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Impact of Accidental Hypothermia on Pulmonary Complications in Multiply Injured Patients With Blunt Chest Trauma - A Matched-pair Analysis.

ABSTRACT: BACKGROUND/AIM:Blunt chest trauma is one of the major injuries in multiply injured patients and is associated with an increased risk of acute respiratory distress syndrome (ARDS) and ventilator-associated pneumonia (VAP). Accidental hypothermia is a common accompaniment of multiply injured patients. The objective of this study was to analyze the influence of accidental hypothermia on pulmonary complications in multiply injured patients with blunt chest trauma. PATIENTS AND METHODS:Multiply injured patients [injury severity score (ISS) ?16] with severe blunt chest trauma [abbreviated injury scale of the chest (AISchest) ?3] were analyzed. Hypothermia was defined as body core temperature <35°C. The primary endpoint was the development of ARDS and VAP. Propensity score matching was performed. RESULTS:Data were analyzed for 238 patients, with a median ISS of 26 (interquartile range=12). A total of 67 patients (28%) were hypothermic on admission. Hypothermic patients were injured more severely (median ISS 34 vs. 24, p<0.001) and had a higher transfusion requirement (p<0.001). Their mortality rate was consequently increased (10% vs. 1%, p=0.002); After propensity score matching, the mortality rate was still higher (10% vs. 2%, p=0.046). However, hypothermia was not an independent predictor of mortality. Hypothermic patients had to be ventilated longer (p=0.02). However, there were no differences in occurrence of ARDS and VAP. Hypothermia was not identified as an independent predictor of ARDS and VAP. CONCLUSION:Among multiply injured patients with severe blunt chest trauma, accidental hypothermia is not an independent predictor of ARDS and VAP and is more likely to be an accompaniment of injury severity and hemorrhage.

SUBMITTER: Winkelmann M

PROVIDER: S-EPMC6755018 | biostudies-literature | 2019 Sep-Oct

REPOSITORIES: biostudies-literature

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Impact of Accidental Hypothermia on Pulmonary Complications in Multiply Injured Patients With Blunt Chest Trauma - A Matched-pair Analysis.

Winkelmann Marcel M Clausen Jan-Dierk JD Graeff Pascal P Schröter Christian C Zeckey Christian C Weber-Spickschen Sanjay S Mommsen Philipp P

In vivo (Athens, Greece) 20190901 5

<h4>Background/aim</h4>Blunt chest trauma is one of the major injuries in multiply injured patients and is associated with an increased risk of acute respiratory distress syndrome (ARDS) and ventilator-associated pneumonia (VAP). Accidental hypothermia is a common accompaniment of multiply injured patients. The objective of this study was to analyze the influence of accidental hypothermia on pulmonary complications in multiply injured patients with blunt chest trauma.<h4>Patients and methods</h4 ...[more]

PMID: 31471402

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Project description:BackgroundIn patients with multiple trauma, a supine chest radiography [chest X-ray (CXR)] is preferred over a erect CXR. However, this method has limitations in detecting post-traumatic pneumothorax. The use of chest computed tomography (CT) to detect traumatic pneumothorax is well known. However, pneumothorax that is not detected before a chest CT scan is known as an occult pneumothorax (OP), and it can cause serious complications in the patient. This study sought to evaluate the frequency and risk factors for OP in trauma patients.MethodsPatients who suffered thoracic trauma at the Level 1 Regional Trauma Center of Wonju Severance Christian Hospital between 2015 and 2022 were included in this study. All patients were at least 18 years old. The study reviewed all patients' supine CXR and chest CT images and classified them into five radiographic diagnoses: pneumothorax, rib fracture, subcutaneous emphysema, lung contusion, and pneumomediastinum.ResultsThe study included 1,284 patients, all with diagnoses of pneumothorax, rib fracture, subcutaneous emphysema, lung contusion, and pneumomediastinum following supine CXR and chest CT. The patient's average age was 58.3±15.2 years. Pneumothorax diagnosis on supine CXR had the lowest accuracy, at 46.7%, and the lowest sensitivity, at 12.7%. In univariate analysis, rib fracture, lung contusion, and subcutaneous emphysema on supine CXR were all found to be statistically significant regarding traumatic OP. In multivariate analysis, the risk factors for OP were lung contusion [odds ratio (OR), 1.440; 95% confidence interval (CI): 1.115-1.860; P=0.005] and subcutaneous emphysema (OR, 25.883; 95% CI: 13.155-50.928; P<0.001) on supine CXR.ConclusionsThe lung contusion and subcutaneous emphysema in supine CXR of trauma patients indicate the presence of OP. Therefore, if chest CT cannot be performed immediately due to unstable vital signs or other circumstances, recognizing the above radiological findings of traumatic pneumothorax may be necessary.

Dataset Information

Impact of Accidental Hypothermia on Pulmonary Complications in Multiply Injured Patients With Blunt Chest Trauma - A Matched-pair Analysis.

Publications

Impact of Accidental Hypothermia on Pulmonary Complications in Multiply Injured Patients With Blunt Chest Trauma - A Matched-pair Analysis.

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