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Does lack of thoracic trauma attenuate the severity of pulmonary failure? An 8-year analysis of critically injured patients

  • Xin Huang
  • Louis J. Magnotti
  • Timothy C. Fabian
  • Martin A. Croce
  • John P. SharpeEmail author
Original Article
  • 27 Downloads

Abstract

Purpose

Patients with thoracic trauma are presumed to be at higher risk for pulmonary dysfunction, but adult respiratory distress syndrome (ARDS) may develop in any patient, regardless of associated chest injury. This study evaluated the impact of thoracic trauma and pulmonary failure on outcomes in trauma patients admitted to the intensive-care unit (ICU).

Methods

All trauma patients admitted to the ICU over an 8-year period were identified. Patients that died within 48 h of arrival were excluded. Patients were stratified by baseline characteristics, injury severity, development of ARDS, and infectious complications. Multiple logistic regression was used to determine variables significantly associated with the development of ARDS.

Results

10,362 patients were identified. After exclusions, 4898 (50%) patients had chest injury and 4975 (50%) did not. 200 (2%) patients developed ARDS (3.6% of patients with chest injury and 0.5% of patients without chest injury). Patients with ARDS were more likely to have chest injury than those without ARDS (87% vs 49%, p < 0.001). However, of the patients without chest injury, the development of ARDS still led to a significant increase in mortality compared to those patients without ARDS (58% vs 5%, p < 0.001). Multiple logistic regression found ventilator-associated pneumonia (VAP) to be the only independent predictor for the development of ARDS in ICU patients without chest injury.

Conclusions

ARDS development was more common in patients with thoracic trauma. Nevertheless, the development of ARDS in patients without chest injury was associated with a tenfold higher risk of death. The presence of VAP was found to be the only potentially preventable and treatable risk factor for the development of ARDS in ICU patients without chest injury.

Keywords

ARDS Ventilator-associated pneumonia Trauma Chest injury 

Notes

Author contributions

Study conception and design: Huang and Sharpe. Acquisition of data: Sharpe and Huang. Analysis and interpretation of data: Sharpe, Huang, Magnotti, Fabian, and Croce. Drafting of manuscript: Sharpe and Huang. Critical revision: Magnotti, Fabian, and Croce.

Compliance with ethical standards

Conflict of interest

Xin Huang MD does not have any financial disclosures or conflicts of interest to declare. Louis J Magnotti MD does not have any financial disclosures or conflicts of interest to declare. Timothy C Fabian MD does not have any financial disclosures or conflicts of interest to declare. Martin A Croce MD does not have any financial disclosures or conflicts of interest to declare. John P Sharpe MD, MS does not have any financial disclosures or conflicts of interest to declare.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of SurgeryUniversity of Tennessee Health Science CenterMemphisUSA

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