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Abstract
Noninvasive ventilation (NIV) provides respiratory support without the use of invasive ventilation with techniques that do not bypass the upper airway. NIV is particularly attractive given its associated reduced risk of complications associated with intubation. Available NIV modes include nasal cannula, simple mask, nonrebreather, high flow nasal cannula, continuous positive airway pressure (CPAP), and bilevel positive airway pressure. Acute exacerbation of COPD, cardiogenic pulmonary edema, and COVID-19 are conditions for which NIV has shown to be beneficial, whereas there is no consensus among the use of NIV in trauma patients and ARDS.
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Affiliation(s)
- Patrycja Popowicz
- Department of General Surgery, East Carolina University- Vidant Medical Center, 2100 Stantonsburg Road, Greenville, NC 27834, USA.
| | - Kenji Leonard
- Division of Trauma, Surgical Critical Care, and Acute Care Surgery, Department of Surgery, East Carolina University- Vidant Medical Center, 2100 Stantonsburg Road, Greenville, NC 27834, USA
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Ahmadinejad M, Moghaddam MA, Shahesmaeili A, Mayel M. Two Supportive Methods on Outcome of Patients with Chest Trauma. ARCHIVES OF PHARMACY PRACTICE 2022. [DOI: 10.51847/akte52dksk] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Fattori S, Reitano E, Chiara O, Cimbanassi S. Predictive Factors of Ventilatory Support in Chest Trauma. Life (Basel) 2021; 11:life11111154. [PMID: 34833030 PMCID: PMC8621668 DOI: 10.3390/life11111154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 10/13/2021] [Accepted: 10/26/2021] [Indexed: 11/21/2022] Open
Abstract
This study aims to define possible predictors of the need of invasive and non-invasive ventilatory support, in addition to predictors of mortality in patients with severe thoracic trauma. Data from 832 patients admitted to our trauma center were collected from 2010 to 2017 and retrospectively analyzed. Demographic data, type of respiratory assistance, chest injuries, trauma scores and outcome were considered. Univariate analysis was performed, and binary logistic regression was applied to significant data. The injury severity score (ISS) and the revised trauma score (RTS) were both found to be predictive factors for invasive ventilation. Multivariate analysis of the anatomical injuries revealed that the association of high-severity thoracic injuries with trauma in other districts is an indicator of the need for orotracheal intubation. From the analysis of physiological parameters, values of systolic blood pressure, lactate, and Glasgow coma scale (GCS) score indicate the need for invasive ventilatory support. Predictive factors for non-invasive ventilation include: RTS, ISS, number of rib fractures and presence of hemothorax. Risk factors for death were: age over 65, the presence of bilateral rib fractures, pulmonary contusion, hemothorax and associated head trauma. In conclusion, the need for invasive ventilatory support in thoracic trauma is associated to the patient’s systemic severity. Non-invasive ventilation is a supportive treatment indicated in physiologically stable patients regardless of the severity of thoracic injury.
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Affiliation(s)
- Silvia Fattori
- General Surgery-Trauma Team, Niguarda Hospital, 20162 Milan, Italy
- Correspondence: (S.F.); (S.C.)
| | - Elisa Reitano
- Division of General Surgery, Department of Translational Medicine, Maggiore della Carità Hospital, University of Eastern Piedmont, 28100 Novara, Italy;
| | - Osvaldo Chiara
- Department of Pathophysiology and Transplants-State, University of Milan-General Surgery-Trauma Team, Niguarda Hospital, 20162 Milan, Italy;
| | - Stefania Cimbanassi
- General Surgery-Trauma Team, Niguarda Hospital, 20162 Milan, Italy
- Correspondence: (S.F.); (S.C.)
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Sulen N, Šimurina T, Karuc E, Tolić A. EPIDURAL ANALGESIA IN MULTIPY INJURED PATIENTS WITH SEVERE CHEST TRAUMA: TWO CASE REPORTS AND LITERATURE REVIEW. Acta Clin Croat 2020; 58:118-123. [PMID: 31741570 PMCID: PMC6813476 DOI: 10.20471/acc.2019.58.s1.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Multiply injured patients with severe chest trauma have different combinations of associated extra thoracic injuries making their treatment complex. Severe pain is a prominent symptom in a vast majority of severe chest injuries and causes deterioration of respiratory function. Epidural analgesia provides efficient pain relief but its use in this group of patients is burdened with complications, contraindications and technical difficulties. We present two cases in which epidural analgesia was successfully used in polytrauma patients with severe chest injuries and hypoxemic respiratory failure, and discuss advantages, possible pitfalls and complications
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Affiliation(s)
| | - Tatjana Šimurina
- 1Department of Anesthesiology, Resuscitation and Intensive Care Medicine, General Hospital Zadar, Zadar, Croatia; 2Department of Anesthesiology, Resuscitation, Intensive Medicine and Pain Management, Faculty of Medicine "Josip Juraj Strossmayer" University, Osijek, Croatia; 3Department of Health Studies, University of Zadar, Zadar, Croatia; 4Department of Radiology, General Hospital Zadar, Zadar, Croatia
| | - Edi Karuc
- 1Department of Anesthesiology, Resuscitation and Intensive Care Medicine, General Hospital Zadar, Zadar, Croatia; 2Department of Anesthesiology, Resuscitation, Intensive Medicine and Pain Management, Faculty of Medicine "Josip Juraj Strossmayer" University, Osijek, Croatia; 3Department of Health Studies, University of Zadar, Zadar, Croatia; 4Department of Radiology, General Hospital Zadar, Zadar, Croatia
| | - Anela Tolić
- 1Department of Anesthesiology, Resuscitation and Intensive Care Medicine, General Hospital Zadar, Zadar, Croatia; 2Department of Anesthesiology, Resuscitation, Intensive Medicine and Pain Management, Faculty of Medicine "Josip Juraj Strossmayer" University, Osijek, Croatia; 3Department of Health Studies, University of Zadar, Zadar, Croatia; 4Department of Radiology, General Hospital Zadar, Zadar, Croatia
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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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Dikmen Y, Bayoumy Delis P, Esquinas AM. Threshold of number of rib fractures in elderly blunt trauma: A simple or complex matter of numbers? Surgery 2017; 162:1343. [DOI: 10.1016/j.surg.2017.03.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 03/10/2017] [Indexed: 10/19/2022]
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Horst K, Andruszkow H, Weber CD, Pishnamaz M, Herren C, Zhi Q, Knobe M, Lefering R, Hildebrand F, Pape HC. Thoracic trauma now and then: A 10 year experience from 16,773 severely injured patients. PLoS One 2017; 12:e0186712. [PMID: 29049422 PMCID: PMC5648226 DOI: 10.1371/journal.pone.0186712] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 10/09/2017] [Indexed: 01/11/2023] Open
Abstract
Background and purpose Thoracic trauma remains to be a relevant injury to the polytraumatised patient. However, literature regarding how far changes in clinical guidelines for pre- and in-hospital trauma management and diagnostic procedures affect the outcome of multiple injured patients with severe chest injury during a long-term observation period is sparse. Methods Multiple traumatised patients (age≥16y) documented in the TraumaRegister DGU® (TR-DGU) from January 1st 2005 to December 31st 2014 with severe chest trauma (AIS≥3) were included in this study. Demographic data, the pattern of injury, injury severity, radiographic emergency procedures, indication for intubation, duration of mechanical ventilation, emergency surgery, occurrence of complications and mortality were evaluated per year and over time. Results A total of 16,773 patients were analysed. The use of whole body computer tomography increased (p<0.001), while the incidence of plain x-rays decreased (p<0.001). Furthermore, incidence of AISThorax = 3 graded injuries increased (p<0.001) while AISThorax = 4 decreased (p<0.001). Both, rate of patients being intubated at the time of ICU admission decreased (p<0.001) and the time of mechanical ventilation decreased (p<0.001). Additionally, need for emergency surgery, lung failure, sepsis, and multi organ failure all decreased (p<0.001). However, mortality remained unchanged. Interpretation Severity of severe chest trauma and associated complications decreased while diagnostics and treatment improved over time. However, mortality remained unchanged. Our results are in line with those expected in the context of the incidence of CT diagnostics, which has increased parallel to the clinical outcome Thus, our data demonstrate a positive trend in the treatment of patients with severe chest trauma.
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Affiliation(s)
- Klemens Horst
- Department of Orthopaedic Trauma, RWTH Aachen University, Aachen, Germany
- Harald Tscherne Research Laboratory, RWTH Aachen University, Aachen, Germany
- * E-mail:
| | - Hagen Andruszkow
- Department of Orthopaedic Trauma, RWTH Aachen University, Aachen, Germany
| | - Christian D. Weber
- Department of Orthopaedic Trauma, RWTH Aachen University, Aachen, Germany
| | - Miguel Pishnamaz
- Department of Orthopaedic Trauma, RWTH Aachen University, Aachen, Germany
| | - Christian Herren
- Department of Orthopaedic Trauma, RWTH Aachen University, Aachen, Germany
| | - Qiao Zhi
- Harald Tscherne Research Laboratory, RWTH Aachen University, Aachen, Germany
| | - Matthias Knobe
- Department of Orthopaedic Trauma, RWTH Aachen University, Aachen, Germany
| | - Rolf Lefering
- IFOM - Institute for Research in Operative Medicine, Faculty of Health, Department of Medicine, Witten / Herdecke University, Cologne, Germany
| | - Frank Hildebrand
- Department of Orthopaedic Trauma, RWTH Aachen University, Aachen, Germany
| | - Hans-Christoph Pape
- Department of Trauma Surgery, University Hospital Zurich, Zurich, Switzerland
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Hardcastle TC, Muckart DJJ, Maier RV. Ventilation in Trauma Patients: The First 24 h is Different! World J Surg 2017; 41:1153-1158. [PMID: 27177646 DOI: 10.1007/s00268-016-3530-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Ventilation of major trauma patients is often needed in both the acute (emergency department and early ICU phase) and subsequent phases of trauma care for those who need ICU admission. What is unclear is whether ICU ventilation strategies should be directly extrapolated to the acute phase of treatment. METHODS This paper reviews the ARDS.net study, highlights recent developments in ventilation strategies, and provides practical ventilation guidance to the trauma surgeon for acute phase (in the ED or ICU) and the subsequent phase of ICU care. RESULTS The acute phase of care in the ED and the ICU is different from the subsequent phases of ICU care as the lung is more recruitable and there are other aspects of resuscitation from metabolic acidosis and traumatic brain injury, which require a different ventilation strategy to the traditional ARDS.net approach. DISCUSSION AND CONCLUSION The acute phase is different from the subsequent phase of care and there appears to be some inappropriate extrapolation of ICU practice to the acute phase. Application of the proposed ventilation strategies should ensure an optimal outcome. It is important to treat patients as individuals during assessment and treatment.
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Affiliation(s)
- Timothy Craig Hardcastle
- Trauma Service, Inkosi Albert Luthuli Central Hospital, 800 Vusi Mzimela Rd, Mayville, Durban, 4091, South Africa.
- Department of Surgery, University of KwaZulu-Natal, Durban, South Africa.
| | - David J J Muckart
- Trauma Service, Inkosi Albert Luthuli Central Hospital, 800 Vusi Mzimela Rd, Mayville, Durban, 4091, South Africa
- Department of Surgery, University of KwaZulu-Natal, Durban, South Africa
| | - Ronald V Maier
- Department of Surgery, Harborview Medical Center, University of Washington, Surgery Clinic, 410 9th Ave, 7th Floor, Seattle, WA, 98104, USA
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Abstract
Chest wall trauma is common, and contributes significantly to morbidity and mortality of trauma patients. Early identification of major chest wall and concomitant intrathoracic injuries is critical. Generalized management of multiple rib fractures and flail chest consists of adequate pain control (including locoregional modalities); management of pulmonary dysfunction by invasive and noninvasive means; and, in some cases, surgical fixation. Multiple studies have shown that patients with flail chest have substantial benefit (decreased ventilator and intensive care unit days, improved pulmonary function, and improved long-term functional outcome) when they undergo surgery compared with nonoperative management.
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Affiliation(s)
- Sarah Majercik
- Division of Trauma and Surgical Critical Care, Intermountain Medical Center, 5121 South Cottonwood Street, Murray, UT 84107, USA.
| | - Fredric M Pieracci
- Department of Surgery, Denver Health Medical Center, University of Colorado School of Medicine, 777 Bannock Street, MC0206, Denver, CO 80204, USA
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Almahmoud K, Teuben M, Andruszkow H, Horst K, Lefering R, Hildebrand F, Pape HC, Pfeifer R. Trends in intubation rates and durations in ventilated severely injured trauma patients: an analysis from the TraumaRegister DGU®. Patient Saf Surg 2016; 10:24. [PMID: 27822309 PMCID: PMC5094000 DOI: 10.1186/s13037-016-0109-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Accepted: 10/13/2016] [Indexed: 01/15/2023] Open
Abstract
Background Endotracheal 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. Methods Patient 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. Results During 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. Conclusion Our 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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Affiliation(s)
- Khalid Almahmoud
- Department of Orthopedics Trauma Surgery, University of Aachen Medical Center, 52074 Aachen, Germany ; Harald Tscherne Laboratory, RWTH Aachen University, 52074 Aachen, Germany
| | - Michel Teuben
- Department of Orthopedics Trauma Surgery, University of Aachen Medical Center, 52074 Aachen, Germany ; Harald Tscherne Laboratory, RWTH Aachen University, 52074 Aachen, Germany
| | - Hagen Andruszkow
- Department of Orthopedics Trauma Surgery, University of Aachen Medical Center, 52074 Aachen, Germany ; Harald Tscherne Laboratory, RWTH Aachen University, 52074 Aachen, Germany
| | - Klemens Horst
- Department of Orthopedics Trauma Surgery, University of Aachen Medical Center, 52074 Aachen, Germany ; Harald Tscherne Laboratory, RWTH Aachen University, 52074 Aachen, Germany
| | - Rolf Lefering
- Institute for Research in Operative Medicine (IFOM), University Witten/Herdecke, 51109 Cologne, Germany
| | - Frank Hildebrand
- Department of Orthopedics Trauma Surgery, University of Aachen Medical Center, 52074 Aachen, Germany ; Harald Tscherne Laboratory, RWTH Aachen University, 52074 Aachen, Germany
| | - Hans Christoph Pape
- Department of Orthopedics Trauma Surgery, University of Aachen Medical Center, 52074 Aachen, Germany ; Harald Tscherne Laboratory, RWTH Aachen University, 52074 Aachen, Germany
| | - Roman Pfeifer
- Department of Orthopedics Trauma Surgery, University of Aachen Medical Center, 52074 Aachen, Germany ; Harald Tscherne Laboratory, RWTH Aachen University, 52074 Aachen, Germany
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Pu XX, Wang J, Yan XB, Jiang XQ. Sequential invasive-noninvasive mechanical ventilation weaning strategy for patients after tracheostomy. World J Emerg Med 2015; 6:196-200. [PMID: 26401180 DOI: 10.5847/wjem.j.1920-8642.2015.03.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 06/28/2015] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Because the continuity and integrity of the trachea are likely damaged to some extent after tracheostomy, the implementation of sequential ventilation has certain difficulties, and sequential invasive-noninvasive ventilation on patients after tracheostomy is less common in practice. The present study aimed to investigate the feasibility of invasive-noninvasive sequential weaning strategy in patients after tracheostomy. METHODS Fifty patients including 24 patients with withdrawal of mechanical ventilation (conventional group) and 26 patients with sequential invasive-noninvasive weaning by directly plugging of tracheostomy (sequential group) were analyzed retrospectively after appearance of pulmonary infection control (PIC) window. The analysis of arterial blood gases, ventilator-associated pneumonia (VAP) incidence, the total duration of mechanical ventilation, the success rate of weaning and total cost of hospitalization were compared between the two groups. RESULTS Arterial blood gas analysis showed that the sequential weaning group was better than the conventional weaning group 1 and 24 hours after invasive ventilation. The VAP incidence was lowered, the duration of mechanical ventilation shortened, the success rate of weaning increased, and the total cost of hospitalization decreased. CONCLUSION Sequential invasive-noninvasive ventilator weaning is feasible in patients after tracheostomy.
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Affiliation(s)
- Xue-Xue Pu
- Department of Geriatric Pulmonary Diseases, Anhui Geriatric Institute, First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
| | - Jiong Wang
- Department of Geriatric Pulmonary Diseases, Anhui Geriatric Institute, First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
| | - Xue-Bo Yan
- Department of Geriatric Pulmonary Diseases, Anhui Geriatric Institute, First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
| | - Xue-Qin Jiang
- Department of Geriatric Pulmonary Diseases, Anhui Geriatric Institute, First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
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