Predictive Factors of Ventilatory Support in Chest Trauma.

Silvia Fattori,Stefania Cimbanassi,Elisa Reitano,Osvaldo Chiara

doi:10.3390/life11111154

Abstract

This study aims to define possible predictors of the need of invasive and non-invasive ventilatory support, in addition to predictors of mortality in patients with severe thoracic trauma. Data from 832 patients admitted to our trauma center were collected from 2010 to 2017 and retrospectively analyzed. Demographic data, type of respiratory assistance, chest injuries, trauma scores and outcome were considered. Univariate analysis was performed, and binary logistic regression was applied to significant data. The injury severity score (ISS) and the revised trauma score (RTS) were both found to be predictive factors for invasive ventilation. Multivariate analysis of the anatomical injuries revealed that the association of high-severity thoracic injuries with trauma in other districts is an indicator of the need for orotracheal intubation. From the analysis of physiological parameters, values of systolic blood pressure, lactate, and Glasgow coma scale (GCS) score indicate the need for invasive ventilatory support. Predictive factors for non-invasive ventilation include: RTS, ISS, number of rib fractures and presence of hemothorax. Risk factors for death were: age over 65, the presence of bilateral rib fractures, pulmonary contusion, hemothorax and associated head trauma. In conclusion, the need for invasive ventilatory support in thoracic trauma is associated to the patient’s systemic severity. Non-invasive ventilation is a supportive treatment indicated in physiologically stable patients regardless of the severity of thoracic injury.

Highlights

Trauma represents one of the most important causes of mortality and morbidity worldwide [1,2]
The following results emerged from the study: Thoracic trauma is associated with the need for invasive ventilatory support in 40.30% and for non-invasive ventilatory support in 21.70%
Thoracic trauma is associated with the need for invasive ventilatory support rather than with local alterations, due to systemic clinical severity

Summary

Introduction

Trauma represents one of the most important causes of mortality and morbidity worldwide [1,2]. As a consequence of these alterations hemorrhage, extravasation of fluid from the vascular bed and pulmonary destruction occur. These events associated with increased alveolar secretions and airways colonization promote alveolar collapse, ventilation-perfusion shunt, consolidation, and pneumonia, all leading to hypoxemia and acute respiratory disease [6,7]. These complications are associated with the development of acute lung failure in up to 20% patients with thoracic trauma [4]

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Discussion

Conclusion