Does Lack of Thoracic Trauma Attenuate the Severity of Pulmonary Failure? An Analysis of Over 10,000 Critically-Injured Patients

Abstract Introduction: The plain film chest x-ray in supine position (CXR) during the initial management of severely injured patients has almost lost its clinical relevance, since it has been challenged by extended focused assessment with sonography in trauma (eFAST) in early trauma management, due to its superiority in detecting a pneumo-/hematothorax. One of the last diagnostic fields in such setting of CXR is the mediastinal vascular injury. These injuries are rare yet life-threatening events. The most easily accessible diagnostic tool to identify these patients would be CXR as it is still one of the standard diagnostic tools in the early assessment of severely injured patients with significant thoracic trauma (Abbreviated Injury Scale, AIS ≥3). This study evaluates the role of early CXR in the Trauma Resuscitation Unit (TRU) in the last diagnostic field where eFAST cannot provide an answer: detecting mediastinal vascular injury in severely injured patients.Method: This retrospective, observational, single-centre study included all primary blunt trauma patients of a 24 months time period, that had been admitted to the TRU. Mediastinal/chest (M/C) ratio measurements were taken from CXRs at three defined levels of the mediastinum. The accuracy of the CXR findings were compared to whole-body computed tomography scans (WBCT) and therapeutic consequences were observed. Additionally a 15 years (2005–2019) time period out of the TraumaRegister DGU® was evaluated regarding usage of eFAST, CXR und WBCT in Level-1, -2, and − 3 Trauma Centres in Germany.Results: A total of 267 patients showed a significant blunt thoracic trauma (27 with mediastinal vascular injury (VThx)). The initial CXR in a supine position was unreliable for detecting mediastinal vascular injury. The sensitivity and specificity at different thresholds of maximum M/C ratio (2.0–3.0) were not clinically acceptable. The aortic contour and haemato- and pneumothorax were not reliably detected in the initial CXRs. No significant differences in the cardiac silhouette were observed between patients with or without mediastinal vascular injury (mean cardiac width, 136.5 mm, p = 0.44). No therapeutic consequences were drawn after CXR in the study period. The data from the TR-DGU (N = 251,095) showed a continuous reduction of CXR from 75% (2005) to 25% (2019), while WBCT raised from 35% to a steady level of about 80%. This development was seen in all trauma hospitals almost simultaneously.Conclusion: In present guidelines, CXR remains an integral diagnostic element during early TRU management, although several prior publications show the superior role of eFAST. Our data support that in most cases, CXR is time consuming and provides no benefit during initial management of severely injured patients and might delay the use of WBCT. The trauma centres in Germany have already significantly reduced the usage of CXR in the TRU. We therefore recommend to revise current guidelines and emphasise eFAST and rapid diagnostic through WBCT if rapidly available.

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Weaning Injured Patients with Prolonged Pulmonary Failure from Mechanical Ventilation in a Non-Intensive Care Unit Setting

The Journal of Trauma: Injury, Infection, and Critical Care ◽

10.1097/00005373-200008000-00007 ◽

2000 ◽

Vol 49 (2) ◽

pp. 224-231 ◽

Cited By ~ 9

Author(s):

Michael W. deBoisblanc ◽

Robert K. Goldman ◽

John C. Mayberry ◽

Dawn M. Brand ◽

Patrick D. Pangburn ◽

...

Keyword(s):

Intensive Care Unit ◽

Mechanical Ventilation ◽

Intensive Care ◽

Intensive Care Unit Setting ◽

Pulmonary Failure ◽

Injured Patients

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Pneumonia in severely injured patients with thoracic trauma: results of a retrospective observational multi-centre study

Scandinavian Journal of Trauma Resuscitation and Emergency Medicine ◽

10.1186/s13049-019-0608-4 ◽

2019 ◽

Vol 27 (1) ◽

Cited By ~ 4

Author(s):

Sebastian Wutzler ◽

Felix M. Bläsius ◽

Philipp Störmann ◽

Thomas Lustenberger ◽

Michael Frink ◽

...

Keyword(s):

Thoracic Trauma ◽

Severely Injured ◽

Severely Injured Patients ◽

Multi Centre Study ◽

Centre Study ◽

Injured Patients

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DELAYED SURGICAL FIXATION OF FEMUR FRACTURES IS A RISK FACTOR FOR PULMONARY FAILURE INDEPENDENT OF THORACIC TRAUMA

Journal of Trauma and Acute Care Surgery ◽

10.1097/00005373-199410000-00023 ◽

1994 ◽

Vol 37 (4) ◽

pp. 667-672 ◽

Cited By ~ 140

Author(s):

William E. Charash ◽

Timothy C. Fabian ◽

Martin A. Croce

Keyword(s):

Risk Factor ◽

Thoracic Trauma ◽

Femur Fractures ◽

Pulmonary Failure ◽

Surgical Fixation

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Thoracic trauma now and then: A 10 year experience from 16,773 severely injured patients

PLoS ONE ◽

10.1371/journal.pone.0186712 ◽

2017 ◽

Vol 12 (10) ◽

pp. e0186712 ◽

Cited By ~ 14

Author(s):

Klemens Horst ◽

Hagen Andruszkow ◽

Christian D. Weber ◽

Miguel Pishnamaz ◽

Christian Herren ◽

...

Keyword(s):

Thoracic Trauma ◽

Severely Injured ◽

Severely Injured Patients ◽

Injured Patients

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Increased serum concentrations of soluble ST2 are associated with pulmonary complications and mortality in polytraumatized patients

Clinical Chemistry and Laboratory Medicine (CCLM) ◽

10.1515/cclm-2017-0762 ◽

2018 ◽

Vol 56 (5) ◽

pp. 810-817 ◽

Cited By ~ 3

Author(s):

Thomas Haider ◽

Elisabeth Simader ◽

Philipp Hacker ◽

Hendrik J. Ankersmit ◽

Thomas Heinz ◽

...

Keyword(s):

Thoracic Trauma ◽

Injury Severity ◽

Area Under The Curve ◽

Pulmonary Complications ◽

Thoracic Injury ◽

Serum Concentrations ◽

Serum Samples ◽

Soluble St2 ◽

Level I ◽

Injured Patients

AbstractBackground:We sought to evaluate the role of soluble ST2 (suppression of tumorigenicity) serum concentrations in polytraumatized patients and its potential role as biomarker for pulmonary complications.Methods:We included severely injured patients (injury severity score≥16) admitted to our level I trauma center and analyzed serum samples obtained on the day of admission and on day 2. Furthermore, patients with isolated thoracic injury and healthy probands were included and served as control groups. Serum samples were analyzed for soluble ST2 concentrations with a commercially available ELISA kit.Results:A total of 130 patients were included in the present study. Five patients with isolated thoracic injury and eight healthy probands were further included. Serum analyses revealed significantly elevated concentrations of soluble ST2 in polytraumatized patients compared to patients suffering from isolated thoracic trauma and healthy probands. In polytraumatized patients who developed pulmonary complications (acute respiratory distress syndrome and pneumonia) and in patients who died, significantly higher serum concentrations of soluble ST2 were found on day 2 (p<0.001). Serum concentrations of soluble ST2 on day 2 were of prognostic value to predict pulmonary complications in polytraumatized patients (area under the curve=0.720, 95% confidence interval=0.623–0.816). Concomitant thoracic trauma had no further impact on serum concentrations of soluble ST2.Conclusions:Serum concentrations of soluble ST2 are upregulated following polytrauma. Increased concentrations were associated with worse outcome.

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Surgical Stabilization of Clavicle Fractures Reduces Organ Failure Rates in Multiply-injured Patients with Thoracic Trauma: An Analysis Based on the TraumaRegister DGU®.

10.21203/rs.3.rs-76223/v1 ◽

2020 ◽

Author(s):

Helge Eberbach ◽

Rolf Lefering ◽

Sven Hager ◽

Klaus Schumm ◽

Lisa Bode ◽

...

Keyword(s):

Multiple Organ Failure ◽

Organ Failure ◽

Thoracic Trauma ◽

Clavicle Fracture ◽

Length Of Hospital Stay ◽

Multiple Organ ◽

Multiply Injured Patients ◽

Lung Failure ◽

Clavicle Fractures ◽

Injured Patients

Abstract Introduction: Thoracic trauma has decisive influence on the outcome of multiply-injured patients and is often associated with clavicle fractures. The affected patients are prone to lung dysfunction and multiple organ failure. The aim of this study is to investigate the influence of surgical stabilization of clavicle fractures in patients with thoracic trauma on specific outcome parameters.Methods: A multi-center, retrospective analysis of patient records documented in the TraumaRegister DGU® between 2009 and 2015 was performed. The inclusion criteria were multiply-injured patients with thoracic trauma and associated clavicle fracture, maximum AIS severity ≥ 3 and admission to the intensive care unit. The influence of operative vs. non-operative clavicular fracture treatment and timing of surgery on lung failure, multiple organ failure, sepsis, length of ICU stay, intubation time and length of hospital stay was assessed by regression analysis.Results: A total of 3,209 patients were included in the analysis. In 1,362 patients (42%) the clavicle fracture was treated operatively after 7.1 ± 5.3 days. Surgically treated patients had a significant reduction in lung failure (p = 0.013, OR = 0.74), multiple organ failure (p = 0.001, OR = 0.64), intubation time (p = 0.004; -1.81 days) and length of hospital stay (p = 0.014; -1.51 days) compared to non-operative treatment. Moreover, surgical fixation of the clavicle within five days following hospital admission significantly reduced the rates of lung failure (p = 0.01, OR = 0.62), multiple organ failure (p = 0.01, OR = 0.59) and length of hospital stay (p = 0.01; -2.1 days).Conclusions: Based on our results, multiply-injured patients with thoracic trauma and concomitant clavicle fracture seem to benefit significantly from surgical stabilization of a clavicle fracture, especially when surgery is performed within the first five days after hospital admission.

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