- 作者：Sebastian Wutzler ; Arasch Wafaisade ; Marc Maegele ; Helmut Laurer ; Emanuel V. Geiger ; Felix Walcher ; John Barker ; Rolf Lefering ; Ingo Marzi ; the Trauma Registry of DGU
- 关键词：Chest trauma ; Pulmonary organ failure ; Multiple trauma ; Organ failure ; Outcome
- 刊名：Injury
- 出版年：2012
- 出版时间：September, 2012
- 年：2012
- 卷：43
- 期：9
- 页码：1507-1512
- 全文大小：241 K
Background
Pulmonary complications are common in multiple trauma patients with chest injury. Factors predisposing these critically ill patients to respiratory organ failure are not fully understood.Methods
Univariate and multivariate logistic regression analyses were used to assess the prognostic value of clinical and laboratory variables (2002-2008; n = 30,616) from the Trauma Registry of the German Trauma Society (DGU). Data from patients admitted to the ICU with lung contusion/lacerations, an Injury Severity Score ¡Ý16 and age ¡Ý18 were included in the study. Severe pulmonary organ failure was defined as PaO2/FiO2 < 200 for ¡Ý3 days and based on the odds ratios (ORs) a simplified Lung Organ Failure Score (LOFS) was developed using integer values.
Results
21.3 % (1254) of the 5892 patients analysed developed severe pulmonary organ failure. We identified seven independent predictors with significant correlation: age, gender, head injury, fluid therapy, injury severity, degree of chest trauma and surgical interventions. The highest ORs were observed in cases of Abbreviated Injury Scale (AIS)Thorax = 5 (1.58), surgical intervention (1.71) and multiple surgeries (2.41). We found that patients with simplified score values ¡Ý21 points were at a maximum risk (>30 % ) for developing severe pulmonary complications.
Conclusion
This scoring method could help trauma surgeons determine which multiple trauma patients are at risk for pulmonary complications after trauma. Efficacy analyses of prophylactic PEEP ventilation or rotational bed therapy in subgroups with comparable risks for respiratory complication could be based on the LOFS.