Abstract
BackgroundThe incidence of severe respiratory complications in patients with pelvis fractures needing intensive care have not previously been studied. Therefore, the aims of this registry study were to 1) determine the number of ICU patients with pelvis fractures who had severe respiratory complications 2) whether the surgical intervention in these patients is associated with the pulmonary condition and 3) whether there is an association between lung complications and mortality. We hypothesized that acute hypoxic failure (AHF) and acute respiratory distress syndrome (ARDS) 1) are common in ICU treated patients with pelvis fractures, 2) are not related to the reconstructive surgery, or to 3) to mortality.MethodsAll patients in the database cohort (n = 112), scheduled for surgical stabilization of pelvis ring and/or acetabulum fractures, admitted to the general ICU at Uppsala University Hospital between 2007 and 2014 for intensive care were included.ResultsThe incidence of AHF/ARDS was 67 % (75/112 patients), i.e., the percentage of patients that at any period during the ICU stay fulfilled the AHF/ARDS criteria. The incidence of AHF was 44 % and incidence of ARDS was 23 %. The patients with AHF/ARDS had more lung contusions and pneumonia than the patients without AHF/ARDS. Overall, there were no significant changes in oxygenation variables associated with surgery. However, 23 patients with pre-operative normal lung status developed AHF/ARDS in relation to the surgical procedure, whereas 12 patients with AHF/ARDS normalized their lung condition. The patients who developed AHF/ARDS had a higher incidence of lung contusion (P = 0.04) and the surgical stabilization was performed earlier (5 versus 10 days) in these patients (P = 0.03).ConclusionsWe found that the incidence of respiratory failure in ICU treated patients with pelvis fractures was high, that the procedure around surgical stabilization seems to be associated with a worsening in the respiratory function in patients with lung contusion, and that mortality was low and was probably not related to the respiratory condition.Trial registrationStudy was registered at ISRCTN.org number, ISRCTN10335587.
Highlights
The incidence of severe respiratory complications in patients with pelvis fractures needing intensive care have not previously been studied
The prespecified aims of this registry study were to 1) assess the incidence of severe respiratory complications, i.e., acute respiratory distress syndrome (ARDS) or severe hypoxemic failure (AHF, as defined as ARDS without radiological criteria or when no radiologic examination was performed) in patients with pelvis fractures in our intensive care unit (ICU), 2) whether the surgical intervention in these patients is associated with worsening of the pulmonary condition and 3) whether the lung complications is associated with mortality
acute hypoxic failure (AHF)/ARDS The total incidence of AHF/ARDS was 67 % (75/112 patients), i.e., the percentage of patients that at any period during the ICU stay fulfilled the AHF/ARDS criteria, and the allocation to the two groups was done according to the analyses of the chest images
Summary
The incidence of severe respiratory complications in patients with pelvis fractures needing intensive care have not previously been studied. The aims of this registry study were to 1) determine the number of ICU patients with pelvis fractures who had severe respiratory complications 2) whether the surgical intervention in these patients is associated with the pulmonary condition and 3) whether there is an association between lung complications and mortality. The prespecified aims of this registry study were to 1) assess the incidence of severe respiratory complications, i.e., ARDS or severe hypoxemic failure (AHF, as defined as ARDS without radiological criteria or when no radiologic examination was performed) in patients with pelvis fractures in our ICU (the hospital is a referral center for pelvis fractures), 2) whether the surgical intervention in these patients is associated with worsening of the pulmonary condition and 3) whether the lung complications is associated with mortality. The hypotheses were that ARDS/AHF 1) is common in ICU treated patients with pelvis fractures, 2) will not be related to surgical stabilization, or 3) to mortality
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