Predictive factors of nebulized morphine failure in North-African patients with chest trauma: a prospective pilot study

Abstract

ABSTRACT Objective To determine the predictive factors of nebulized morphine (nMOR) failure in patients with chest trauma. Research design and methods This was an interventional clinical study. Patients admitted with isolated chest trauma with a pain visual analog score > 4 were included. Each patient received 10 mg nMOR. If pain was still > 4 after 10 minutes of nebulization, the latter was repeated every 10 minutes until pain was relieved (i.e. ≤ 4). If pain was > 4 at 30 minutes, nMOR was considered a failure. Patients were divided into two groups: MOR (+) and MOR (-) (good response to and nMOR failure, respectively). Results Seventy-five patients were included. Analysis of the risk factors revealed that road traffic accidents (relative risk (RR): 0.117 [0.031–0.443]; p = 0.002), number of fractured ribs > 4 (RR: 0.317 [0.092–0.543]; p = 0.006), bilateral injury (RR: 0.114 [0.037–0.349]; p < 0.001), flail chest (RR: 0.120 [0.037–0.386]; p < 0.001), hemothorax (RR: 0.203 [0.062–0.660]; p = 0.008), pulmonary contusion (RR: 0.202 [0.069–0.589]; p = 0.003), and pain at admission > 7 (RR: 0.363 [0.147–0.579]; p = 0.004) were predictors of nMOR failure. Conclusion Our results can help optimize the analgesic management of chest trauma patients by identifying the most eligible patients to benefit from nMOR. Clinical trial registration www.clinicaltrials.gov identifier is NCT03580187.