Trauma de tórax en la unidad de cuidados intensivos: Factores de riesgo de ventilación prolongada y de muerte

Ana Graciela França Silva; Carlos Formento Aramburu; Soledad Olivera; Carmen Martínez Fassanella; Anela De Armas Leiva; Alejandro Ebeid Bocchi

Authors

Ana Graciela França Silva Sanatorio Juan Pablo II. Círculo Católico de Obreros del Uruguay. Unidad de Cuidados Intensivos Polivalente de Adultos
Carlos Formento Aramburu Sanatorio Juan Pablo II. Círculo Católico de Obreros del Uruguay. Unidad de Cuidados Intensivos Polivalente de Adultos
Soledad Olivera Sanatorio Juan Pablo II. Círculo Católico de Obreros del Uruguay. Unidad de Cuidados Intensivos Polivalente de Adultos
Carmen Martínez Fassanella Sanatorio Juan Pablo II. Círculo Católico de Obreros del Uruguay. Unidad de Cuidados Intensivos Polivalente de Adultos
Anela De Armas Leiva Sanatorio Juan Pablo II. Círculo Católico de Obreros del Uruguay. Unidad de Cuidados Intensivos Polivalente de Adultos
Alejandro Ebeid Bocchi Sanatorio Juan Pablo II. Círculo Católico de Obreros del Uruguay. Unidad de Cuidados Intensivos Polivalente de Adultos

Keywords:

THORACIC INJURIES, ARTIFICIAL RESPIRATION, RISK FACTORS, MORTALITY

Abstract

Introduction: thoracic trauma is a common condition, 70% of cases lie within the framework of polytrauma and 46.5% correspond to traffic accidents. Trauma involves young patients with mortality rates of 30%.
Method: we conducted a cohort study oo adult patients in critical condition from March, 2014 to June, 2015.
The following data was collected prospectively: demographic details, comorbilities, injury severity scores, mechanical ventilation, treatment, complications and evolution. Risk factors were studied in connection with prolonged mechanical ventilation (=>7 days) and univariate and multivariate logistic regression analyses were conducted, expressed in odds ratio (OR) with 95% confidence intervals. Student’s t Test and Mann-Whitney U tests were used for quantitative variables; Chi-square test and Fisher exact test were used for qualitative variables. The level of statistical significance was <0,05.
Results: the study included 66 patients, 82% of them were male. Average age 43±17years old (±1 standard deviation). 73% accounted for traffic accidents, 94% were cases of closed trauma, 60,6% with invasive mechanical ventilation. Independent risk factors for prolonged ventilation: Injury Severity Score (ISS), and late ventilator-associated pneumonia (VAP). Every time the ISS increases the risk of needing mechanical ventilation assistance ? 7days rises 1.28 more times and the late VAP increases it this need by 27.46%.
All patients who died (9%) were on mechanical ventilation, although there was no relationship between death and prolonged ventilation. Univariate risk factors: obesity, early VAP, Hemorrhagic shock, Apache II ?18.
Conclusions: late VAP was an independent risk factor for prolonged mechanical ventilation, the same as increase in the value of the ISS score, when compared to the lower levels or scores. Obese patients, those with early mechanical ventilation, Hemorrhagic shock and Apache II ?18 were in risk.