Tracheostomy in trauma patients with rib fractures.

Flail Chest / surgery Humans Injury Severity Score Length of Stay Retrospective Studies Rib Fractures / surgery Thoracic Injuries / surgery Tracheostomy
Chest trauma Rib fracture scoring systems Rib fractures Tracheostomy

Journal

European journal of trauma and emergency surgery : official publication of the European Trauma Society
ISSN: 1863-9941
Titre abrégé: Eur J Trauma Emerg Surg
Pays: Germany
ID NLM: 101313350

Informations de publication

Date de publication:
Aug 2021
Historique:
received: 08 11 2018
accepted: 13 05 2019
pubmed: 24 5 2019
medline: 16 10 2021
entrez: 24 5 2019
Statut: ppublish

Résumé

Patients with rib fractures (RF) may require prolonged mechanical ventilation and tracheostomy. Indications for tracheostomy in trauma patients with RF remain debatable. The goal was to delineate characteristics of patients who underwent tracheostomy due to thoracic versus extra-thoracic causes, such as maxillofacial-mandibular injury (MFM), traumatic brain injury (TBI), and cervical vertebrae trauma (CVT), and to analyze clinical outcomes. The predictive values of chest trauma scoring systems for tracheostomy were also evaluated. We hypothesized that tracheostomized patients were more severely injured with more ribs fractured and had more pulmonary co-injuries. Retrospective review included 471 patients with RF admitted to two Level 1 trauma centers. Patients with tracheostomy (n = 124, 26.3%) were compared to patients with endotracheal intubation (n = 347, 73.7%). Analyzed variables included age, gender, injury severity score (ISS), Glasgow Coma Scale, number of ribs fractured, total fractures of ribs, prevalence of bilateral rib fractures, flail chest, clavicle fractures, MFM, TBI, CVT, co-injuries, comorbidities, RF treatment options, hospital length of stay (HLOS), intensive care unit LOS (ICULOS), duration of mechanical ventilation (DMV). Tracheostomized compared to intubated patients had statistically higher ISS, more ribs fractured, total fractures of the ribs, bilateral and clavicle fractures, MFM, spine, chest, and orthopedic co-injuries and longer HLOS, ICULOS and DMV. Tracheostomy for thoracic reasons was performed in 64 patients (51.6%) and for extra-thoracic reasons in 60 patients (48.4%). Mean tracheostomy timing was 9.9 days and was significantly shorter in the extra-thoracic compared to the thoracic group (8.0 versus 11.6 days, p < 0.001). All chest trauma scoring system values were significantly higher in tracheostomized patients. Predictive values of scoring systems for tracheostomy increased in patients with thoracic trauma only. A quarter of mechanically ventilated patients with RF required tracheostomy. Tracheostomized compared to intubated patients were more severely injured with more ribs fractured and were intubated longer. An increased amount of RF was associated with an increase in tracheostomies, especially for thoracic reasons.

Identifiants

DOI: 10.1007/s00068-019-01149-7 PMID: 31119319
pubmed: 31119319
doi: 10.1007/s00068-019-01149-7
pii: 10.1007/s00068-019-01149-7
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

965-974

Informations de copyright

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

Références

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Auteurs

Alexander Fokin (A)

Division of Trauma and Critical Care Services, Delray Medical Center, 5352 Linton Boulevard, Delray Beach, FL, 33484, USA. Alexander.Fokin@tenethealth.com.

Joanna Wycech (J)

Division of Trauma and Critical Care Services, Delray Medical Center, 5352 Linton Boulevard, Delray Beach, FL, 33484, USA.
Division of Trauma and Critical Care Services, Broward Health Medical Center, 1600 S Andrews Ave, Fort Lauderdale, FL, 33316, USA.

Kyle Chin Shue (K)

Charles E. Schmidt College of Medicine, Department of Surgery, Florida Atlantic University, 777 Glades Rd, Boca Raton, FL, 33431, USA.

Ryan Stalder (R)

Wake Forest University, 1834 Wake Forest Rd, Winston-Salem, NC, 27109, USA.

Jose Lozada (J)

Division of Trauma and Critical Care Services, Broward Health Medical Center, 1600 S Andrews Ave, Fort Lauderdale, FL, 33316, USA.

Ivan Puente (I)

Division of Trauma and Critical Care Services, Delray Medical Center, 5352 Linton Boulevard, Delray Beach, FL, 33484, USA.
Division of Trauma and Critical Care Services, Broward Health Medical Center, 1600 S Andrews Ave, Fort Lauderdale, FL, 33316, USA.
Charles E. Schmidt College of Medicine, Department of Surgery, Florida Atlantic University, 777 Glades Rd, Boca Raton, FL, 33431, USA.
Herbert Wertheim College of Medicine, Department of Surgery, Florida International University, 11200 SW 8th St, Miami, FL, 33199, USA.

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Classifications MeSH

questionsmedicales.fr › Plaies et blessures › Blessures du thorax › Volet thoracique › Tracheostomy in trauma patients with rib fractures.
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Tracheostomy in trauma patients with rib fractures.
questionsmedicales.fr › Qualité, accès, évaluation des soins de santé › Qualité des soins de santé › Mécanismes d'évaluation des soins de santé › Score de gravité des lésions traumatiques › Tracheostomy in trauma patients with rib fractures.
questionsmedicales.fr › Établissements, main d'oeuvre et services de soins de santé › Services de santé › Soins aux patients › Hospitalisation › Durée du séjour › Tracheostomy in trauma patients with rib fractures.
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études rétrospectives › Tracheostomy in trauma patients with rib fractures.
questionsmedicales.fr › Plaies et blessures › Blessures du thorax › Fractures de côte › Tracheostomy in trauma patients with rib fractures.
questionsmedicales.fr › Plaies et blessures › Blessures du thorax › Tracheostomy in trauma patients with rib fractures.
questionsmedicales.fr › Procédures de chirurgie opératoire › Procédures de chirurgie thoracique › Trachéostomie › Tracheostomy in trauma patients with rib fractures.