Abstract
BackgroundThe incidence of pulmonary failure in trauma patients is considered to be influenced by several factors such as liver injury. We intended to assess the association of various potential predictors of pulmonary failure following thoracic trauma and liver injury.MethodsRecords of 12,585 trauma patients documented in the TraumaRegister DGU® of the German Trauma Society were analyzed regarding the potential impact of concomitant liver injury on the incidence of pulmonary failure using uni- and multivariate analyses. Pulmonary failure was defined as pulmonary failure of ≥ 3 SOFA-score points for at least two days. Patients were subdivided according to their injury pattern into four groups: group 1: AIS thorax < 3; AIS liver < 3; group 2: AIS thorax ≥ 3; AIS liver < 3; group 3: AIS thorax < 3; AIS liver ≥ 3 and group 4: AIS thorax ≥ 3; AIS liver ≥ 3.ResultsOverall, 2643 (21%) developed pulmonary failure, 12% (n= 642) in group 1, 26% (n= 697) in group 2, 16% (n= 30) in group 3, and 36% (n= 188) in group 4. Factors independently associated with pulmonary failure included relevant lung injury, pre-existing medical conditions (PMC), sex, transfusion of more than 10 units of packed red blood cells (PRBC), Glasgow Coma Scale (GCS) ≤ 8, and the ISS. However, liver injury was not associated with an increased risk of pulmonary failure following severe trauma in our setting.ConclusionsSpecific factors, but not liver injury, were associated with an increased risk of pulmonary failure following trauma. Trauma surgeons should be aware of these factors for optimized intensive care treatment.
Highlights
The incidence of pulmonary failure in trauma patients is considered to be influenced by several factors such as liver injury
TraumaRegister DGU® of the German Trauma Society (TR-DGU) The TraumaRegister DGU® of the German Trauma Society is a multi-center database, where severely injured patients are prospectively documented at standardized time points: (1) pre-hospital phase: mechanism of injury, initial physiology, first therapy, neurological signs, prehospital time; (2) emergency room (ER): physiology, laboratory findings, suspected pattern of injury, therapy, time sequence of diagnostics; (3) intensive care unit (ICU): status on admission, organ failure, sepsis, duration of ventilation; and (4) final outcome: hospital stay, survival, complete list of injuries including anatomic injury assessment using the Injury Severity Score (ISS) [10], operative procedures, and pre-existing medical conditions (PMCs)
The largest proportion of patients who developed pulmonary failure was found in group 4 (36%; n = 188)
Summary
The incidence of pulmonary failure in trauma patients is considered to be influenced by several factors such as liver injury. Patients were subdivided according to their injury pattern into four groups: group 1: AIS thorax < 3; AIS liver < 3; group 2: AIS thorax ≥ 3; AIS liver < 3; group 3: AIS thorax < 3; AIS liver ≥ 3 and group 4: AIS thorax ≥ 3; AIS liver ≥ 3 Several factors such as age [1], base excess [2], number of units of fresh frozen plasma (FFP) transfused [3] and Injury Severity Score (ISS) [4] have been identified as predictors for pulmonary failure in trauma patients. We intended to analyze risk factors for the development of pulmonary failure in severely injured trauma patients
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