This study aimed at determining predictors of in-hospital mortality and prehospital monitoring limitations in severely injured intubated blunt trauma patients. We retrospectively reviewed patients' charts. Prehospital vital signs, Injury Severity Score (ISS), initial Glasgow Coma Scale (GCS), Revised Trauma Score (RTS), arterial blood gases, and lactate were compared in two study groups: survivors (n = 40) and nonsurvivors (n = 30). There were no significant differences in prehospital vital signs between compared groups. Nonsurvivors were older (P = 0.006), with lower initial GCS (P < 0.001) and higher ISS (P < 0.001), along with higher lactate (P < 0.001) and larger base deficit (BD; P = 0.006), whereas RTS (P = 0.001) was lower in nonsurvivors. For predicting mortality, area under the curve (AUC) was calculated: for lactate 0.82 (P < 0.001), for ISS 0.82 (P < 0.001), and for BD 0.69 (P = 0.006). Lactate level of 3.4 mmol/L or more was 82% sensitive and 75% specific for predicting in-hospital death. In a multivariate logistic regression model, ISS (P = 0.037), GCS (P = 0.033), and age (P = 0.002) were found to be independent predictors of in-hospital mortality. The AUC for regression model was 0.93 (P < 0.001). Increased levels of lactate and BD on admission indicate more severe occult hypoperfusion in nonsurvivors whereas vital signs did not differ between the groups.

In prehospital intubated patients with isolated severe TBI only ISS and mydriasis were found to be independent predictors of in-hospital mortality.

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Introduction. Medications during rapid sequence intubation (RSI) have known detrimental side effects. Prehospital mechanical ventilation after successful endotracheal intubation also increases mortality due to hyperventilation and positive pressure ventilation. The aim of this retrospective analysis was to determine the impact of RSI on prehospital hemodynamic parameters and prehospital ventilation status on mortality rate and functional outcome in trauma patients. Methods. Charts of 73 trauma patients, who underwent prehospital RSI over a 12-year period, were retrospectively reviewed. Prehospital vital signs, before and after RSI, were compared. Patients were divided, according to ventilation status, into three groups based on initial PaCO2: hypocarbic/hyperventilated (PaCO2<35mmHg), normocarbic/normoventilated (PaCO2 35-45 mmHg) and hypercarbic/hypoventilated (PaCO2>45mmHg). Results. Seventy-three patients were enrolled in the retrospective analysis. There was a significant difference in respiratory rate (p=0.046), arterial oxygen saturation (p<0.001), mean arterial pressure (p<0.001) and Glasgow Coma Scale (GCS) (p<0.001) before and after RSI. GCS at discharge (p=0.003) and arterial oxygen saturation (p=0.05) were significantly higher in the normoventilated group. There was no significant difference in survival to hospital discharge among compared groups. Conclusion. Our retrospective analysis suggests that prehospital RSI has no detrimental hemodynamic side effects and that normoventilation leads to a favorable neurological outcome.