Trauma Intensive Care Unit Research Articles

Functional outcomes of patients in the medical and trauma critical care units using the chelsea critical care physical assessment tool

Abstract Background Outcome measures in clinical practice assist in establishing progress for effective quality of care. Physiotherapists in the intensive care unit (ICU) promote lung function and facilitate early mobilization to prevent ICU-related complications. Objectives To determine the physical functional outcomes in critically ill patients in the trauma and medical critical care units at three hospitals in the Tshwane District. Method This was a quantitative prospective observational cohort study. Adult patients admitted in the trauma, medical ICU, and high care (HC) units were recruited. Ethical clearance was obtained from the [Masked for blind review], the National Department of Health Research (NHRD), and the Chief Executive Officers (CEOs) of the hospitals. Written consent was obtained from the recruited patients. Assessments were done on Mondays, Wednesdays, and Fridays using the Chelsea Critical Care Physical Assessment (CPAx) Tool until discharge from the units. Data were analyzed using SPSS version 28. Results Functional outcomes that improved quicker were respiratory function, cough reflex, rolling in the bed, and grip strength. An increase in CPAx scores correlated with improvement in the Glasgow coma scale (GCS) in both groups. Median and inter-quartile CPAx scores in the medical ICU for the initial assessments were 3(2–8) with an increase to 8(3.75–28.25) in the final assessment (p = 0.003). The median and interquartile CPAxs scores for initial assessments in the trauma ICU were 2(1–11.75) and 5(3.25–14) for the final assessments, with a p-value of 0.005 which showed statistical significance. Conclusion CPAx mean scores in the trauma ICU were higher than in the medical ICU. There were significant positive changes in the scoring of both populations but this was slightly better in the trauma ICU. Using the CPAx tool in a HC setting seemed feasible and patients showed higher scores compared to both trauma and medical ICU. Clinical implications The CPAX tool assists in the development of rehabilitation goals in the ICU and HC by physiotherapists. The tool can be adapted in the medical and trauma critical care units to assess functional outcomes. Trial registration Pan African Clinical Trials Registry, PACTR202305860988637, Registered 7 May 2023-Retrospectively registered, https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=25542.

Early Adequate Nutrition in ICU is Associated with Survival Gain : Retrospective Cohort Study in Patient with Traumatic Brain Injury.

Patients with traumatic brain injury (TBI) commonly exhibit a poor mental health status and can easily develop aspiration pneumonia. Thus, early proper nutrition through oral or tube feeding is difficult to achieve, leading to malnutrition. However, evidence regarding early nutritional support in the intensive care unit (ICU) is lacking. We aimed to assess the effect of early nutrition in patients with TBI admitted to the ICU. Data of adult patients with TBI admitted to the trauma ICU of a regional trauma center in Korea between 2022 and 2023 were retrospectively analyzed. Those with ICU stay <7 days, younger than 18 years, and with underlying diseases that could alter baseline metabolism, were excluded. Nutritional support on day 4 of ICU admission was measured. The patients were classified into mortality and survival groups, and risk factors for mortality were evaluated. Subgroup analyses were performed based on TBI severity. Overall, 864 patients were diagnosed with acute TBI, of whom 227 were included in this study. The mortality rate in the study population was 15% (n=34). Those in the survival group were younger, had longer hospital stays, had a higher initial Glasglow Coma Scale (GCS) score, and had a higher intake of calorie supplements than those in the mortality group. In a subgroup analysis of patients with non-severe TBI (GCS>8), total calorie intake (751.4 vs 434.2 kcal, p=0.029), total protein intake (37.5 vs. 22.1 g, p=0.045), and ratio of supplied to target calories (0.49 vs 0.30, p=0.047) were higher in the survival group than in the mortality group. Logistic regression analysis revealed that calorie intake (B=-0.002, p=0.040) and initial hemoglobin level (B=-0.394, p=0.005) were risk factors for mortality in patients with non-severe TBI. More calories were supplied to the survival group than the mortality group among patients with TBI. Additionally, logistic regression analysis showed that increased calorie supply was associated with reduced mortality in patients with non-severe TBI. The mortality group had low protein intake; however, this did not emerge as a risk factor for mortality. Early sufficient nutritional support improves the prognosis of patients with TBI.

Predicting Unplanned Trauma ICU Admissions for Initial Nonoperative, Non-ICU Patients.

Unplanned intensive care unit (ICU) admissions are associated with increased morbidity and mortality. This study uses interpretable machine learning to predict unplanned ICU admissions for initial nonoperative trauma patients admitted to non-ICU locations. TQIP (2020-2021) was queried for initial nonoperative adult patients admitted to non-ICU locations. Univariable analysis compared patients who required an unplanned ICU admission to those who did not. Using variables that could be known at hospital admission, gradient boosting machines (CatBoost, LightGBM, XGBoost) were trained on 2021 data and tested on 2020 data. SHapley Additive exPlanations (SHAP) were used for interpretation. The cohort had 1,107,822 patients; 1.6% had an unplanned ICU admission. Unplanned ICU admissions were older (71 [58-80] vs. 61 [39-76] years, p < 0.01), had a higher Injury Severity Score (ISS) (9 [8-13] vs. 9 [4-10], p < 0.01), longer length of stay (11 [7-17] vs. 4 [3-6] days, p < 0.01), higher rates of all complications and most comorbidities and injuries (p < 0.05). All models had an AUC of 0.78 and an F1 score of 0.12, indicating poor performance in predicting the minority class. Mean absolute SHAP values revealed ISS (0.46), age (0.29), and absence of comorbidities (0.16) as most influential in predictions. Dependency plots showed greater SHAP values for greater ISS, age, and presence of comorbidities. Machine learning may outperform prior attempts at predicting the risk of unplanned ICU admissions in trauma patients while identifying unique predictors. Despite this progress, further research is needed to improve predictive performance by addressing class imbalance limitations.

Evaluation of Plasma-Lyte Versus Lactated Ringer's in Surgical Intensive Care Unit Trauma Patients as Fluid Resuscitation.

In critically ill patients, fluid resuscitation with balanced crystalloids close to plasma osmolarity have a lower risk of electrolyte imbalances and demonstrated better clinical outcomes compared to normal saline (NS). While lactated ringer's (LR) has shown benefit over NS, plasma-lyte (PL) with a higher osmolarity and different electrolyte formulation is hypothesized to be superior. We performed a retrospective observational cohort study over 37 months at a tertiary hospital. Inclusion criteria were hospitalization in the surgical intensive care unit (SICU), trauma indication, ≥18 years old, and received either PL or LR. All PL administrations and every fifth patient with LR as resuscitation were included in order to match the sample size in each group. Primary outcomes were SICU length of stay (LOS), hospital LOS, and mortality. Secondary outcomes were biomarker changes from baseline. There were 113 patients in both PL and LR groups. The PL arm had higher APACHE II scores (16 vs 13, P = .033) and were more likely ventilated (39.3% vs 20.4%, P = .002) compared to LR. Median hospital LOS (12.0 vs 8.0, P < .001) and SICU LOS (6.0 vs 3.0, P < .001) are significantly longer in PL group compared to the LR group. However, there was no difference in in-hospital mortality (5.3% vs 3.5% P = .519) and SICU mortality (9.7% vs 5.3%, P > .208) between PL and LR. Overall, PL use was associated with prolonged hospital and SICU LOS. PL use did not demonstrate mortality benefit. However, patients were more critically ill in PL group based on higher APACHE II scores and higher rates of mechanical ventilation, which could be contributing to these unfavorable outcomes.

Management of non-vascular injuries in patients admitted in trauma ICU secondary to polytrauma with major vascular injury – Institutional experience

BackgroundVascular injuries are associated with high morbidity and mortality. The management is exceedingly demanding and requires involvement of senior clinician. There are known complications associated with vascular injury ranging from limb loss, stroke, and death. There are limited studies examining other injuries that are associated with vascular trauma. This study aimed to review the pattern, management and outcomes of the other injuries associated with vascular injuries. MethodA retrospective cross-sectional study chart review of patients with vascular trauma requiring ICU admission between January 2013 and December 2021. Additional data was prospectively collected from January 2022 to December 2022. All patients admitted to trauma ICU with polytrauma including a vascular injury were reviewed, except patients who died prior the confirmation of vascular injury. The injury was either confirmed by imaging or via exploration. The non-vascular injuries were identified. The pattern, management and outcomes were documented. A pre-designed data proforma was used identifying injury type, management strategy, and outcomes. ResultsOut of 2805 patients that were admitted in trauma ICU from 2013 to 2022, 153 (5 %) patients had vascular injuries. There were 154 documented vascular injuries and 212 associated injuries. This study found that fractures are the most common injuries to be associated with vascular injury ConclusionThe nature of vascular injury and delay to intervention determines outcome of patients, however associated injuries also play an important role in affecting outcomes. The presence of associated injury encourages the multi-disciplinary approach to optimise outcomes.

Nutritional adequacy in ICU trauma patients

Nutritional adequacy in ICU trauma patients

Incidence of Multi-Drug Resistant Organisms in Trauma and Surgical Intensive Care Units at Beni-Suef University Hospital: A Comparative Analysis

Incidence of Multi-Drug Resistant Organisms in Trauma and Surgical Intensive Care Units at Beni-Suef University Hospital: A Comparative Analysis

Evaluation of the Geriatric Trauma Outcome Score (GTOS) as a Prognostic Tool in Intensive Care Unit Trauma Patients.

Existing prognostic scoring systems for intensive care unit (ICU) trauma patients require extensive data collection. The Geriatric Trauma Outcome Score (GTOS), which is based on age, injury severity, and transfusion need, has been validated for predicting mortality in elderly patients with trauma; however, its utility in the general ICU trauma population remains unexplored. This retrospective study included 2952 adult ICU trauma patients admitted between 2016 and 2021. The GTOS was calculated as follows: age + (Injury Severity Score × 2.5) + 22 (if transfused within 24 h). The area under the receiver operating characteristic curve (AUROC) was used to assess GTOS's ability to predict mortality. The optimal GTOS cutoff was determined using Youden's index. Mortality rates were compared between the high and low GTOS groups, including a propensity score-matched analysis adjusted for baseline characteristics. This study included 2952 ICU trauma patients, with an overall mortality rate of 11.0% (n = 325). GTOS demonstrated good predictive accuracy for mortality (AUROC 0.80). The optimal cutoff was 121.8 (sensitivity, 0.791; specificity, 0.685). Despite adjustments, patients with GTOS ≥ 121.8 had significantly higher mortality (17.4% vs. 6.2%, p < 0.001) and longer hospital stays (20.3 vs. 15.3 days, p < 0.001) compared to GTOS < 121.8. GTOS showed a reasonable ability to predict mortality in ICU trauma patients across all ages, although not as accurately as more complex ICU-specific models. With its simplicity, the GTOS may serve as a rapid screening tool for risk stratification in acute ICU trauma settings when combined with other data.

Clinical vs. autopsy diagnostic discrepancies in the intensive care unit: a systematic review and meta-analysis of autopsy series.

The aim of this study was to assess whether there is a discrepancy between clinical and autopsy-based diagnoses in adult intensive care unit (ICU) patients. We conducted a systematic review of cohort studies reporting on conventional autopsy-confirmed missed diagnoses. The discrepancy rate was per study calculated by dividing the number of patients with a missed diagnosis by the number of autopsies. Missed diagnoses were classified according to the Goldman classification as 'major' and 'minor' with major missed diagnoses further differentiated into Class I missed diagnoses (i.e., diagnoses that may have altered therapy or survival) and Class II missed diagnoses (i.e., diagnoses that would not have altered therapy or survival). Class I missed diagnoses constitute the primary outcome of interest. Pooled estimates for discrepancy rates (95% confidence intervals) were calculated using a mixed-effects logistic regression model with 'study' as random effect. Meta-regression was used to assess relationships between major discrepancy rates and autopsy rates, start year of study, and ICU type. Forty-two studies were identified totaling 6305 analyzed autopsies and 1759 patients with missed diagnoses. The pooled discrepancy rates for Class I and major missed diagnoses were 6.5% (5-8.5) and 19.3% (15.3-24), respectively. Meta-regression analysis revealed that autopsy rate was inversely associated with discrepancy rate. Class I discrepancy rates did not change over time. Burn and trauma ICUs had lower discrepancy rates as compared to medical ICUs, possibly because of higher autopsy rates. Missed diagnoses remain common in ICUs. A higher autopsy rate does not reveal more major diagnostic errors. These data support a clinically driven autopsy policy rather than a systematic autopsy policy.

Early Recognition of Drug-Induced Febrile Neutropenia Leads to an Improved Outcome in the Trauma Intensive Care Unit: A Case Report

AbstractTraumatic brain injury necessitates the use of antiepileptics for seizure prophylaxis, which are associated with multiple side effects including neutropenia, which may be dose dependent or idiosyncratic. We report the case of a young male with traumatic brain injury who developed febrile neutropenia, likely secondary to antiepileptic use. Early recognition and stopping of the drugs with use of granulocyte colony-stimulating factor led to the successful management of the patient.

Geriatric Trauma Intensive Care Unit Admission Guideline Is Associated With Reduction in Unplanned Intensive Care Unit Admissions

IntroductionGeriatric trauma patients experience disproportionate adverse outcomes compared to younger patients with similar injuries and represent an important target for quality improvement. Our institution created a Geriatric Trauma Intensive Care Unit (ICU) Admission Guideline to identify high-risk patients and elevate their initial level of care. The goal of implementation was reducing unplanned ICU admissions (UIAs), a recognized surrogate marker for adverse outcomes. MethodsThe Geriatric Trauma ICU Admission Guideline was implemented on July 1, 2020, at a large academic level-1 trauma center. Using trauma registry data, we retrospectively analyzed geriatric patients who met the criteria for ICU admission 2 y preimplementation and postimplementation. The main outcome was UIAs in the target geriatric population. Secondary outcomes included hospital length of stay, ICU length of stay, ventilator days, mortality, and 30-d readmissions. Characteristics between groups were compared with t-test, Mann-Whitney U test, or chi-square test. Risk-adjusted logistic and negative binomial regressions were used for the categorical and continuous outcomes, respectively. ResultsA total of 1075 patients were identified with 476 in the preimplementation and 599 in the postimplementation group. The groups were similar across most demographic and physiologic characteristics, with the exception of a higher incidence of hypertension in the preimplementation group (77.7% versus 71.6%, P = 0.02) and COVID in the postimplementation group (3.8% versus 0.4%, P < 0.001). While mechanism of injury was similar, there was a higher incidence of traumatic brain injury in the preimplementation group (35.1% versus 26.2%, P = 0.002). In the postimplementation group, there was a higher incidence ≥3 rib fractures (68% versus 61.3%, P = 0.02) and an expected increase in initial ICU level of care (69.5% versus 37.1%, P < 0.001). The odds of a UIA after guideline implementation were reduced by half (adjusted odds ratio 0.52, 95% confidence interval 0.3-0.92). There was not a significant difference in the secondary outcomes of mortality, 30-d readmission, hospital-free days, ICU-free days, or ventilator-free days. ConclusionsImplementation of the Geriatric Trauma ICU Admission Guideline was associated with a reduction in UIAs by half in the target population. There was not a significant change in hospital-free days, ICU-free days, ventilator-free days, mortality, 30-d readmission, or venous thromboembolism. Further research is needed to better refine admission guidelines, examine the association of preventative admission on delirium, and determination of criteria that would allow safe, earlier downgrade.

Innovate and renovate: Environmental intensive care unit design.

This article describes the reallocation of space and construction of a new adult shock trauma intensive care unit implementing methods to mitigate the environmental impact. The environmental burden was reduced through innovative reallocation of space and diversity of lighting sources. Circular economy principles were implemented which enabled much of the infrastructure materials to be reused. Collaboration among interdisciplinary health care teams, such as described in this article, helped to ensure expertise was shared so that the environmental impact was lessened. This article provides insight into innovative methods to mitigate the carbon footprint of a critical care renovation project.

Clinical Significance of the Control CT Rotterdam Score Compared With the Admission CT Rotterdam Score in Patients With Isolated Severe Traumatic Brain Injury in the Intensive Care Unit.

The Rotterdam scale is one of the most commonly used radiological scales for evaluating and predicting outcomes in traumatic brain injury (TBI) cases. Given the evolving nature of TBI, our study is designed to compare the Rotterdam score of computed tomography (CT) findings upon admission (Rotterdam score I) with the score after 72 hours (Rotterdam score II) of treatment in the trauma intensive care unit (ICU). A retrospective observational study was conducted on 54 patients who received intensive care treatment for isolated severe TBI over five years. We included severe TBI patients with no age restrictions who required admission to the ICU within 12 hours of the onset of trauma. An initial Rotterdam CT score was obtained via a CT head scan within four hours of the trauma, followed by a control CT head scan 72 hours after ICU admission. It was essential to have documentation on the clinical and laboratory treatment course and access to radiological CT diagnostics. Receiver operating characteristic (ROC) curves were employed in this study to evaluate the accuracy of diagnostic tests, such as the Rotterdam score. The ROC curves provided a graphical representation of the tests' diagnostic performance, which helped assess their effectiveness. There was a significant difference (p < 0.001) in the diagnostic scores of CT scans upon admission (Rotterdam score I) and control CT scans after 72 hours (Rotterdam score II) in the total sample. The Rotterdam score I was notably higher, 3.6 (±0.8), in patients requiring neurosurgical intervention compared to those who did not, 2.8 (±0.9), with significance (p = 0.003). The Rotterdam score I demonstrated a substantial predictive value for unfavorable outcomes (p = 0.048), as did the Rotterdam score II after the 72-hour mark (p = 0.006). The control Rotterdam score 72 hours after admission predicts mortality in isolated TBI patients more significantly than the Rotterdam score determined at the patient's admission to the intensive care unit.

Best Case/Worst Case-ICU: protocol for a multisite, stepped-wedge, randomised clinical trial of scenario planning to improve communication in the ICU in US trauma centres for older adults with serious injury

IntroductionPoor communication about serious injury in older adults can lead to treatment that is inconsistent with patient preferences, create conflict and strain healthcare resources. We developed a communication intervention called...

Sedation and analgesia in the trauma intensive care unit of Inkosi Albert Luthuli Central Hospital - the effect of anti-retroviral therapy: A retrospective chart analysis.

Adequate access to antiretrovirals (ARV) has improved the longevity and quality of life of people living with the human immunodeficiency virus(HIV). Antiretrovirals are known to cause multiple drug-drug interactions. It was noted clinically that patients on ARVs appeared to be more difficult to sedate. This begs the question of the clinical impact of these drug interactions, should clinicians adjust sedative dosages when managing patients on ARVs? This study aimed to investigate the presence of and measure the differences in sedation and analgesic utilisation between polytrauma patients on ARVs and those not on ARVs. This retrospective observational chart review included consecutive adult polytrauma patients admitted to the Trauma ICU IALCH between January 2016 and December 2019. HIV status and ARV use was documented. The total sedation per drug utilised at 24, 48 and 72-hour interval was calculated and tabulated accordingly. Drug utilisation was compared to ARV status. A total of 216 adult polytrauma patients were included in the study. A total of 44 patients were HIV positive and 172 were HIV negative. Of the HIV positive patients 41 (93.2%) were on ARVs. Multiple comparisons were confirmed, however the primary analysis compared HIV negative patients with HIV positive patients on ARV. Total morphine, ketamine, midazolam and propofol doses were all numerically greater in patients on ARVs, although none of these reached statistical significance. The use of morphine rescue boluses during the first 72h of ICU admission and the doses of ketamine and propofol on ICU day 3 were significantly greater in those on ARVs. The data analysis showed that patients on ARVs required higher doses of some analgesia and sedation in ICU and lower doses of midazolam. This needs to be considered when sedating patients in a setting with a high HIV prevalence.

Orthopedic pelvic and extremity injuries increase overall hospital length of stay but not in-hospital complications or mortality in trauma ICU patients: Orthopedic Injuries in Trauma ICU Patients

BackgroundThe purpose of this study was to compare the ICU length of stay (LOS), overall hospital LOS, in-hospital complications, and mortality rate between trauma ICU patients with orthopedic injuries versus those without. MethodsThis was a retrospective cohort study in which the trauma registry of a single level 1 trauma center was queried over a 6-year period for patients admitted to the ICU during hospitalization. Patients were stratified based on the presence/absence of an orthopedic fracture. Negative binomial regression was used to evaluate the effect of orthopedic injury on overall hospital and ICU LOS while controlling for confounding factors. Secondary outcomes included group differences with respect to in-hospital complications, mortality, and discharge disposition. ResultsA total of 1,785 trauma patients were admitted to the ICU and included. Among all trauma ICU patients, 61.1 % (n = 1,091) had no associated orthopedic injuries whereas 38.9 % (n = 694) had at least one. Patients with orthopedic injuries had higher odds of being severely injured (ISS ≥ 16: OR [CI] =1.47 [1.2–1.8]; p < 0.001) despite presenting with a higher level of consciousness than those without orthopedic injuries (mean GCS: 13.3 ± 3.5 vs 12.5 ± 4.1, p < 0.001). Multivariable models demonstrated having an orthopedic injury did not moderate ICU LOS (IRR [CI] = 0.93 [0.9–1.0]; p = 0.110) but did contribute significantly to increasing hospital LOS (IRR [CI] = 1.23 [1.1–1.3]; p < 0.001). There was no evidence to suggest that orthopedic injury increases the risk of in-hospital complication or in-hospital mortality. Orthopedically injured trauma ICU patients were less likely to be discharged home than those without orthopedic injuries. ConclusionsTrauma ICU patients with an associated orthopedic injury have significantly longer hospital stays compared to those without an orthopedic injury, despite no evidence to suggest that the orthopedic injury affects the duration of ICU stay or in-hospital complications. Level of evidenceIII, Retrospective cohort study

Evaluation of demographic, clinical characteristics and risk factors in patients with persistent hiccups due to traumatic brain injury: A trauma-ICU based study

Persistent hiccups in neurocritical care patients can lead to negative outcomes, including exhaustion, sleep deprivation, malnutrition, depression, and even death. This study aims to evaluate demographic and clinical characteristics, risk factors, and management in trauma intensive care unit patients. This study investigates persistent hiccups in traumatic brain injury (TBI) patients admitted to the Trauma ICU at Banaras Hindu University, Varanasi, from July 2020 to January 2024. The study involved monitoring and recording hiccups during patients' ICU stays. Exclusion criteria included not participating, having GERD, advanced cancer, spinal cord injury, other CNS pathologies, deranged liver and renal profile, or on drugs causing hiccups, on sedative and neuro-muscular blocking agents. The study involved 59.8% of patients aged &amp;#60;40 years, with a mean age of 41.75±17.16 years. Most patients were male, with a male-to-female ratio of 1.88:1. Road traffic accidents (RTAs) were present in 60.3% of patients, followed by falls from height (17.5%). 75.7% of patients had severe type TBI, while the remaining had moderate type TBI. Out of 189 patients, 86 (45.5%) died and 103 (54.5%) survived. Age was a significant factor in TBI-related persistent hiccups, with severe TBI significantly associated with female gender and ventilator-associated pneumonia and the need for mechanical ventilation. The type of TBI (moderate or severe) and length of ICU stay were also associated with TBI-related persistent hiccups. A strong relationship was observed between severe TBI patients who fall from height and were not responsive to drugs for hiccups compared to moderate TBI. The length of ICU stay was also associated with TBI-related persistent hiccups, with patients with a length of ICU stay of &amp;#62;14 days having a higher risk of hiccups.Severe TBI is linked to female gender, ventilator-associated pneumonia, and mechanical ventilation. The type of TBI and length of ICU stay are also linked to persistent hiccups. Patients with severe TBI who fell from height are less responsive to hiccup drugs. Patients with over 14 days of ICU stay have a higher risk of developing persistent hiccups.

Prognosis of major trauma in patients older than 85years admitted to the ICU, a registry-based study.

The aging population in France and Western Europe is on the rise, particularly among individuals aged 65years and older. Although older adults are susceptible to traumatic injuries, they constitute a minority of trauma center admissions especially those aged 85 and above. The aim of our study was to investigate the prognostic factors for mortality among the older old population (aged 85years and above) managed in ICU of Traumabase group trauma centers. This retrospective observational cohort study, conducted from 2013 to 2022, analyzed all severely injured older patients (aged ≥ 85years) managed in 14 ICU trauma centers enrolled in the Traumabase registry. The study examined sociodemographic, clinical, and outcome variables. Frailty was assessed using the Clinical Frailty Scale. Among the 365 older trauma patients, 190 (52.1%) were classified as non-frail (CFS 1-3), 80 (21.9%) as pre-frail (CFS 4,5), and 95 (26%) as frail (CFS 6-9). Falls were the most common mechanism of injury. High mortality rates were observed, with 43.5% ICU mortality and 45.5% mortality at day 30. Factors most associated with ICU mortality included traumatic brain injury (CGS < 13), pre-hospital micromethod hemoglobin < 13 and severity of injury (ISS > 16). Factors such as traumatic brain injury and severe hemorrhage (micromethod hemoglobin < 13) and ISS > 16 are associated with ICU mortality in in patients older than 85years trauma patient. Early geriatric intervention is crucial for optimizing outcomes in this vulnerable population.

Propofol administration for induction is associated with peri-intubation instability in trauma critical care unit patients

IntroductionPeri-intubation hypotension is associated with increased hospital length of stay and morbidity. Propofol is associated with alterations in hemodynamics. We hypothesize that using propofol for induction leads to peri-intubation hypotension in trauma critical care patients. MethodsPatients that underwent unplanned intubation in the trauma intensive care unit (TICU) were prospectively enrolled. Peri-intubation vitals and medications were recorded to assess hypotension within 10 ​min of intubation. Patients were divided into propofol (PROP) or other medication (OTR) groups. ResultsData was complete for 69 patients; 31 PROP and 38 OTR. In OTR there was an 8.8-point (−21.1, 3.6) SBP decrease (p ​= ​0.159) and in PROP there was a 30.8-point (−45.6, −16.0) SBP decrease (p ​= ​0.0002) with significant increases in heart rate (HR) and shock index (SI) (HR p ​= ​0.001, SI p ​< ​0.0001). ConclusionIn patients without hypotension prior to intubation, we observed a statistically significant drop in the patients’ SBP with use of propofol. In trauma critical care unit patients, we recommend considering an induction medication for unplanned intubation other than propofol.

Enhancing Mortality Probability Model II (MPM II) Predictive Accuracy with the Lethal Triad in ICU Trauma Patients

Abstract Introduction The Mortality Probability Model II (MPM II) is a well-recognized predictive tool in the intensive care unit (ICU) scoring system. The presence of a lethal triad, including hypothermia, acidosis, and coagulopathy, is associated with a worse outcome for trauma patients. This study aimed to assess whether integrating the lethal triad could enhance the MPM II predictive accuracy for trauma patients in the ICU. Methods The study conducted a retrospective analysis of adult trauma patients admitted to an ICU from January 1, 2016, to December 31, 2022, in a Level I trauma center in southern Taiwan. It assessed the impact of the lethal triad variables incorporated into MPM II scores using the area under the receiver operating characteristic curve (AUC of ROC). Results Of the 3,410 patients included, 257 had the lethal triad and 3,153 do not. The mortality rate was significantly higher in patients presenting the lethal triad than those without (46.7% vs. 8%, p &lt; 0.001). However, there was no significant improvement in predictive accuracy with both the MPM II with or without incorporating the variable of lethal triad having an area under the Receiver Operating Characteristic curve of 0.893. Conclusion While the lethal triad is important for understanding trauma-induced physiological changes, straight inclusion into MPM II has no substantial prognostic value. These findings indicate that the existing variables in the MPM II may already be indirectly capturing the impacts of the lethal triad, emphasizing the intricate interplay of physiological components in trauma patients. This underscores the importance of continued study in improving the prognostic modeling to ultimately predicting outcomes for trauma patients.