RESUMEN
BACKGROUND: Thoracic trauma is a relevant source of comorbidity throughout multiply-injured patient care. We aim to determine a measurable influence of chest trauma's severity on early resuscitation, intensive care therapy, and mortality in severely injured patients. METHODS: Patients documented between 2002 and 2012 in the TraumaRegister DGU®, aged ≥ 16 years, injury severity score (ISS) ≥ 16 are analyzed. Isolated brain injury and severe head injury led to exclusion. Subgroups are formed using the Abbreviated Injury ScaleThorax. RESULTS: Twenty-two thousand five hundred sixty-five patients were predominantly male (74%) with mean age of 45.7 years (SD 19.3), blunt trauma (95%), mean ISS 25.6 (SD 9.6). Overall mean intubation period was 5.6 days (SD 10.7). Surviving patients were discharged from the ICU after a mean of about 5 days following extubation. Thoracic trauma severity (AISThorax ≥ 4) and fractures to the thoracic cage significantly prolonged the ventilation period. Additionally, fractures extended the ICU stay significantly. Suffering from more than one thoracic injury was associated with a mean of 1-2 days longer intubation period and longer ICU stay. Highest rates of sepsis, respiratory, and multiple organ failure occurred in patients with critical compared to lesser thoracic trauma severity. CONCLUSION: Thoracic trauma severity in multiply-injured patients has a measurable impact on rates of respiratory and multiple organ failure, sepsis, mortality, time of mechanical ventilation, and ICU stay.
Asunto(s)
Traumatismo Múltiple/cirugía , Sistema de Registros/estadística & datos numéricos , Traumatismos Torácicos/cirugía , Adolescente , Adulto , Comorbilidad , Femenino , Alemania , Humanos , Puntaje de Gravedad del Traumatismo , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Traumatismo Múltiple/epidemiología , Traumatismos Torácicos/epidemiología , Centros Traumatológicos/organización & administración , Centros Traumatológicos/estadística & datos numéricosRESUMEN
BACKGROUND: During circulatory arrest, effective external chest compression (ECC) is a key element for patient survival. In 2005, international emergency medical organisations changed their recommended compression-ventilation ratio (CVR) from 15:2 to 30:2 to acknowledge the vital importance of ECC. We hypothesised that physical fitness, biometric data and gender can influence the quality of ECC. Furthermore, we aimed to determine objective parameters of physical fitness that can reliably predict the quality of ECC. METHODS: The physical fitness of 30 male and 10 female healthcare professionals was assessed by cycling and rowing ergometry (focussing on lower and upper body, respectively). During ergometry, continuous breath-by-breath ergospirometric measurements and heart rate (HR) were recorded. All participants performed two nine-minute sequences of ECC on a manikin using CVRs of 30:2 and 15:2. We measured the compression and decompression depths, compression rates and assessed the participants' perception of exhaustion and comfort. The median body mass index (BMI; male 25.4 kg/m2 and female 20.4 kg/m2) was used as the threshold for subgroup analyses of participants with higher and lower BMI. RESULTS: HR during rowing ergometry at 75 watts (HR75) correlated best with the quality of ECC (r = -0.57, p < 0.05). Participants with a higher BMI and better physical fitness performed better and showed less fatigue during ECC. These results are valid for the entire cohort, as well as for the gender-based subgroups. The compressions of female participants were too shallow and more rapid (mean compression depth was 32 mm and rate was 117/min with a CVR of 30:2). For participants with a lower BMI and higher HR75, the compression depth decreased over time, beginning after four minutes for the 15:2 CVR and after three minutes for the 30:2 CVR. Although found to be more exhausting, a CVR of 30:2 was rated as being more comfortable. CONCLUSION: The quality of the ECC and fatigue can both be predicted by BMI and physical fitness. An evaluation focussing on the upper body may be a more valid predictor of ECC quality than cycling based tests. Our data strongly support the recommendation to relieve ECC providers after two minutes.