Early predictors of prolonged mechanical ventilation in major torso trauma patients who require resuscitation

Abstract

Background The study purpose was to identify early predictors of prolonged mechanical ventilation in major torso trauma patients. Methods This was a retrospective review of torso trauma patients who met specific criteria for shock resuscitation and required 48 hours of mechanical ventilation. Independent variables evaluated included patient demographics, injury characteristics, and initial 24-hour resuscitation parameters. Univariate and multivariate logistic regression analyses were performed using a significance level of P <.05. Results Over 59 months, 224 patients met study criteria. Age was 34 years (range 25 to 69), 68% were male, 78% sustained blunt trauma, and injury severity score was 27 (range 18 to 38). Thirty-three percent required prolonged mechanical ventilation. In the analysis, predictors of prolonged mechanical ventilation included total fluid resuscitation, facial trauma, age, positive end-expiratory pressure ≥10 mm Hg on admission, arterial partial pressure of oxygen divided by the fraction of inspired oxygen ratio less than 300 at 24 hours, and chest abbreviated injury scale score. Conclusions The need for prolonged mechanical ventilation can be accurately predicted and these predictors may assist clinicians in resource allocation and patient management decisions.