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Risk factors and outcomes of unrecognised endobronchial intubation in major trauma patients.
Heyne, Guido; Ewens, Sebastian; Kirsten, Holger; Fakler, Johannes Karl Maria; Özkurtul, Orkun; Hempel, Gunther; Krämer, Sebastian; Struck, Manuel Florian.
Afiliación
  • Heyne G; Department of Anesthesiology and Intensive Care Medicine, Universitätsklinikum Leipzig, Leipzig, Sachsen, Germany.
  • Ewens S; Department of Anesthesiology, Intensive Care, and Emergency Medicine, BG Klinikum Bergmannstrost Halle, Halle, Sachsen-Anhalt, Germany.
  • Kirsten H; Department of Diagnostic and Interventional Radiology, Universitätsklinikum Leipzig, Leipzig, Sachsen, Germany.
  • Fakler JKM; Institute for Medical Informatics, Statistics and Epidemiology, Universität Leipzig Medizinische Fakultät, Leipzig, Sachsen, Germany.
  • Özkurtul O; Division of Traumatology, Department of Orthopedics, Traumatology and Plastic Surgery, Universitätsklinikum Leipzig, Leipzig, Sachsen, Germany.
  • Hempel G; Division of Traumatology, Department of Orthopedics, Traumatology and Plastic Surgery, Universitätsklinikum Leipzig, Leipzig, Sachsen, Germany.
  • Krämer S; Department of Anesthesiology and Intensive Care Medicine, Universitätsklinikum Leipzig, Leipzig, Sachsen, Germany.
  • Struck MF; Division of Thoracic Surgery, Department of Visceral, Transplant, Thoracic and Vascular Surgery, Universitätsklinikum Leipzig, Leipzig, Sachsen, Germany.
Emerg Med J ; 39(7): 534-539, 2022 Jul.
Article en En | MEDLINE | ID: mdl-34376465
BACKGROUND: Emergency tracheal intubation during major trauma resuscitation may be associated with unrecognised endobronchial intubation. The risk factors and outcomes associated with this issue have not previously been fully defined. METHODS: We retrospectively analysed adult patients admitted directly from the scene to the ED of a single level 1 trauma centre, who received either prehospital or ED tracheal intubation prior to initial whole-body CT from January 2008 to December 2019. Our objectives were to describe tube-to-carina distances (TCDs) via CT and to assess the risk factors and outcomes (mortality, length of intensive care unit stay and mechanical ventilation) of patients with endobronchial intubation (TCD <0 cm) using a multivariable model. RESULTS: We included 616 patients and discovered 26 (4.2%) cases of endobronchial intubation identified on CT. Factors associated with an increased risk of endobronchial intubations were short body height (OR per 1 cm increase 0.89; 95% CI 0.84 to 0.94; p≤0.001), a high body mass index (OR 1.14; 95% CI 1.04 to 1.25; p=0.005) and ED intubation (OR 3.62; 95% CI 1.39 to 8.90; p=0.006). Eight of 26 cases underwent tube thoracostomy, four of whom had no evidence of underlying chest injury on CT. There was no statistically significant difference in mortality or length of stay although the absolute number of endobronchial intubations was small. CONCLUSIONS: Short body height and high body mass index were associated with endobronchial intubation. Before considering tube thoracostomy in intubated major trauma patients suspected of pneumothorax, the possibility of unrecognised endobronchial intubation should be considered.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Servicios Médicos de Urgencia Tipo de estudio: Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Adult / Humans Idioma: En Revista: Emerg Med J Asunto de la revista: MEDICINA DE EMERGENCIA Año: 2022 Tipo del documento: Article País de afiliación: Alemania Pais de publicación: Reino Unido
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Servicios Médicos de Urgencia Tipo de estudio: Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Adult / Humans Idioma: En Revista: Emerg Med J Asunto de la revista: MEDICINA DE EMERGENCIA Año: 2022 Tipo del documento: Article País de afiliación: Alemania Pais de publicación: Reino Unido