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Kim SH, Huh U, Song S, Kim MS, Wang IJ, Tak YJ. Outcomes in trauma patients undergoing veno-venous extracorporeal membrane oxygenation for acute respiratory distress syndrome. Perfusion 2022:2676591221093880. [PMID: 35678471 DOI: 10.1177/02676591221093880] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The use of veno-venous extracorporeal membrane oxygenation (VV ECMO) remains controversial in trauma patients with acute respiratory distress syndrome (ARDS). Here, we aimed to investigate the therapeutic benefits of VV ECMO and the factors affecting patient outcomes. METHODS From 2017 to 2019, 21/1938 trauma patients (median age: 47 years; 18 men) at a level I trauma center received VV ECMO for post-traumatic ARDS. Demographic, injury-specific, ECMO, and outcome data were prospectively collected and retrospectively reviewed to analyze the factors affecting hospital mortality and ECMO results. RESULTS 19 patients (90.5%) were successfully weaned off ECMO; 16 patients (76.2%) survived to discharge. In univariate analysis, there was a significant difference in survival between the groups with a Trauma and Injury Severity Score (TRISS) ⩾0.5 and TRISS <0.5 (p = 0.05). The area under the receiver operating characteristic curve (AUC) for both TRISS and Respiratory Extracorporeal Membrane Oxygenation Survival Prediction (RESP) scores for death was 0.78. In those who failed ECMO weaning, the AUCs of the TRISS and RESP scores were 0.90 and 0.80, respectively. CONCLUSIONS In patients with ARDS caused by severe trauma and supported by VV ECMO, survival is associated with TRISS; TRISS and RESP scores may be predictive of mortality and failure in ECMO weaning.
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Affiliation(s)
- Seon Hee Kim
- Departments of Trauma Surgery, Pusan National University School of Medicine, Biomedical Research Institute, Pusan National University Hospital Trauma Center, Republic of Korea
| | - Up Huh
- Department of Thoracic and Cardiovascular Surgery, Pusan National University School of Medicine, Biomedical Research Institute, Pusan National University Hospital, Republic of Korea
| | - Seunghwan Song
- Department of Thoracic and Cardiovascular Surgery, Pusan National University School of Medicine, Biomedical Research Institute, Pusan National University Hospital, Republic of Korea
| | - Min Su Kim
- Department of Thoracic and Cardiovascular Surgery, Pusan National University School of Medicine, Biomedical Research Institute, Pusan National University Hospital, Republic of Korea
| | - Il Jae Wang
- Department of Emergency Medicine, Pusan National University School of Medicine, Biomedical Research Institute, Pusan National University Hospital, Republic of Korea
| | - Young Jin Tak
- Department of Family Medicine, Pusan National University School of Medicine, Biomedical Research Institute, Pusan National University Hospital, Republic of Korea
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Vollrath JT, Schindler CR, Marzi I, Lefering R, Störmann P. Lung failure after polytrauma with concomitant thoracic trauma in the elderly: an analysis from the TraumaRegister DGU®. World J Emerg Surg 2022; 17:12. [PMID: 35197078 PMCID: PMC8867717 DOI: 10.1186/s13017-022-00416-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 02/08/2022] [Indexed: 11/19/2022] Open
Abstract
Background In developed countries worldwide, the number of older patients is increasing. Pulmonary complications are common in multiple injured patients with chest injuries. We assessed whether geriatric patients develop lung failure following multiple trauma with concomitant thoracic trauma more often than younger patients.
Methods A retrospective analysis of severely injured patients with concomitant blunt thoracic trauma registered in the TraumaRegister DGU® (TR-DGU) between 2009 and 2018 was performed. Patients were categorized into four age groups: 55–64 y, 65–74 y, 75–84 y, and ≥ 85 y. Adult patients aged 18–54 years served as a reference group. Lung failure was defined as PaO2/FIO2 ≤ 200 mm Hg, if mechanical ventilation was performed. Results A total of 43,289 patients were included, of whom 9238 (21.3%) developed lung failure during their clinical stay. The rate of posttraumatic lung failure was seen to increase with age. While lung failure markedly increased the length of hospital stay, duration of mechanical ventilation, and length of ICU stay independent of the patient’s age, differences between younger and older patients with lung failure in regard to these parameters were clinically comparable. In addition, the development of respiratory failure showed a distinct increase in mortality with higher age, from 16.9% (18–54 y) to 67.2% (≥ 85 y). Conclusion Development of lung failure in severely injured patients with thoracic trauma markedly increases hospital length of stay, length of ICU stay, and duration of mechanical ventilation in patients, regardless of age. The development of respiratory failure appears to be related to the severity of the chest trauma rather than to increasing patient age. However, the greatest effects of lung failure, particularly in terms of mortality, were observed in the oldest patients.
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Affiliation(s)
- Jan Tilmann Vollrath
- Department of Trauma, Hand, and Reconstructive Surgery, University Hospital Frankfurt am Main, Goethe University, Theodor-Stern-Kai 7, 60596, Frankfurt am Main, Germany.
| | - Cora Rebecca Schindler
- Department of Trauma, Hand, and Reconstructive Surgery, University Hospital Frankfurt am Main, Goethe University, Theodor-Stern-Kai 7, 60596, Frankfurt am Main, Germany
| | - Ingo Marzi
- Department of Trauma, Hand, and Reconstructive Surgery, University Hospital Frankfurt am Main, Goethe University, Theodor-Stern-Kai 7, 60596, Frankfurt am Main, Germany
| | - Rolf Lefering
- Institute for Research in Operative Medicine (IFOM), Cologne Merheim Medical Center (CMMC), University of Witten/Herdecke, Cologne, Germany
| | - Philipp Störmann
- Department of Trauma, Hand, and Reconstructive Surgery, University Hospital Frankfurt am Main, Goethe University, Theodor-Stern-Kai 7, 60596, Frankfurt am Main, Germany
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Amos T, Bannon-Murphy H, Yeung M, Gooi J, Marasco S, Udy A, Fitzgerald M. ECMO (extra corporeal membrane oxygenation) in major trauma: A 10 year single centre experience. Injury 2021; 52:2515-2521. [PMID: 33832706 DOI: 10.1016/j.injury.2021.03.058] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 03/26/2021] [Indexed: 02/02/2023]
Abstract
Aim To review the indications, complications and outcomes of extracorporeal membrane oxygenation (ECMO) in major trauma patients. Methods Single centre, retrospective, cohort study. Results Over a ten year period, from 13,420 major trauma patients, 11 were identified from our institutional trauma registry as having received ECMO. These patients were predominantly younger (mean 39 +/- 17 years), male (91%) and severely traumatised (median ISS 50, IQR 34 - 54). Veno-venous (VV) ECMO was used predominantly (n = 7, 64%), to treat hypoxic respiratory failure (mean PaO2/FiO2 ratio 69.7 +/- 38.6), secondary to traumatic lung injury. Veno-arterial (VA) ECMO was used less frequently, primarily to treat massive pulmonary embolism following trauma. Major bleeding complications occurred in four patients, however only one patient died from haemorrhage. Heparin free (2/11), delayed (3/11) or low dose heparin (2/11) therapy was frequently utilised. The median time from injury to ECMO initiation was 1 day (IQR 0.5 - 5.5) and median ECMO duration 9 days (IQR 6.5 - 10.5). ECMO was initiated <72 hours in 6 patients, with survival to discharge 67%, compared to 20% in those initiated >72 hours. Overall survival to discharge was 45%, and was higher with VV ECMO (64%), than other configurations (25%). Conclusion ECMO was rarely used in major trauma, the most common indication being severe hypoxaemic respiratory failure secondary to lung injury. In this severely injured cohort, overall survival was poor but better in VV compared to VA and better if initiated early (<72 hours), compared to late.
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Affiliation(s)
- Timothy Amos
- Emergency and Trauma Centre, The Alfred, Australia.
| | | | - Meei Yeung
- National Trauma Research Institute, Australia; Trauma Services, The Alfred, Australia; Breast, Endocrine and General Surgery (BES) Unit, The Alfred, Australia
| | - Julian Gooi
- Cardiothoracic Surgical Unit, The Alfred, Australia
| | | | - Andrew Udy
- Department of Intensive Care & Hyperbaric Medicine, The Alfred, Australia; Australian and New Zealand Intensive Care - Research Centre, Monash University, Australia
| | - Mark Fitzgerald
- National Trauma Research Institute, Australia; Trauma Services, The Alfred, Australia
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Kasotakis G, Stanfield B, Haines K, Vatsaas C, Alger A, Vaslef SN, Brooks K, Agarwal S. Acute Respiratory Distress Syndrome (ARDS) after trauma: Improving incidence, but increasing mortality. J Crit Care 2021; 64:213-218. [PMID: 34022661 DOI: 10.1016/j.jcrc.2021.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 05/04/2021] [Accepted: 05/05/2021] [Indexed: 01/24/2023]
Abstract
PURPOSE Acute Respiratory Distress Syndrome (ARDS) is an infrequent, yet morbid inflammatory complication in injury victims. With the current project we sought to estimate trends in incidence, determine outcomes, and identify risk factors for ARDS and related mortality. MATERIALS & METHODS The national Trauma Quality Improvement Program dataset (2010-2014) was queried. Demographics, injury characteristics and outcomes were compared between patients who developed ARDS and those who did not. Logistic regression models were fitted for the development of ARDS and mortality respectively, adjusting for relevant confounders. RESULTS In the studied 808,195 TQIP patients, incidence of ARDS decreased over the study years (3-1.1%, p < 0.001), but related mortality increased (18.-21%, p = 0.001). ARDS patients spent an additional 14.7 ± 10.3 days in the hospital, 9.7 ± 7.9 in the ICU, and 6.6 ± 9.4 on mechanical ventilation (all p < 0.001). Older age, male gender, African American race increased risk for ARDS. Age, male gender, lower GCS and higher ISS also increased mortality risk among ARDS patients. Several pre-existing comorbidities including chronic alcohol use, diabetes, smoking, and respiratory disease also increased risk. CONCLUSION Although the incidence of ARDS after trauma appears to be declining, mortality is on the rise.
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Affiliation(s)
- George Kasotakis
- Department of Surgery, Duke University School of Medicine, United States of America.
| | - Brent Stanfield
- Department of Surgery, Duke University School of Medicine, United States of America.
| | - Krista Haines
- Department of Surgery, Duke University School of Medicine, United States of America.
| | - Cory Vatsaas
- Department of Surgery, Duke University School of Medicine, United States of America.
| | - Amy Alger
- Department of Surgery, Duke University School of Medicine, United States of America.
| | - Steven N Vaslef
- Department of Surgery, Duke University School of Medicine, United States of America.
| | - Kelli Brooks
- Department of Surgery, Duke University School of Medicine, United States of America.
| | - Suresh Agarwal
- Department of Surgery, Duke University School of Medicine, United States of America.
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Parker BM, Menaker J, Berry CD, Tesoreiero RB, O'Connor JV, Stein DM, Scalea TM. Single Center Experience With Veno-Venous Extracorporeal Membrane Oxygenation in Patients With Traumatic Brain Injury. Am Surg 2020; 87:949-953. [PMID: 33295187 DOI: 10.1177/0003134820956360] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
METHODS We retrospectively reviewed TBI patients ≥ 18 years of age treated with VV-ECMO. The primary outcome was survival to discharge. Secondary outcomes included progression of intracranial hemorrhage, bleeding complications, and episodes of oxygenator thrombosis requiring exchange. Medians and interquartile ranges were reported where appropriate. RESULTS 13 TBI patients received VV-ECMO support during the study period. The median age was 28 years (Interquartile range (IQR) 25-37.5) and 85% were men. Median admission Glasgow coma scale was 5 (IQR 3-13.5). Median injury severity score (ISS) was 48 (IQR 33.5-66). Median pre-ECMO PaO2:FiO2 ratio was 58 (IQR 47-74.5). Five (38.4%) patients survived to discharge. Six patients (46%) received systemic A/C while on ECMO. No patient had worsening of intracranial hemorrhage on computed tomography imaging. There were two bleeding complications in patients on A/C, neither was related to TBI. Four patients required an oxygenator change; 2 in patients on A/C. CONCLUSION VV-ECMO appears safe with TBI. We have demonstrated that A/C can be withheld without increased complications. Traumatic brain injury should not be considered an absolute contraindication to the use of VV-ECMO for severe respiratory failure and should be decided on a case by case basis. Additional research is needed to confirm these preliminary findings.
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Affiliation(s)
- Brandon M Parker
- Department of Surgery, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Jay Menaker
- Department of Surgery, School of Medicine, University of Maryland Baltimore, MD, USA
| | - Cherisse D Berry
- Department of Surgery, School of Medicine, New York University, New York, NY, USA
| | | | - James V O'Connor
- Department of Surgery, School of Medicine, University of Maryland Baltimore, MD, USA
| | - Deborah M Stein
- Department of Surgery, Univeristy of California, San Francisco, CA, USA
| | - Thomas M Scalea
- Department of Surgery, School of Medicine, University of Maryland Baltimore, MD, USA
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Ramin S, Charbit J, Jaber S, Capdevila X. Acute respiratory distress syndrome after chest trauma: Epidemiology, specific physiopathology and ventilation strategies. Anaesth Crit Care Pain Med 2019; 38:265-276. [DOI: 10.1016/j.accpm.2018.09.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 09/05/2018] [Accepted: 09/06/2018] [Indexed: 01/07/2023]
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Stonko DP, Dennis BM, Callcut RA, Betzold RD, Smith MC, Medvecz AJ, Guillamondegui OD. Identifying temporal patterns in trauma admissions: Informing resource allocation. PLoS One 2018; 13:e0207766. [PMID: 30507930 PMCID: PMC6277067 DOI: 10.1371/journal.pone.0207766] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Accepted: 11/06/2018] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Increased knowledge of the temporal patterns in the distribution of trauma admissions could be beneficial to staffing and resource allocation efforts. However, little work has been done to understand how this distribution varies based on patient acuity, trauma mechanism or need for intervention. We hypothesize that temporal patterns exist in the distribution of trauma admissions, and that deep patterns exist when traumas are analyzed by their type and severity. STUDY DESIGN We conducted a cross-sectional observational study of adult patient flow at a level one trauma center over three years, 7/1/2013-6/30/2016. Primary thermal injuries were excluded. Frequency analysis was performed for patients grouped by ED disposition and mechanism against timing of admission; in subgroup analysis additional exclusion criteria were imposed. RESULTS 10,684 trauma contacts were analyzed. Trauma contacts were more frequent on Saturdays and Sundays than on weekdays (p<0.001). Peak arrival time was centered around evening shift change (6-7pm), but differed based on ED disposition: OR and ICU or Step-Down admissions (p = 0.0007), OR and floor admissions (p<0.0001), and ICU or Step-Down and floor admissions (p<0.0001). Step-Down and ICU arrival times (p = 0.42) were not different. Penetrating injuries peaked later than blunt (p<0.0001). Trauma varies throughout the year; we establish a high incidence trauma season (April to late October). Different mechanisms have varying dependence upon season; Motorcycle crashes (MCCs) have the greatest dependence. CONCLUSION We identify new patterns in the temporal and seasonal variation of trauma and of specific mechanisms of injury, including the novel findings that 1) penetrating trauma tends to present at later times than blunt, and 2) critically ill patients requiring an OR tend to present later than those who are less acute and require an ICU or Step-Down unit. These patients present later than those who are admitted to the floor. Penetrating trauma patients arriving later than blunt may be the underlying reason why operative patients arrive later than other patients.
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Affiliation(s)
- David P. Stonko
- The Johns Hopkins Hospital, Department of Surgery, Baltimore, MD, United States of America
| | - Bradley M. Dennis
- Vanderbilt University Hospital, Division of Trauma and Surgical Critical Care, Nashville, TN, United States of America
| | - Rachael A. Callcut
- Department of Surgery, University of California, San Fransisco, San Fransisco, CA, United States of America
| | - Richard D. Betzold
- Vanderbilt University Hospital, Division of Trauma and Surgical Critical Care, Nashville, TN, United States of America
| | - Michael C. Smith
- Vanderbilt University Hospital, Division of Trauma and Surgical Critical Care, Nashville, TN, United States of America
| | - Andrew J. Medvecz
- Vanderbilt University Hospital, Division of Trauma and Surgical Critical Care, Nashville, TN, United States of America
| | - Oscar D. Guillamondegui
- Vanderbilt University Hospital, Division of Trauma and Surgical Critical Care, Nashville, TN, United States of America
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Menaker J, Tesoriero RB, Tabatabai A, Rabinowitz RP, Cornachione C, Lonergan T, Dolly K, Rector R, O'Connor JV, Stein DM, Scalea TM. Veno-Venous Extracorporeal Membrane Oxygenation (VV ECMO) for Acute Respiratory Failure Following Injury: Outcomes in a High-Volume Adult Trauma Center with a Dedicated Unit for VV ECMO. World J Surg 2018; 42:2398-2403. [PMID: 29340723 DOI: 10.1007/s00268-018-4480-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION The use of veno-venous extracorporeal membrane oxygenation (VV ECMO) has increased over the past decade. The purpose of this study was to evaluate outcomes in adult trauma patients requiring VV ECMO. METHODS Data were collected on adult trauma patients admitted between January 1, 2015, and November 1, 2016. Demographics, injury-specific data, ECMO data, and survival to discharge were recorded. Medians [interquartile range (IQR)] were reported. A p value ≤0.05 was considered statistically significant. RESULTS Eighteen patients required VV ECMO during the study period. Median age was 28.5 years (IQR 24-43). Median injury severity score (ISS) was 27 (IQR 21-41); median PaO2/FiO2 (P/F) prior to ECMO cannulation was 61 (IQR 50-70). Median time from injury to cannulation was 3 (IQR 0-6) days. Median duration of ECMO was 266 (IQR 177-379) hours. Survival to discharge was 78%. Survivors had a significantly higher ISS (p = 0.03), longer intensive care unit length of stay (ICU LOS) (p < 0.0004), hospital LOS (p < 0.000004), and time on the ventilator (p < 0.0003). Median time of injury to cannulation was significantly longer in patients who survived to discharge (p = 0.01). There was no difference in P/F ratio prior to cannulation (p = ns). CONCLUSION We have demonstrated improved outcome of patients requiring VV ECMO following injury compared to historical data. Although shorter time from injury to cannulation for VV ECMO was associated with death, select patients who meet criteria for VV ECMO early following injury should be referred/transferred to a tertiary care facility that specializes in trauma and ECMO care.
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Affiliation(s)
- Jay Menaker
- Program in Trauma, R Adams Cowley Shock Trauma Center, 22 South Greene Street, Baltimore, MD, 21201, USA.
| | - Ronald B Tesoriero
- Program in Trauma, R Adams Cowley Shock Trauma Center, 22 South Greene Street, Baltimore, MD, 21201, USA
| | - Ali Tabatabai
- Program in Trauma, R Adams Cowley Shock Trauma Center, 22 South Greene Street, Baltimore, MD, 21201, USA
| | - Ronald P Rabinowitz
- Program in Trauma, R Adams Cowley Shock Trauma Center, 22 South Greene Street, Baltimore, MD, 21201, USA
| | - Christopher Cornachione
- Program in Trauma, R Adams Cowley Shock Trauma Center, 22 South Greene Street, Baltimore, MD, 21201, USA
| | - Terence Lonergan
- Program in Trauma, R Adams Cowley Shock Trauma Center, 22 South Greene Street, Baltimore, MD, 21201, USA
| | - Katelyn Dolly
- Program in Trauma, R Adams Cowley Shock Trauma Center, 22 South Greene Street, Baltimore, MD, 21201, USA
| | - Raymond Rector
- Program in Trauma, R Adams Cowley Shock Trauma Center, 22 South Greene Street, Baltimore, MD, 21201, USA
| | - James V O'Connor
- Program in Trauma, R Adams Cowley Shock Trauma Center, 22 South Greene Street, Baltimore, MD, 21201, USA
| | - Deborah M Stein
- Program in Trauma, R Adams Cowley Shock Trauma Center, 22 South Greene Street, Baltimore, MD, 21201, USA
| | - Thomas M Scalea
- Program in Trauma, R Adams Cowley Shock Trauma Center, 22 South Greene Street, Baltimore, MD, 21201, USA
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O'Leary MP, Keeley JA, Yule A, Suruki C, Plurad DS, Moazzez A, Neville AL, Putnam BA, Kim DY. Clinical predictors of early acute respiratory distress syndrome in trauma patients. Am J Surg 2016; 212:1096-1100. [PMID: 27780558 DOI: 10.1016/j.amjsurg.2016.09.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Revised: 09/06/2016] [Accepted: 09/06/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND The objectives of this study were to examine the incidence and severity of early acute respiratory distress syndrome (ARDS) according to the Berlin Definition and to identify risk factors associated with the development of early post-traumatic ARDS. METHODS A 2.5-year retrospective database of adult trauma patients who required mechanical ventilation for greater than 48 hours at a level 1 trauma center was analyzed for variables predictive of early (<48 hours after injury), mild, moderate, and severe ARDS and in-hospital mortality. RESULTS Of 305 patients, 59 (19.3%) developed early ARDS: mild, 27 (45.8%); moderate, 26 (44.1%); and severe, 6 (10.1%). Performance of an emergent thoracotomy, blunt mechanism, and fresh frozen plasma administration were independently associated with the development of early ARDS. ARDS was not predictive of mortality. CONCLUSIONS Trauma patients with blunt mechanism, who receive fresh frozen plasma, or undergo thoracotomy, are at risk of developing early ARDS.
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Affiliation(s)
- Michael P O'Leary
- Harbor-UCLA Medical Center, Department of Surgery, 1000 West Carson Street Box 461, Torrance, CA 90502, USA
| | - Jessica A Keeley
- Harbor-UCLA Medical Center, Department of Surgery, 1000 West Carson Street Box 461, Torrance, CA 90502, USA
| | - Arthur Yule
- Harbor-UCLA Medical Center, Department of Surgery, 1000 West Carson Street Box 461, Torrance, CA 90502, USA
| | - Caitlyn Suruki
- Harbor-UCLA Medical Center, Department of Surgery, 1000 West Carson Street Box 461, Torrance, CA 90502, USA
| | - David S Plurad
- Harbor-UCLA Medical Center, Department of Surgery, 1000 West Carson Street Box 461, Torrance, CA 90502, USA
| | - Ashkan Moazzez
- Harbor-UCLA Medical Center, Department of Surgery, 1000 West Carson Street Box 461, Torrance, CA 90502, USA
| | - Angela L Neville
- Harbor-UCLA Medical Center, Department of Surgery, 1000 West Carson Street Box 461, Torrance, CA 90502, USA
| | - Brant A Putnam
- Harbor-UCLA Medical Center, Department of Surgery, 1000 West Carson Street Box 461, Torrance, CA 90502, USA
| | - Dennis Y Kim
- Harbor-UCLA Medical Center, Department of Surgery, 1000 West Carson Street Box 461, Torrance, CA 90502, USA.
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Ried M, Bein T, Philipp A, Müller T, Graf B, Schmid C, Zonies D, Diez C, Hofmann HS. Extracorporeal lung support in trauma patients with severe chest injury and acute lung failure: a 10-year institutional experience. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2013; 17:R110. [PMID: 23786965 PMCID: PMC4056791 DOI: 10.1186/cc12782] [Citation(s) in RCA: 112] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Accepted: 06/20/2013] [Indexed: 12/16/2022]
Abstract
Introduction Severe trauma with concomitant chest injury is frequently associated with acute lung failure (ALF). This report summarizes our experience with extracorporeal lung support (ELS) in thoracic trauma patients treated at the University Medical Center Regensburg. Methods A retrospective, observational analysis of prospectively collected data (Regensburg ECMO Registry database) was performed for all consecutive trauma patients with acute pulmonary failure requiring ELS during a 10-year interval. Results Between April 2002 and April 2012, 52 patients (49 male, three female) with severe thoracic trauma and ALF refractory to conventional therapy required ELS. The mean age was 32 ± 14 years (range, 16 to 72 years). Major traffic accident (73%) was the most common trauma, followed by blast injury (17%), deep fall (8%) and blunt trauma (2%). The mean Injury Severity Score was 58.9 ± 10.5, the mean lung injury score was 3.3 ± 0.6 and the Sequential Organ Failure Assessment score was 10.5 ± 3. Twenty-six patients required pumpless extracorporeal lung assist (PECLA) and 26 patients required veno-venous extracorporeal membrane oxygenation (vv-ECMO) for primary post-traumatic respiratory failure. The mean time to ELS support was 5.2 ± 7.7 days (range, <24 hours to 38 days) and the mean ELS duration was 6.9 ± 3.6 days (range, <24 hours to 19 days). In 24 cases (48%) ELS implantation was performed in an external facility, and cannulation was done percutaneously by Seldinger's technique in 98% of patients. Cannula-related complications occurred in 15% of patients (PECLA, 19% (n = 5); vv-ECMO, 12% (n = 3)). Surgery was performed in 44 patients, with 16 patients under ELS prevention. Eight patients (15%) died during ELS support and three patients (6%) died after ELS weaning. The overall survival rate was 79% compared with the proposed Injury Severity Score-related mortality (59%). Conclusion Pumpless and pump-driven ELS systems are an excellent treatment option in severe thoracic trauma patients with ALF and facilitate survival in an experienced trauma center with an interdisciplinary treatment approach. We encourage the use of vv-ECMO due to reduced complication rates, better oxygenation and best short-term outcome.
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Bakowitz M, Bruns B, McCunn M. Acute lung injury and the acute respiratory distress syndrome in the injured patient. Scand J Trauma Resusc Emerg Med 2012; 20:54. [PMID: 22883052 PMCID: PMC3518173 DOI: 10.1186/1757-7241-20-54] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2012] [Accepted: 06/11/2012] [Indexed: 12/27/2022] Open
Abstract
Acute lung injury and acute respiratory distress syndrome are clinical entities of multi-factorial origin frequently seen in traumatically injured patients requiring intensive care. We performed an unsystematic search using PubMed and the Cochrane Database of Systematic Reviews up to January 2012. The purpose of this article is to review recent evidence for the pathophysiology and the management of acute lung injury/acute respiratory distress syndrome in the critically injured patient. Lung protective ventilation remains the most beneficial therapy. Future trials should compare intervention groups to controls receiving lung protective ventilation, and focus on relevant outcome measures such as duration of mechanical ventilation, length of intensive care unit stay, and mortality.
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Affiliation(s)
- Magdalena Bakowitz
- Department of Anesthesiology & Critical Care, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA.
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Navarrete-Navarro P, Rivera-Fernández R, Rincón-Ferrari MD, García-Delgado M, Muñoz A, Jiménez JM, Ortega FJF, García DMM. Early markers of acute respiratory distress syndrome development in severe trauma patients. J Crit Care 2006; 21:253-8. [PMID: 16990093 DOI: 10.1016/j.jcrc.2005.12.012] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2005] [Revised: 09/02/2005] [Accepted: 12/20/2005] [Indexed: 11/30/2022]
Abstract
PURPOSE The aim of the study was to identify early risk factors for development of acute respiratory distress syndrome (ARDS) in severe trauma patients. MATERIALS AND METHODS This was a prospective observational study of 693 severe trauma patients (Injury Severity Score >or=16 and/or Revised Trauma Score <or=11) in 17 hospitals in a Spanish region of 8 million inhabitants from July 2002 to December 2002. RESULTS Acute respiratory distress syndrome developed in 6.9% of patients who were more severely ill with higher APACHE II (P < .001) and Injury Severity Score (P = .002) scores vs patients not developing ARDS. Acute respiratory distress syndrome development was associated (P < .001) with fractures of femur (International Classification of Diseases, Ninth Revision [ICD-9] codes 820, 821), tibia (ICD-9 code 823), humerus, and pelvis, with a number (>or=2) of long bone fractures, and with chest injuries (rib/sternal fracture [ICD-9 code 807] and hemo/pneumothorax [ICD-9 code 860/861]). Patients with ARDS required more colloids (P = .005) and red blood cell units (P = .02) than patients without ARDS during the first 24 hours. Multivariate analysis showed that ARDS was related to chest trauma diagnosis (ICD-9 code 807) (odds ratio [OR], 3.85), femoral fracture (OR, 3.16), APACHE II score (OR, 1.05), and blood transfusion during resuscitation (OR, 1.32). CONCLUSIONS Risk of ARDS development is related to the first 24-hour admission variables, including severe physiologic derangements and specific ICD-9-classified injuries. Blood transfusion may play an independent role.
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