title: Low incidence of multiple organ failure after major trauma.
abstract: 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.
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, University of Leipzig Medical Faculty, 04103 Leipzig, Germany.
authors.forename: Sven
authors.initials: S
authors.lastname: Laudi
authors.forename: Bernd
authors.initials: B
authors.lastname: Donaubauer
authors.forename: Thilo
authors.initials: T
authors.lastname: Busch
authors.forename: Thoralf
authors.initials: T
authors.lastname: Kerner
authors.forename: Sven
authors.initials: S
authors.lastname: Bercker
authors.forename: Hermann
authors.initials: H
authors.lastname: Bail
authors.forename: Aarne
authors.initials: A
authors.lastname: Feldheiser
authors.forename: Norbert
authors.initials: N
authors.lastname: Haas
authors.forename: Udo
authors.initials: U
authors.lastname: Kaisers
mesh_terms: 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