Trauma Intensive Care Unit Research Articles

High-protein delivery in mechanically ventilated patients: A study protocol for a randomized trial

Background: Critically ill patients are at risk of malnutrition; thus, optimal nutrition delivery is a key treatment for better outcomes. Inadequate energy and protein intake increase rate of hospital-acquired infection, duration of mechanical ventilation and mortality. However, there is no clear consensus regarding optimal protein dose in mechanically ventilated patients. In this study, we aim to compare between the effect of high and usual protein delivery on clinical outcomes in this patient group. Methods: This is a single-centered, open-labelled, parallel-group, randomized controlled study conducting in medical, surgical and trauma intensive care units (ICU) at a tertiary university hospital in Bangkok, Thailand. We plan to enroll 240 adult mechanically ventilated patients who are expected to require ventilator support for at least 3 days. The intervention group will be prescribed high protein dose (at least 1.5 g/kg/day) throughout ICU stay since day 4 until a maximum of 28 days, whereas the control group will be prescribed usual protein dose (1-1.3 g/kg/day). Nutrition is provided by enteral or parenteral route or both. The primary outcome is ventilator-free days at 28 days. The main secondary outcomes include the temporal change in muscle mass and SOFA score, rate of nosocomial infection and 28-day mortality. Conclusion: The robust evidence whether delivering high protein in critically ill patients improves outcome is lacking. This randomized trial will examine the consequence of high protein delivery in ICU population.

A case of mysterious ascites

A 69-year-old woman presented to our major trauma hospital after being involved in a motor vehicle accident. She had past medical history of renal transplant, insulin dependent diabetes mellitus and ischaemic heart disease. She was admitted to our trauma ICU for multi-system trauma including subarachnoid haemorrhage, spinal fractures, flail chest, liver lacerations and haemoperitoneum. She had multiple operations for her injuries including exploratory laparoscopy. Her condition deteriorated from day 35 of admission, and she was noted to have a large volume ascites which drained six litres of fluid.

Dynamics of immune responses are inconsistent when trauma patients are grouped by injury severity score and clinical outcomes

The injury severity score (ISS) is used in daily practice to evaluate the severity of trauma patients; however, the score is not always consistent with the prognosis. After injury, systemic inflammatory response syndrome (SIRS) and compensatory anti-inflammatory response syndrome (CARS) are related to the prognosis of trauma patients. We aimed to evaluate the associations between the immune response and prognosis in trauma patients. Patients who admitted to the Trauma Intensive Care Unit (ICU) were eligible. Whole blood samples were collected at admission, and then 6, 12, 24, 48 and 72 h after admission. Natural killer (NK) cells, lymphocyte subset population and cytokines release were identified using flow cytometry. We grouped patients by their ISS (≤ 25 and > 25 as very severe injury) and ICU stay (≤ 10 days as a short ICU stay and > 10 days as a long ICU stay) for evaluation. Fifty-three patients were enrolled. ICU stay but not ISS was close correlated with activity daily living (ADL) at discharge. Patients with a long ICU stay had an immediate increase in NK cells followed by lymphopenia which persisted for 48 h. Immediate activation of CD8+ T cells and then exhaustion with a higher programmed cell death-1 (PD-1) expression and suppression of CD4+ T cells with a shift to an anti-inflammatory Th2 phenotype were also observed in the patients with a long ICU stay. When the patients were grouped by ISS, the dynamics of immune responses were inconsistent to those when the patients were grouped by ICU stay. Immune responses are associated with the prognosis of trauma patients, however the currently used clinical parameters may not accurately reflect immune responses. Further investigations are needed to identify accurate predictors of prognosis in trauma patients.

Methicillin-Resistant Staphylococcus aureus Nasal Swab Is Insufficient to Withhold Empiric Methicillin-Resistant Staphylococcus aureus Pneumonia Coverage in a Trauma Population

IntroductionMethicillin-resistant staphylococcus aureus (MRSA) nasal colonization is a predictor of MRSA pneumonia in intensive care unit (ICU) patients. Negative nasal swabs have shown up to a 97% negative predictive value for MRSA pneumonia in nontrauma populations, though little investigation has been pursued in trauma patients. Materials and methodsAll trauma patients admitted to the ICU from April 2018 to February 2019 were screened for MRSA colonization by nasal swab. Patients with suspicion for pneumonia underwent bronchoalveolar lavage or quantitative sputum culture and were started on empiric antibiotic therapy based on the swab result. Swab-positive patients were started on empiric MRSA coverage and swab-negative patients were not. ResultsMRSA nasal swab screening was performed in 601 trauma ICU patients. Ninety-six patients subsequently underwent pneumonia workup and were started on an empiric antibiotic regimen based on nasal swab results. Seventeen (17.7%) patients were MRSA nasal swab positive on screening, and 22 (22.9%) patients subsequently had significant growth of MRSA on quantitative respiratory culture. The sensitivity of nasal swab was 50.0% and the specificity was 91.9%. Eleven patients had a negative MRSA nasal swab but a positive MRSA pneumonia (11.5%). Patients with inadequate antibiotic coverage had statistically longer hospital length of stay, ICU length of stay, ventilator days, and rates of unplanned intubation compared to patients with adequate antibiotic coverage. ConclusionsNasal swab screening was not sensitive enough in a trauma population with a high endemic incidence of MRSA colonization to warrant withholding empiric antibiotic MRSA coverage in patients with suspected pneumonia.

Improving the handover of complex trauma patients by implementing a standardised process

BackgroundPatient handover continues to be an international health priority in the prevention of patient harm. Transitioning patients from the intensive care unit (ICU) to the ward is complex, particularly for trauma patients, due to the multifaceted aspects of their care requirements as a result of multiple injuries and different speciality teams. Objectives/aimTo design, implement, and evaluate the efficacy of a standardised handover process and tool for the transfer of ICU trauma patients. MethodsA multimethod before/after study design was used. This included observations before and after an implemented transfer process and semistructured interviews with ICU and ward nurses caring for trauma patients. Comparisons were made of data before and after the intervention. ResultsEleven patient handovers were observed, and 21 nurses (11 from the ICU and 10 from the ward) were interviewed. Patients and family members were included during the handover following the intervention (n = 0/10 [0%] vs n = 4/11 [36%]) and the ward nurses were asked if they had any concerns (n = 5/10 [50%] vs n = 10/11 [91%]). Improvements in patient observations handed over were reported following the intervention. However, omissions remained in some key areas including patient introduction, patient identity, fluid balance, and allergies/alerts. Thematic analysis of interviews revealed that the new handover process was perceived advantageous by both ICU and ward nurses because of its structured and comprehensive approach. Identified future improvements included the need for hospital service managers to ensure integration of ICU and ward electronic health record systems. ConclusionPrecise, accurate, and complete handover remains a patient safety concern. Improvements were achieved using a standardised process and handover tool for the transfer of complex trauma patients. Further improvements are required to reduce the failure to hand over essential patient information.

Delirium in trauma ICUs: a review of incidence, risk factors, outcomes, and management.

This article reviews the impact and importance of delirium on patients admitted to the ICU after trauma, including the latest work on prevention and treatment of this condition. As the population ages, the incidence of geriatric trauma will continue to increase with a concomitant rise in the patient and healthcare costs of delirium in this population. Recent studies have further defined the risk factors for delirium in the trauma ICU patient population, as well as better demonstrated the poor outcomes associated with the diagnosis of delirium in these patients. Recent trials and meta-analysis offer some new evidence for the use of dexmedetomidine and quetiapine as preferred agents for prevention and treatment of delirium and add music interventions as a promising part of nonpharmacologic bundles. Trauma patients requiring admission to the ICU are at significant risk of developing delirium, an acute neuropsychiatric disorder associated with increased healthcare costs and worse outcomes including increased mortality. Ideal methods for prevention and treatment of delirium are not well established, especially in this population, but recent research helps to clarify optimal prevention and treatment strategies.

Control of Candida auris Septicemia in Patients of Trauma Intensive Care Unit in a Tertiary Care Hospital

Introduction: Candida auris is associated with nosocomial outbreaks in intensive care settings, and transmission despite the implementation of enhanced infection prevention and control (IPC) measures is a particular concern. Objective: Isolation and identification of C. auris from suspected cases of fungal septicemia and its surveillance. Materials and Methods: Blood culture samples of all suspected cases of fungal septicemia were taken from the trauma intensive care unit (TICU) of a tertiary care hospital in New Delhi between September 2019 and November 2019 as part of surveillance of device-associated infections. All the samples were obtained by central venous catheter line. Samples were processed in BacT/Alert automated blood culture system. Positive flagged bottles were further subcultured unto blood agar, MacConkey agar, and Sabouraud Dextrose Agar with and without cycloheximide and incubated at 37°C. All suspected Candida isolates were identified by conventional methods and the suspected C. auris isolates were further confirmed by matrix-assisted laser desorption time of flight. Results: Out of 24 suspected fungal septicemia cases from TICU, three patients had C. auris septicemia and all three isolates were resistant to fluconazole and voriconazole. Action Taken: IPC practices were reinforced as per the Centers for Disease Control and Prevention guidelines by the infection control team. Conclusion: This article depicts the emergence of multidrug-resistant C. auris and controlling its spread by appropriate infection control measures.

Developing a Trauma Intermediate Care Unit.

Trauma-specific nursing units are integral to providing quality trauma care. Yet, little has been published on intermediate care units for the trauma population. This article aims to describe one trauma center's journey to develop and implement a trauma intermediate care unit. The need for a trauma intermediate care unit was identified during the review of patient care at a Level II trauma center. An interdisciplinary team was created and met weekly for 6 months to plan the implementation of a trauma intermediate care unit. Education plans, training, equipment procurement, and staffing were evaluated throughout the process. Positive results were noted from the implementation of the intermediate care unit through the first year following implementation. The average length of stay for patients in the surgical trauma intensive care unit was reduced, resulting in cost savings for the organization. In addition, this collaborative work positively impacted patient safety, staff engagement, and finances. With leadership support, the proper key stakeholders, clear deliverables, and a well-defined development plan, the implementation of this intermediate care unit was successful.

Bacteriological profile of ventilator-associated pneumonia in trauma intensive care unit of a tertiary care hospital

Bacteriological profile of ventilator-associated pneumonia in trauma intensive care unit of a tertiary care hospital

Outbreak of extensively drug-resistant Serratia marcescens in an intensive care unit.

We present the investigation and control of an extensively drug-resistant Serratia marcescens outbreak in a 30-bed intensive care unit (ICU). Within 6 weeks, 4 critically ill trauma patients were infected by the same strain. Intensive containment measures limited the spread of this strain while sustaining the capacity of the trauma ICU.

CT-PTSD following a COVID-19 ICU admission in the context of unresolved grief, delirium and incurable cancer: a single case design with an older adult client

Abstract This case study recounts an application of Ehlers and Clark’s (2000) cognitive model of post-traumatic stress disorder (PTSD) to post-intensive care unit (post-ICU) PTSD. An AB single case design was implemented. The referred patient, Rosalind (pseudonym), completed several psychometric measures prior to the commencement of therapy (establishing a baseline), as well as during and at the end of therapy. Idiosyncratic measures were also implemented to capture changes during specific phases of treatment. The importance of the therapeutic alliance, particularly in engendering a sense of safety, was highlighted. Findings support the use of cognitive therapy for PTSD (CT-PTSD) with an older adult, in the context of a coronavirus infectious disease (COVID-19)-related ICU admission. This case is also illustrative of the effectiveness of implementing CT-PTSD in the context of co–morbid difficulties and diagnoses of delirium, depression, and complicated grief. Key learning aims (1) To recognise the therapeutic value of CT-PTSD in addressing PTSD following a COVID-19 admission, in the context of complicated grief and delirium. (2) To consider the importance of a strong therapeutic alliance when undertaking CT–PTSD. (3) To understand the intersection of complicated grief and delirium in the context of ICU trauma. (4) To consider the challenges in working with PTSD, whereby the target trauma (COVID–19 ICU admission) is linked with ongoing uncertainty and continuing indeterminate threat.

Long-term health-related quality of life and independence among older survivors of serious injury.

Little is known about the recovery experiences of older trauma intensive care unit (TICU) survivors and the relationship between geriatric trauma care and long-term functional ability and health-related quality of life (HRQOL). We conducted a prospective cohort study of 218 patients (age, ≥65 years) admitted to a Level 1 regional trauma center TICU before versus after implementation of a geriatric care bundle with protocolized geriatrics consultations (Geri-T). Survivors or their proxies were interviewed approximately 1 year after hospitalization. Outcomes included the Katz Index of Independence in Activities of Daily Living (ADLs), Lawton Instrumental Activities of Daily Living (IADLs), and EQ-5D-5L HRQOL survey. Two investigator-developed questions regarding recovery experiences were included. Differences in outcomes among survivors admitted before versus after Geri-T were analyzed using multivariable linear regression. Responses to questions about recovery experiences were qualitatively assessed using content analysis. We reached 67% (146/218) of hospital survivors or their proxies across both groups; 126 patients were still alive and completed the survey. Mean age was 76 (SD, 8), 36% were female, and 90% were independent with ADLs preinjury. At follow-up, independence with ADLs was 76% and IADLs was 63%. The mean EQ-5D-5L index score was 0.78 (SD, 0.18). Most patients (65%) reported having not returned to preinjury functional status. Neither functional ability or HRQOL differed significantly among patients admitted before versus after Geri-T. Content analysis of open-ended questions revealed themes of activity limitations, persistent pain, and cognitive dysfunction. Nearly one-fifth of TICU survivors experienced loss of ADL function 1 year after injury, and most reported having not returned to preinjury functional status. Nonetheless, patient-reported HRQOL was comparable to age-adjusted norms. Geri-T was not associated with differences in HRQOL or functional ability. Survivors reported persistent difficulty with activities beyond those of daily living, pain, and cognition. Prognostic and Epidemiologic, Level III.

Feasibility of Muscle Endurance Testing in Critically Ill Trauma Patients: A Pilot Study.

Intensive care unit-acquired weakness (ICUAW) occurs secondary to patients treated for life-threatening conditions in the ICU being diagnosed based on the Medical Research Council sum score (MRC-SS). However, patients often complain of fatigability and poor endurance, which are not evaluated by muscle strength. In this study, we explored the feasibility of assessing muscle quality and endurance in trauma ICU patients. The modified Functional Index-2 (FI2) testing was applied to evaluate muscle endurance. The maximal voluntary contraction (MVC) was measured when evaluating the MRC-SS using surface electromyography (sEMG), and the fatigue index (FI) was also recorded at the time of endurance testing. The ultrasonic muscle echogenicity by gray-scale analysis of rectus femoris (RF) and tibialis anterior (TA) muscles was evaluated at the initial (<72 h) and end of ICU care. A total of 14 patients were enrolled in this study. Fatigue was induced in eight patients (fatigue group), and six (non-fatigue group) completed endurance testing. All patients except one had an MRC-SS exceeding 48 points. There was no difference in US echogenicity, MRC-SS, and FI between groups. In sEMG, the root mean square (RMS) values of MVC in RF and TA muscles showed a significant difference (p < 0.05). To evaluate and predict the functional activity of ICU patients, measuring muscle strength alone is insufficient, and it is necessary to evaluate muscle endurance. In this respect, the modified FI2 test and sEMG monitoring are considered to be promising procedures for evaluating the muscle condition of critically ill patients even in complex situations in the ICU.

The Feasibility of Early Chemical Thromboprophylaxis in Traumatic Brain Injury Patients Admitted to a Trauma ICU

The Feasibility of Early Chemical Thromboprophylaxis in Traumatic Brain Injury Patients Admitted to a Trauma ICU

The HIV Testing Trends and Outcomes at a Johannesburg Trauma ICU unit: A Retrospective Cohort Study

The HIV Testing Trends and Outcomes at a Johannesburg Trauma ICU unit: A Retrospective Cohort Study

1287: METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS NARES SCREEN LEADS TO VANCOMYCIN DE-ESCALATION IN TRAUMA

Introduction: Methicillin-resistant Staphylococcus aureus (MRSA) polymerase chain reaction (PCR) nares swab is a proven screening tool to de-escalate vancomycin therapy due to its high negative predictive value in pneumonia and other infections. However, data are lacking on the utility of this test in the critically ill trauma population, which is at high risk for hospital-acquired infections. This study evaluated the impact of empiric MRSA PCR nares screening on de-escalation of vancomycin therapy in critically ill trauma patients. Methods: This is a single center, pre-post observational cohort study conducted at an academic, level I trauma center. Adult patients who were admitted for trauma and received empiric vancomycin therapy for suspected infection in the trauma intensive care unit were included. Patients were grouped by whether they were included 6 months before (pre-cohort) and 6 months after (post-cohort) the implementation of empiric rapid MRSA PCR nares screening in September 2021. The primary outcome was duration of vancomycin therapy. Secondary outcomes included rate of acute kidney injury (AKI), positive MRSA screen or cultures, ICU length of stay (LOS), hospital LOS, and mortality. Results: One-hundred fifty-eight patients were included: 82 in the pre-cohort group and 76 in the post-cohort group. Ninety vancomycin initiation orders were observed in the pre-cohort versus 80 orders in the post-cohort. Baseline demographics were similar between groups. There was a significantly higher rate of MRSA PCR orders in the post-cohort group (75%) compared to (21%) in the pre-cohort (p< 0.001). The pre-cohort group had higher rates of positive MRSA screens (26 vs. 13%, p=0.18) and MRSA positive cultures (17 vs. 9%, p=0.22) compared to post-cohort. There were no reported instances of positive MRSA cultures with a negative PCR. Vancomycin duration was significantly shorter in the post-cohort group (2.55 days vs. 3.5, p=0.02). Hospital and ICU LOS, rates of AKI, and mortality were not different between groups. Conclusions: Implementation of empiric rapid MRSA nares screening led to a shorter overall duration of vancomycin therapy by nearly one day in critically ill trauma patients. Further study is required to evaluate the potential cost savings of empiric MRSA screening in critically ill trauma patients.

482: ROLE OF PNEUMONIA PCR PANEL ON METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS COVERAGE IN A TRAUMA ICU

Introduction: Pneumonia polymerase chain reaction (PCR) tests are a novel tool used to identify bacterial pathogens within hour(s) after sample collection versus up to 72 hours from a bronchoalveolar lavage (BAL). Early experience revealed a strong correlation between Staphylococcus aureus isolation and detection of resistance, and the trauma intensive care unit (TICU) adopted a protocol in September 2021 to escalate or de-escalate Methicillin-resistant Staphylococcus aureus (MRSA) coverage based on results. Methods: BioFire FilmArray pneumonia PCR panel assay results were evaluated in comparison to BAL culture results between September 2021 to March 2022 for patients admitted to the TICU of a large, academic, level 1 trauma center. Patients were categorized as early (< 5 days) or late (≥5 days) pneumonia in an ICU setting. The PCR panel assay was determined to correlate with the BAL if at least one organism identified in the PCR grew in the BAL. For patients treated for pneumonia, antibiotic regimens, antibiotic days, recurrence and clinical cure were evaluated and Fisher’s exact and Chi-square tests used for statistical analysis. Results: Pneumonia was suspected and PCR and BAL were obtained in 153 instances. Of those, 96 PCR panel assays detected bacteria (62.7%) with false negatives in 10/153 (6.5%) instances. Positive PCR panels correlated with BAL results in 52/96 (54.2%) of cases, with a positive predictive value (PPV) of 46.0%. 32 PCR assays detected S. aureus and 12 were detected in the corresponding BAL (PPV 37.4%). The presence or absence of methicillin-resistance correlated with cultures in all but one instance. Clinical outcomes were similar between groups for acute kidney injury, antibiotics days, MRSA days of coverage, recurrent pneumonia, and clinical cure. Conclusions: Pneumonia PCR panel assay demonstrated a 46% PPV with BAL culture results. The PCR assay demonstrates high sensitivity for S. aureus confirmed by BAL cultures and opportunities for de-escalation of MRSA coverage were identified in a majority of patients. Future educational efforts towards early antimicrobial streamlining may impact MRSA antibiotic duration, and larger sample sizes may reveal more correlation patterns.

1293: ENTERAL VASOPRESSOR USE IN CRITICALLY ILL TRAUMA PATIENTS

Introduction: Enteral vasopressor (EV) therapies have been used to facilitate the weaning of IV vasopressors in critically ill patients. Studies have shown mixed results in the medically critically ill population; however this practice is still common. The use of EVs in the critically ill trauma population is less well described. The purpose of this medication use evaluation was to describe the use of EV therapy in our trauma and surgical ICU and to identify subpopulations which may benefit from EV therapy. Methods: This was an IRB approved single-center, retrospective medication use evaluation at a Level 1 trauma center. Inclusion criteria included: adult patients admitted from January 1st, 2020 to March 15th, 2022 to the trauma and surgical ICU; received IV continuous vasopressor(s) for more than 24 hours; and concomitant use of IV and EV(s). EV therapy was defined as midodrine and/or pseudoephedrine. The primary endpoint was overall success in weaning of IV continuous infusion vasopressors and successful weaning at < 24 hour and < 48 hour post-EV initiation. Secondary endpoints were bradycardiac events (HR < 50 bpm) and IV continuous infusion vasopressor free days in patients requiring a defined duration of vasopressor support. Results: 106 patients were included in the evaluation with 83.0% receiving midodrine and 13.2% receiving pseudoephedrine with or without midodrine. 3.8% of patients were transitioned between agents. Among the whole ICU cohort, 56.7% of patients had spinal cord injury and 54.7% had defined minimum MAP goal and duration. Overall success of IV vasopressor weaning was 78.3%. Weaning of IV vasopressors at < 24 hours and < 48 hours from EV initiation was 28.3% and 48.1%, respectfully. Bradycardia occurred in 41.5% of patients; however symptomatic bradycardia was 6.6%. Among patients with spinal cord injury and defined MAP goal duration, EV therapy was associated with a median of 3 IV vasopressor free days (interquartile range: 0-4). Conclusions: EV therapy can be used to facilitate weaning of IV vasopressor therapy in the traumatic, critically ill patients. Midodrine and pseudoephedrine use may benefit spinal cord injury patients by reducing IV vasopressor days. Future prospective studies are needed to confirm this finding.

321: OUTPATIENT DIABETES MANAGEMENT INFLUENCES GLYCEMIC CONTROL IN ICU PATIENTS DURING NUTRITION SUPPORT

Introduction: Appropriate glycemic control improves clinical outcomes during critical illness. We proposed that outpatient diabetes management would influence glycemic control in critically ill patients who require nutrition support (NS). Methods: Adult patients admitted to the trauma intensive care unit (ICU), who required NS, and exhibited hyperglycemia (blood glucose concentration (BG) > 150 mg/dL) or had diabetes mellitus (DM), were retrospectively evaluated. Outpatient DM pharmacotherapy was discontinued upon ICU admission. NS was initiated on day 3 + 3 following ICU admission. A serum hemoglobin (Hgb) A1c was obtained on day 3 + 3. The daily amount/mode of insulin therapy, carbohydrate intake, and point of care BGs for the first 7 days of NS were recorded. Patients were classified as controlled DM (Hgb A1c < 7%), uncontrolled DM (Hgb A1c >/= 7%), or as hyperglycemic patients without DM (Hgb A1c < 6.5%). Target BG was 70 to 150 mg/dL. Hypoglycemia was defined as a BG < 70 mg/dL. Regular human insulin sliding scale (SSI), subcutaneous NPH insulin with concurrent SSI, or continuous intravenous insulin infusion (CIVI) were used for glycemic control at the discretion of the NS service or primary service. Continuous data were given as mean + S.D. Chi-square analysis or ANOVA were used to compare groups. Results: Seventy-eight (14 controlled DM, 21 uncontrolled DM, and 43 non-DM) patients were studied. Maximum BG prior to initiation of NS was significantly different between groups (201 + 54 vs. 334 + 192 vs. 191 + 57 mg/dL, respectively, P < 0.001). The proportion of patients who required higher intensity insulin therapy (NPH + SSI or CIVI) was different among groups (50% vs. 86% vs. 15%, respectively, P < 0.001). The amount of insulin given per gram of carbohydrate intake was 0.45 + 0.50, 1.24 + 1.21, and 0.15 + 0.21 units/g, respectively, P < 0.001. Time within the target BG range was 11 + 6, 12 + 5, and 17 + 6 hrs/day, respectively, P < 0.001. Hypoglycemia occurred in 1 (7%), 5 (24%), and 3 (7%) patients, respectively (P = 0.120). Conclusions: Glycemic control during NS in the ICU is more challenging for those patients whose outpatient DM was uncontrolled compared to those with controlled DM and those with stress-induced hyperglycemia without DM.

824: THE EFFECT OF DEXMEDETOMIDINE ON DELIRIUM IN TRAUMA ICU PATIENTS

Introduction: Delirium is an acute disturbance in attention and cognition that develops over a short period of time. It is the most common complication afflicting patients admitted to the ICU. Despite the numerous scores developed to detect delirium such as CAM-ICU and RASS scales, delirium is still often misdiagnosed. Sedation in intensive care setting aims to keep the patient calm, cooperative, and able to communicate their needs. Literature showed that dexmedetomidine has a different pattern of sedation and favorable effects on delirium in non-trauma patients. This study aims to determine if dexmedetomidine may prevent delirium in trauma ICU patients. Methods: This was a retrospective cohort study of patients admitted to Charleston Area Medical Center’s (CAMC) Surgical/Trauma ICU (STICU) between January 1, 2017 and December 31, 2021. Patients with a traumatic injury above the age of 18 under sedation in the STICU were dichotomized into patients receiving dexmedetomidine and those receiving other sedative agents. The primary objective was rate of delirium. Secondary objectives included evaluation of hemodynamic stability, ICU length of stay, and hospital length of stay. Results: A total of 273 patients were evaluated with 163 in the dexmedetomidine group and 110 in the non-dexmedetomidine group. No difference in baseline characteristics were observed including home antipsychotic and antidepressant use. The primary outcome was similar between groups with delirium rates being 17 (10.4%) patients in the dexmedetomidine group vs 14 (12.7%) in the non-dexmedetomidine group. Individual risk factors for delirium included pre-existing psychiatric illness (OR = 2.83, 95% CI 1.19-6.74, p = 0.01) and benzodiazepine exposure (OR = 3.14, 95% CI 1.12-8.78, p=0.02). No difference in secondary outcomes were observed. Conclusions: Our study showed no difference in delirium between patients that received dexmedetomidine vs those that received other agents. Results on independent risk factors were consistent with previously reported literature, which supports existing evidence that delirium risk has both modifiable and non-modifiable factors. However, this adds to the growing literature that choosing dexmedetomidine may have less impact on decreasing delirium compared to appropriate assessment and targeting light sedation.