Epidural analgesia in ICU chest trauma patients with fractured ribs: retrospective study of pain control and intubation requirements.
Chest trauma
Epidural analgesia
Journal
Annals of intensive care
ISSN: 2110-5820
Titre abrégé: Ann Intensive Care
Pays: Germany
ID NLM: 101562873
Informations de publication
Date de publication:
27 Aug 2020
27 Aug 2020
Historique:
received:
27
04
2020
accepted:
17
08
2020
entrez:
28
8
2020
pubmed:
28
8
2020
medline:
28
8
2020
Statut:
epublish
Résumé
Nonintubated chest trauma patients with fractured ribs admitted to the intensive care unit (ICU) are at risk for complications and may require invasive ventilation at some point. Effective pain control is essential. We assessed whether epidural analgesia (EA) in patients with fractured ribs who were not intubated at ICU admission decreased the need for invasive mechanical ventilation (IMV). We also looked for risk factors for IMV. This retrospective, observational, multicenter study conducted in 40 ICUs in France included consecutive patients with three or more fractured ribs who were not intubated at admission between July 2013 and July 2015. Of the 974 study patients, 788 were included in the analysis of intubation predictors. EA was used in 130 (16.5%) patients, and 65 (8.2%) patients required IMV. Factors independently associated with IMV were chronic respiratory disease (P = 0.008), worse SAPS II (P < 0.0001), flail chest (P = 0.02), worse Injury Severity Score (P = 0.0003), higher respiratory rate at admission (P = 0.02), alcohol withdrawal syndrome (P < 0.001), and noninvasive ventilation (P = 0.04). EA was not associated with decreases in IMV requirements, median numerical rating scale pain score, or intravenous morphine requirements from day 1 to day 7. EA was not associated with a lower risk of IMV in chest trauma patients with at least 3 fractured ribs, moderate pain, and no intubation on admission. Further studies are needed to clarify the optimal pain control strategy in chest trauma patients admitted to the ICU, notably those with severe pain or high opioid requirements.
Sections du résumé
BACKGROUND
BACKGROUND
Nonintubated chest trauma patients with fractured ribs admitted to the intensive care unit (ICU) are at risk for complications and may require invasive ventilation at some point. Effective pain control is essential. We assessed whether epidural analgesia (EA) in patients with fractured ribs who were not intubated at ICU admission decreased the need for invasive mechanical ventilation (IMV). We also looked for risk factors for IMV.
STUDY DESIGN AND METHODS
METHODS
This retrospective, observational, multicenter study conducted in 40 ICUs in France included consecutive patients with three or more fractured ribs who were not intubated at admission between July 2013 and July 2015.
RESULTS
RESULTS
Of the 974 study patients, 788 were included in the analysis of intubation predictors. EA was used in 130 (16.5%) patients, and 65 (8.2%) patients required IMV. Factors independently associated with IMV were chronic respiratory disease (P = 0.008), worse SAPS II (P < 0.0001), flail chest (P = 0.02), worse Injury Severity Score (P = 0.0003), higher respiratory rate at admission (P = 0.02), alcohol withdrawal syndrome (P < 0.001), and noninvasive ventilation (P = 0.04). EA was not associated with decreases in IMV requirements, median numerical rating scale pain score, or intravenous morphine requirements from day 1 to day 7.
CONCLUSIONS
CONCLUSIONS
EA was not associated with a lower risk of IMV in chest trauma patients with at least 3 fractured ribs, moderate pain, and no intubation on admission. Further studies are needed to clarify the optimal pain control strategy in chest trauma patients admitted to the ICU, notably those with severe pain or high opioid requirements.
Identifiants
pubmed: 32852675
doi: 10.1186/s13613-020-00733-0
pii: 10.1186/s13613-020-00733-0
pmc: PMC7450151
doi:
Types de publication
Journal Article
Langues
eng
Pagination
116Références
Thorax. 2020 Sep;75(9):805-807
pubmed: 32522764
Surgery. 2004 Aug;136(2):426-30
pubmed: 15300210
J Trauma. 2000 Jun;48(6):1040-6; discussion 1046-7
pubmed: 10866248
Reg Anesth Pain Med. 2018 Apr;43(3):225-262
pubmed: 29278603
Anesth Analg. 2017 Jun;124(6):1906-1911
pubmed: 28525509
Am Surg. 2015 Oct;81(10):950-4
pubmed: 26463287
Injury. 2012 Oct;43(10):1667-71
pubmed: 22704784
JAMA. 1993 Dec 22-29;270(24):2957-63
pubmed: 8254858
Can J Anaesth. 2009 Mar;56(3):230-42
pubmed: 19247744
J Trauma. 1999 Sep;47(3):564-7
pubmed: 10498316
PLoS One. 2017 Oct 19;12(10):e0186712
pubmed: 29049422
Chest. 2007 Aug;132(2):410-7
pubmed: 17573487
Scand J Trauma Resusc Emerg Med. 2014 Sep 03;22:52
pubmed: 25204466
Anaesthesia. 1999 Oct;54(10):990-4
pubmed: 10540066
Am J Surg. 2005 Mar;189(3):327-30
pubmed: 15792761
World J Surg. 2020 Jul;44(7):2243-2254
pubmed: 32179975
J Trauma Acute Care Surg. 2014 Feb;76(2):462-8
pubmed: 24458051
J Trauma. 1991 Apr;31(4):443-9; discussion 449-51
pubmed: 1902264
J Trauma. 1990 Jul;30(7):799-804; discussion 804-5
pubmed: 2380997
Anaesth Crit Care Pain Med. 2019 Jun;38(3):265-276
pubmed: 30342102
Intensive Care Med. 1996 Apr;22(4):286-93
pubmed: 8708164
Injury. 2016 Jan;47(1):147-53
pubmed: 26358517
Acta Anaesthesiol Scand. 2015 Jul;59(6):698-709
pubmed: 25683770
Medicine (Baltimore). 2016 Jan;95(2):e2374
pubmed: 26765412
Eur J Trauma Emerg Surg. 2019 Aug;45(4):597-622
pubmed: 29411048
Crit Care Med. 2006 Jun;34(6):1642-6
pubmed: 16625122
Chest. 1990 Apr;97(4):943-8
pubmed: 2182301
Surgery. 2014 Oct;156(4):988-93
pubmed: 25239357
J Trauma Acute Care Surg. 2016 Sep;81(3):463-7
pubmed: 27270854
Am J Crit Care. 2001 Sep;10(5):320-7; quiz 328-9
pubmed: 11548565
Anaesth Crit Care Pain Med. 2017 Apr;36(2):135-145
pubmed: 28096063
J Trauma. 2005 Nov;59(5):1256-67
pubmed: 16385313
J Trauma. 1994 Dec;37(6):975-9
pubmed: 7996614
Ann Adv Automot Med. 2011;55:255-65
pubmed: 22105401
Br J Anaesth. 2017 Mar 1;118(3):474-475
pubmed: 28203765
Ann Intensive Care. 2019 Jun 13;9(1):69
pubmed: 31197492
J Trauma Acute Care Surg. 2016 Nov;81(5):936-951
pubmed: 27533913
Reg Anesth. 1989 Jan-Feb;14(1):43-7
pubmed: 2486586
J Trauma. 1994 Jun;36(6):865-9; discussion 869-70
pubmed: 8015010
Acta Anaesthesiol Scand. 1998 Jul;42(6):614-20
pubmed: 9689264
J Trauma Acute Care Surg. 2014 Jan;76(1):39-45; discussion 45-6
pubmed: 24368355
Injury. 2012 Jan;43(1):8-17
pubmed: 21256488
Surgery. 2005 Oct;138(4):717-23; discussion 723-5
pubmed: 16269301
Crit Care. 2014 May 14;18(3):R98
pubmed: 24887537
Ann Surg. 1999 May;229(5):684-91; discussion 691-2
pubmed: 10235527