Ventilation in chest trauma

Richter, Torsten; Ragaller, M.

doi:10.4103/0974-2700.82215

Cited by 57 publications

(33 citation statements)

References 90 publications

(75 reference statements)

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“…Mechanical ventilation in volume-controlled mode with lung-protective ventilation parameters was applied (6–8 ml/kg/BW); i.e. inspiratory oxygen fraction (FiO 2 ) of 0.5; positive end-expiratory pressure (PEEP) 8 mmHg (plateau pressure < 28 mmHg) adjusted by capnometry targeting a pCO 2 of 35–45 mmHg (Draeger, Evita, Lübeck, Germany) as indicated for the treatment of patients with chest trauma7374. Vital parameters were monitored by electrocardiographic (ECG) recordings and ECG-synchronized pulse oximetry, as previously described75.…”

Section: Methodsmentioning

confidence: 99%

Characterization of blunt chest trauma in a long-term porcine model of severe multiple trauma

Horst

Simon

Pfeifer

et al. 2016

Sci Rep

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Chest trauma has a significant relevance on outcome after severe trauma. Clinically, impaired lung function typically occurs within 72 hours after trauma. However, the underlying pathophysiological mechanisms are still not fully elucidated. Therefore, we aimed to establish an experimental long-term model to investigate physiological, morphologic and inflammatory changes, after severe trauma. Male pigs (sus scrofa) sustained severe trauma (including unilateral chest trauma, femur fracture, liver laceration and hemorrhagic shock). Additionally, non-injured animals served as sham controls. Chest trauma resulted in severe lung damage on both CT and histological analyses. Furthermore, severe inflammation with a systemic increase of IL-6 (p = 0.0305) and a local increase of IL-8 in BAL (p = 0.0009) was observed. The pO2/FiO2 ratio in trauma animals decreased over the observation period (p < 0.0001) but not in the sham group (p = 0.2967). Electrical Impedance Tomography (EIT) revealed differences between the traumatized and healthy lung (p < 0.0001). In conclusion, a clinically relevant, long-term model of blunt chest trauma with concomitant injuries has been developed. This reproducible model allows to examine local and systemic consequences of trauma and is valid for investigation of potential diagnostic or therapeutic options. In this context, EIT might represent a radiation-free method for bedside diagnostics.

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Section: Methodsmentioning

confidence: 99%

Characterization of blunt chest trauma in a long-term porcine model of severe multiple trauma

Horst

Simon

Pfeifer

et al. 2016

Sci Rep

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“…Moreover, ventilation in trauma patients is challenging because of the difficulty in achieving an optimal balance between sufficient ventilation and the avoidance of additional barotrauma to the lungs [20, 21]. …”

Section: Discussionmentioning

confidence: 99%

Trends in intubation rates and durations in ventilated severely injured trauma patients: an analysis from the TraumaRegister DGU®

et al. 2016

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BackgroundEndotracheal intubation in severely injured patients is known to be a risk factor for systemic complications. We aimed to examine the changes in intubation rates and durations in severely injured trauma patients, and rates of the systemic complications associated with ventilation changes by using a large trauma registry over the period of 13 years.MethodsPatient demographics, Injury Severity Score (ISS), ventilation days, ventilation free days (VFD), and prevalence of systemic complications (sepsis and multiple organ failure (MOF)) were obtained from the TraumaRegister DGU® and were compared over the study period.ResultsDuring the study period (2002 – 2014), 35,232 patients were recorded in TraumaRegister DGU®. 72.7 % of patients (n = 25,629) were intubated, and 27.3 % (n = 9603) of patients did not require mechanical ventilation throughout their hospital stay. The mean age was 48 ± 21 years, mean ISS was 27.9 ± 11.5, mean length of ICU stay was 11.7 ± 13.8 days, mean time on mechanical ventilator was 7.1 ± 11.3 days, and mean ventilation free days (spontaneous respiration) was 19.5 ± 11.9 days. We observed a reduction in the intubation rates (87.5 % in 2002 versus 63.6 % in 2014), and early extubation (10 ventilation days in 2002, and 5.9 days in 2014) over time.ConclusionOur study reveals a reduction in intubation rates and ventilation duration during the observation period. Moreover, we were able to observe decreased incidence of systemic complications such as sepsis over the 13 year study period, while no changes in incidence of MOF were registered. The exact relationship can not be proven in our study. This needs to be addressed in further analysis.

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“…Thus, we decided to perform left-sided OLV before induction of anesthesia. By doing this, we expected to increase alveolar ventilation of the left lung [ 2 , 5 , 6 ].…”

Section: Discussionmentioning

confidence: 99%

“…Traumatic lung laceration, which produces inadequate ventilation due to air leakage, is usually managed by chest tube insertion in order to expand the damaged lung. In most cases, chest tube insertion and thoracic drainage is enough to maintain adequate oxygenation; endotracheal intubation, lung separation, and positive pressure ventilation support are required when the air leakage flow rate through traumatic bronchopulmonal fistular is high [ 2 ]. We report the case of a patient who required lung separation due to substantial air leakage from lung laceration.…”

mentioning

confidence: 99%

Management of traumatic pneumothorax with massive air leakage: role of a bronchial blocker: a case report

Lee

Lim

et al. 2014

Korean J Anesthesiol

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Massive air leakage through a lacerated lung produces inadequate ventilation and hypoxemia. Tube exchange from a single to double lumen endotracheal tube (DLT), and lung separation to maintain oxygenation, are challenging for seriously injured patients. In this case report, we aim to describe how a bronchial blocker (BB) makes it easier to perform a lung separation in this situation; it also increases the overall safety of the procedure. A 35-year-old female (163 cm, 47 kg) suffered from blunt chest trauma due to a traffic accident; the accident caused right-sided lung laceration with massive air leakage. Paradoxically, positive ventilation worsened SaO2 and leakage increased through a chest tube. We introduced BB while the patient was still awake: Left-side one-lung ventilation (OLV) was established and anesthesia was induced. After PaO2 was maximized with OLV, we changed the endotracheal tube to DLT without a hypoxic event. By BB placement, we maintained PaO2 at a secure level, conducted mechanical ventilation and exchanged the tube without deterioration.

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Ventilation in chest trauma

Cited by 57 publications

References 90 publications

Characterization of blunt chest trauma in a long-term porcine model of severe multiple trauma

Characterization of blunt chest trauma in a long-term porcine model of severe multiple trauma

Trends in intubation rates and durations in ventilated severely injured trauma patients: an analysis from the TraumaRegister DGU®

Management of traumatic pneumothorax with massive air leakage: role of a bronchial blocker: a case report

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