Low incidence of multiple organ failure after major trauma.
BACKGROUND
In major trauma patients, multiple organ failure (MOF) is considered a leading cause of death. Acute lung injury is deemed a "pacemaker" of MOF. The purpose of this study was to determine if incidence of organ failure and mortality in multiple trauma patients can be reduced by implementation of lung-protective strategies.


METHODS
All critically ill multiple trauma patients admitted to the ICU of a major trauma center in Berlin, Germany from January 1999 to December 2002 were analyzed retrospectively. Patients were ventilated pressure controlled with low tidal volumes and adequate PEEP.


RESULTS
n=287 patients were included. The most frequent injuries were traumatic brain injury (TBI-68%), chest trauma (68%), and lung contusions (55%). Injury severity score (ISS) was 32+/-19 (mean+/-standard deviation), polytraumaschluessel (PTS) 34+/-19, and APACHE II 14+/-7. During their ICU-stay 16 patients died, 9 (56%) from TBI. Single-organ-failure occurred in n=69 patients (24%, mortality 5%), two-organ-failure in n=22 (8%, mortality 14%), and MOF in n=9 (3%, mortality 13%); one patient died from MOF 14 days after trauma. The number of days on mechanical ventilation increased depending on the number of organs failed (R=0.618, p<0.001). Seven patients (2%) fulfilled ARDS criteria for longer than 24h despite optimized ventilatory settings, one died of irreversible shock. Patients with MOF had a significantly increased ICU-LOS (35+/-15 days) compared to patients without organ failure (11+/-11 days; p<0.001).


CONCLUSIONS
The low incidence of MOF in our series of trauma patients suggests that MOF may be prevented in some patients by implementation of lung-protective strategies. The improved outcome was associated with an increased ICU-LOS.
Laudi
Sven
S
Department of Anesthesiology and Intensive Care Medicine, University of Leipzig Medical Faculty, 04103 Leipzig, Germany.
Donaubauer
Bernd
B
Busch
Thilo
T
Kerner
Thoralf
T
Bercker
Sven
S
Bail
Hermann
H
Feldheiser
Aarne
A
Haas
Norbert
N
Kaisers
Udo
U
D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000401:mortality* / Q000517:prevention & control / Q000628:therapy; D009104:Multiple Trauma / Q000401:mortality* / Q000517:prevention & control / Q000628:therapy; D011175:Positive-Pressure Respiration / Q000379:methods; D012121:Respiration, Artificial / Q000379:methods*; D012189:Retrospective Studies; D014193:Trauma Centers