Chronic critical illness in polytrauma. Results of the Spanish trauma in ICU registry

Abstract

Purpose Chronic critical illness after trauma injury has not been fully evaluated, and there is little evidence in this regard. We aim to describe the prevalence and risk factors of chronic critical illness (CCI) in trauma patients admitted to the intensive care unit. Material and Methods Retrospective observational multicenter study (Spanish Registry of Trauma in ICU (RETRAUCI)). Period March 2015 to December 2019. Trauma patients admitted to the ICU, who survived the first 48 h, were included. Chronic critical illness (CCI) was considered as the need for mechanical ventilation for a period greater than 14 days and/or placement of a tracheostomy. The main outcomes measures were prevalence and risk factors of CCI after trauma. Results 1290/9213 (14%) patients developed CCI. These patients were older (51.2 ± 19.4 vs 49 ± 18.9); p < .01) and predominantly male (79.9%). They presented a higher proportion of infectious complications (81.3% vs 12.7%; p < .01) and multiple organ dysfunction syndrome (MODS) (27.02% vs 5.19%; p < .01). CCI patients required longer stays in the ICU and had higher ICU and overall in‐hospital mortality. Age, injury severity score, head injury, infectious complications, and development of MODS were independent predictors of CCI. Conclusion CCI in trauma is a prevalent entity in our series. Early identification could facilitate specific interventions to change the trajectory of this process.

Prevalence and Factors Associated With Chronic Critical Disease in Hospitalized for Trauma in Intensive Care

“…The study population consisted of adult patients who suffered trauma. For the sample calculation, we considered a 14% percentage occurrence of CCD 7 , a confidence level of 95% and a margin of error of 3%. A percentage for losses of 15% was predicted.…”

Prevalência E Fatores Associados À Doença Crítica Crônica Em Hospitalizados Por Trauma Em Terapia Intensiva

“…A população do estudo foi composta por pacientes adultos que sofreram trauma. Para o cálculo amostral, consideraram-se percentual de ocorrência de DCC de 14% 7 , um nível de confiança de 95% e margem de erro de 3%. Foi previsto um percentual para perdas de 15%.…”

Chronic critical illness – What is it and what can be done about it?

“…The effect of age and frailty on CCI are somewhat neglected by Ballesteros et al 1 Age per se is not usually a risk factor – but rather the frailty and comorbidities associated with it may affect CCI 6 . These aspects of age were not assessed in the study.…”

“…In this issue of the Journal, we find an interesting paper addressing the issue of chronic critical illness (CCI) in trauma patients, with information extracted retrospectively from the national trauma database in Spain. 1 The aims of the review were to describe several aspects of CCI in trauma patients, including its prevalence (14%), risk factors for developing CCI and complications of CCI, such as infectious complications, high resource utilization, ongoing organ dysfunction (e.g. the ongoing need for supportive measures such as mechanical ventilation, renal replacement therapy [RRT] etc).…”

“…Interventions such as appropriate nutrition with care to achieve adequate energy and protein intake, early mobilization to mitigate muscle deconditioning, management of delirium, antibiotic stewardship, continuing lung protective strategies during mechanical ventilation and implementing lower levels of sedation and using spontaneous breathing trials could all be beneficial to prevent and ameliorate CCI. 5 The effect of age and frailty on CCI are somewhat neglected by Ballesteros et al 1 Age per se is not usually a risk factorbut rather the frailty and comorbidities associated with it may affect CCI. 6 These aspects of age were not assessed in the study.…”