Adult respiratory distress syndrome among blunt and penetrating trauma patients: Demographics, mortality, and resource utilization over 8 years

Navarrete-Navarro, Pedro; Rodríguez, Aurelio; Reynolds, Neal; West, Robert; Rivera, Ricardo; Scalea, Thomas M.

doi:10.1053/jcrc.2001.25230

Cited by 15 publications

(6 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Blunt trauma comprises the vast majority of all trauma at this and most other centers [25–27] and consequently drives the patterns of overall trauma admissions. However, during subgroup analysis, we observe a relative delay in timing of penetrating traumas.…”

Section: Discussionmentioning

confidence: 99%

Identifying temporal patterns in trauma admissions: Informing resource allocation

Stonko

Dennis

Callcut³

et al. 2018

PLoS ONE

View full text Add to dashboard Cite

BackgroundIncreased knowledge of the temporal patterns in the distribution of trauma admissions could be beneficial to staffing and resource allocation efforts. However, little work has been done to understand how this distribution varies based on patient acuity, trauma mechanism or need for intervention. We hypothesize that temporal patterns exist in the distribution of trauma admissions, and that deep patterns exist when traumas are analyzed by their type and severity.Study designWe conducted a cross-sectional observational study of adult patient flow at a level one trauma center over three years, 7/1/2013–6/30/2016. Primary thermal injuries were excluded. Frequency analysis was performed for patients grouped by ED disposition and mechanism against timing of admission; in subgroup analysis additional exclusion criteria were imposed.Results10,684 trauma contacts were analyzed. Trauma contacts were more frequent on Saturdays and Sundays than on weekdays (p<0.001). Peak arrival time was centered around evening shift change (6-7pm), but differed based on ED disposition: OR and ICU or Step-Down admissions (p = 0.0007), OR and floor admissions (p<0.0001), and ICU or Step-Down and floor admissions (p<0.0001). Step-Down and ICU arrival times (p = 0.42) were not different. Penetrating injuries peaked later than blunt (p<0.0001). Trauma varies throughout the year; we establish a high incidence trauma season (April to late October). Different mechanisms have varying dependence upon season; Motorcycle crashes (MCCs) have the greatest dependence.ConclusionWe identify new patterns in the temporal and seasonal variation of trauma and of specific mechanisms of injury, including the novel findings that 1) penetrating trauma tends to present at later times than blunt, and 2) critically ill patients requiring an OR tend to present later than those who are less acute and require an ICU or Step-Down unit. These patients present later than those who are admitted to the floor. Penetrating trauma patients arriving later than blunt may be the underlying reason why operative patients arrive later than other patients.

show abstract

Section: Discussionmentioning

confidence: 99%

Identifying temporal patterns in trauma admissions: Informing resource allocation

Stonko

Dennis

Callcut³

et al. 2018

PLoS ONE

View full text Add to dashboard Cite

show abstract

“…On the other hand, the ARDS mortality rate in both blunt and penetrating trauma patients decreased over time [20]. ECMO has the unique potential to support gas exchange without causing further lung damage from invasive positive pressure ventilation (barotrauma) in adult patients with fulminant respiratory failure and may improve patient survival [21].…”

Section: Discussionmentioning

confidence: 99%

Extracorporeal lung support in trauma patients with severe chest injury and acute lung failure: a 10-year institutional experience

Ried¹,

et al. 2013

View full text Add to dashboard Cite

IntroductionSevere trauma with concomitant chest injury is frequently associated with acute lung failure (ALF). This report summarizes our experience with extracorporeal lung support (ELS) in thoracic trauma patients treated at the University Medical Center Regensburg.MethodsA retrospective, observational analysis of prospectively collected data (Regensburg ECMO Registry database) was performed for all consecutive trauma patients with acute pulmonary failure requiring ELS during a 10-year interval.ResultsBetween April 2002 and April 2012, 52 patients (49 male, three female) with severe thoracic trauma and ALF refractory to conventional therapy required ELS. The mean age was 32 ± 14 years (range, 16 to 72 years). Major traffic accident (73%) was the most common trauma, followed by blast injury (17%), deep fall (8%) and blunt trauma (2%). The mean Injury Severity Score was 58.9 ± 10.5, the mean lung injury score was 3.3 ± 0.6 and the Sequential Organ Failure Assessment score was 10.5 ± 3. Twenty-six patients required pumpless extracorporeal lung assist (PECLA) and 26 patients required veno-venous extracorporeal membrane oxygenation (vv-ECMO) for primary post-traumatic respiratory failure. The mean time to ELS support was 5.2 ± 7.7 days (range, <24 hours to 38 days) and the mean ELS duration was 6.9 ± 3.6 days (range, <24 hours to 19 days). In 24 cases (48%) ELS implantation was performed in an external facility, and cannulation was done percutaneously by Seldinger's technique in 98% of patients. Cannula-related complications occurred in 15% of patients (PECLA, 19% (n = 5); vv-ECMO, 12% (n = 3)). Surgery was performed in 44 patients, with 16 patients under ELS prevention. Eight patients (15%) died during ELS support and three patients (6%) died after ELS weaning. The overall survival rate was 79% compared with the proposed Injury Severity Score-related mortality (59%).ConclusionPumpless and pump-driven ELS systems are an excellent treatment option in severe thoracic trauma patients with ALF and facilitate survival in an experienced trauma center with an interdisciplinary treatment approach. We encourage the use of vv-ECMO due to reduced complication rates, better oxygenation and best short-term outcome.

show abstract

“…Acute respiratory distress syndrome (ARDS) is a common cause of death in trauma patients, with an incidence of 4.3%–8.5% and an associated mortality of 20%–40%. 1 If conventional treatment fails, veno-venous extracorporeal membrane oxygenation (VV ECMO) may be an optimal strategy to assure sufficient gas exchange and tissue perfusion while reducing positive pressure ventilation and allowing the lungs to heal.…”

Section: Introductionmentioning

confidence: 99%

Outcomes in trauma patients undergoing veno-venous extracorporeal membrane oxygenation for acute respiratory distress syndrome

et al. 2022

View full text Add to dashboard Cite

Background: The use of veno-venous extracorporeal membrane oxygenation (VV ECMO) remains controversial in trauma patients with acute respiratory distress syndrome (ARDS). Here, we aimed to investigate the therapeutic benefits of VV ECMO and the factors affecting patient outcomes. Methods From 2017 to 2019, 21/1938 trauma patients (median age: 47 years; 18 men) at a level I trauma center received VV ECMO for post-traumatic ARDS. Demographic, injury-specific, ECMO, and outcome data were prospectively collected and retrospectively reviewed to analyze the factors affecting hospital mortality and ECMO results. Results 19 patients (90.5%) were successfully weaned off ECMO; 16 patients (76.2%) survived to discharge. In univariate analysis, there was a significant difference in survival between the groups with a Trauma and Injury Severity Score (TRISS) ⩾0.5 and TRISS <0.5 ( p = 0.05). The area under the receiver operating characteristic curve (AUC) for both TRISS and Respiratory Extracorporeal Membrane Oxygenation Survival Prediction (RESP) scores for death was 0.78. In those who failed ECMO weaning, the AUCs of the TRISS and RESP scores were 0.90 and 0.80, respectively. Conclusions: In patients with ARDS caused by severe trauma and supported by VV ECMO, survival is associated with TRISS; TRISS and RESP scores may be predictive of mortality and failure in ECMO weaning.

show abstract

Adult respiratory distress syndrome among blunt and penetrating trauma patients: Demographics, mortality, and resource utilization over 8 years

Cited by 15 publications

References 19 publications

Identifying temporal patterns in trauma admissions: Informing resource allocation

Identifying temporal patterns in trauma admissions: Informing resource allocation

Extracorporeal lung support in trauma patients with severe chest injury and acute lung failure: a 10-year institutional experience

Outcomes in trauma patients undergoing veno-venous extracorporeal membrane oxygenation for acute respiratory distress syndrome

Contact Info

Product

Resources

About