Abstract
Objective To explore the factors affecting the timing and prognosis of early tracheostomy(within 7 days after tracheal intubation) in patients with multiple rib fractures. Methods A retrospective analysis of the medical history of 222 patients with multiple rib fractures who were admitted to the department of emergency intensive care unit(EICU) of the affiliated hospital of Yangzhou University from February 2015 to October 2019 underwent early tracheostomy. According to the time from tracheal intubation to tracheostomy after admission, the patients were divided into two groups: early tracheostomy group (within 7 days after tracheal intubation,ET) and late tracheostomy group (after the 7th day, LT). The propensity score matching analysis technique was used to compare the differences between the two groups in a 1:1 ratio. Results A total of 222 patients were enrolled, with 118 in the ET group and 104 in the LT group. After matching, 87 in the ET group and 87 in the LT group. The proportion of acute respiratory distress syndrome(ARDS)[59(67.8%)], the volume of pulmonary contusion (VPC)[33.8±11.4], and number of total rib fractures (NTRF)[10.8±2.7] in the ET were significantly higher than those in the LT group, P<0.05. Binary Logistic regression analysis showed that ARDS[OR=3.740, 95%CI(1.441, 9.711)], VPC[OR=1.087, 95%CI(1.052, 1.124)], and NTRF [OR=1.775, 95%CI(1.439, 2.188)] were independent risk factors for ET.The Pearson analysis showed that VPC and NTRF had significant correlation(R=0.369, P=0.01), ARDS and VPC had low degree correlation(R=0.179, P=0.018), while ARDS and NTRF had no significant correlation(R=0.132, P=0.110). Receiver operating characteristic(ROC)curve analysis showed that the area under VPC and NTRF curves [0.832(95%CI: 0.770~0.893),0.804(95%CI: 0.740~0.868)] were significantly more than the number of rib fractures(NFR), glasgow coma scale(GCS), and injury severity score(ISS), P<0.05. COX regression analysis showed that patients with underwent ET survived significantly better than the LT, P<0.05. Conclusions We found that ARDS, VPC, and NTFR were independent risk factors for ET; VPC ≥ 23.9% and (or) NTRF ≥ 8.5 could be used as predictors of ET in patients with multiple rib fractures. There was a linear relationship between NTRF and VPC. ET might benefit patients with multiple rib fractures.