Prolonged Mechanical Ventilation in Pediatric Trauma Patients in a Combat Zone

Abstract

It is well known that polytrauma can lead to acute lung injury. Respiratory failure has been previously observed in combat trauma, but not reported in children, who account for over 11% of bed days at deployed Military Treatment Facilities (MTFs) using significant resources. We seek to identify risk factors associated with prolonged mechanical ventilation (PMV) which is important in resource planning and allocation in austere environments. DESIGN:Retrospective review of prospectively collected data within the United States Department of Defense Trauma Registry.

Crystalloid Volume is Associated with Short Term Morbidity in Children with Severe Traumatic Brain Injury: An Eastern Association for the Surgery of Trauma Multicenter Trial Post-Hoc Analysis

“…Optimal resuscitation practices for pediatric trauma patients with sTBI have not been well established. Previous studies, however, have shown that high-volume crystalloid resuscitation is associated with poor outcomes in injured children, including prolonged duration of mechanical ventilation 19 . This study was a post hoc analysis of data from a previously published multi-institution study of resuscitation practices in pediatric trauma patients (all injury types), which found that administration of ≥1 crystalloid bolus was associated with worsened outcomes 16 .…”

A scoping review of two decades of pediatric humanitarian care during wartime

“…Gale et al 40 found that mechanical ventilation was the most frequent intervention (67.6%) for children who had a prolonged length intensive care unit (ICU) stay. Moulton et al 41 found that 18% of pediatric casualties experienced prolonged mechanical ventilation. Increased occurrence of prolonged mechanical ventilation was associated with multiple factors, including serious injuries to the thorax and skin along with administration of crystalloids, platelets, plasma, and packed RBCs 41 …”

“…Moulton et al 41 found that 18% of pediatric casualties experienced prolonged mechanical ventilation. Increased occurrence of prolonged mechanical ventilation was associated with multiple factors, including serious injuries to the thorax and skin along with administration of crystalloids, platelets, plasma, and packed RBCs 41 …”

“…Increased occurrence of prolonged mechanical ventilation was associated with multiple factors, including serious injuries to the thorax and skin along with administration of crystalloids, platelets, plasma, and packed RBCs. 41 Tris(hydroxymethyl)aminomethane (THAM) administration was most frequently administered to patients injured by submersion or burns and who had high ISS, serious injuries to the abdomen, and longer stays in the ICU and hospital. 42 Those who received THAM had lower survival rates.…”

Editor’s Choice Articles for December

“…First, there are five articles to use as updates in respiratory and ventilatory practice. We have an article about fluid accumulation during mechanical ventilation (13), an article about prolonged mechanical ventilation in pediatric trauma (14), and a feature meta-narrative review about the clinical challenges in “liberation” from pediatric ventilation (15). The other two articles that I’m really excited about–not that all articles aren’t exciting–because they add worthwhile reading in the PCCM Trials section.…”