Chronic critical illness after trauma injury: outcomes and experience in a trauma center

Abstract

Objective To determine the prevalence, risk factors and functional results of chronic critical illness (CCI) in polytrauma patients. Design Single-center observational retrospective study Setting ICU at a tertiary hospital in Santander, Spain, between 2015 and 2019. Patients Adult trauma patients who survived beyond 48 h after injury. CCI was defined as the need for mechanical ventilation for at least 14 days or tracheostomy for difficult weaning. Measurements and main results About 62/575 developed CCI. These patients were characterized by higher ISS score [17 (SD 10) vs. 13.8 (SD 8.2); p < 0.001] and higher NISS (26 (SD 11) vs. 19.2 (SD 10.5); p = 0.001). CCI group had greater proportion of hospital-acquired infections (100% vs. 18.1%; p < 0.001), and acute kidney failure (33.9% vs. 22.8% p < 0.001). During the first 24 h of admission, CCI group required in a greater proportion surgical intervention (50% vs. 29%; p = 0.001), and blood products (31.3% vs. 20.5%; p < 0.047). Hospital ward stay was longer in CCI patients [9.5 days (IQR 5–16.9) vs. 43.9 (IQR 30.3–53) p < 0.001]. The CCI mortality was higher (19.5% vs. 8.1%; p = 0.004). Surgical intervention in the first 24 h (OR 2.5 95% CI 1.1–4.1), age (> 55 years) (OR 2.1 95%CI 1.1–4.2), ISS score (OR 1.1 95%CI 1.02–1.3), GCS score (OR 0.8 95%CI 0.4–23.2) and multiple organ failure (OR 9.5 95%CI 3.9–23.2) were predictors of CCI in the multivariate analysis. Conclusions CCI after severe trauma appears in a considerable proportion of patients. Early identification and implementation of specific interventions could change the evolution of this process.