Chronic critical illness in polytrauma. Results of the Spanish trauma in ICU registry.

Abstract

Chronic critical illness after trauma injury has not been fully evaluated, and there is little evidence in this regard. We aim to describe the prevalence and risk factors of chronic critical illness (CCI) in trauma patients admitted to the intensive care unit. Retrospective observational multicenter study (Spanish Registry of Trauma in ICU (RETRAUCI)). Period March 2015 to December 2019. Trauma patients admitted to the ICU, who survived the first 48h, were included. Chronic critical illness (CCI) was considered as the need for mechanical ventilation for a period greater than 14days and/or placement of a tracheostomy. The main outcomes measures were prevalence and risk factors of CCI after trauma. 1290/9213 (14%) patients developed CCI. These patients were older (51.2±19.4 vs 49±18.9); p<.01) and predominantly male (79.9%). They presented a higher proportion of infectious complications (81.3% vs 12.7%; p<.01) and multiple organ dysfunction syndrome (MODS) (27.02% vs 5.19%; p<.01). CCI patients required longer stays in the ICU and had higher ICU and overall in-hospital mortality. Age, injury severity score, head injury, infectious complications, and development of MODS were independent predictors of CCI. CCI in trauma is a prevalent entity in our series. Early identification could facilitate specific interventions to change the trajectory of this process.