysis Based on the TraumaRegister DGU®.

The Success of ECMO in Flail Chest and ARDS Following Thoracic Gunshot Wound

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