[Prophylactic ventilation of severely injured patients with thoracic trauma--does it always make sense?].
For therapy of blunt thoracic trauma in multiple injured patients, some studies have recommended prophylactic ventilation with kinetic therapy for 3-5 days. In contrast other clinics prefer to reduce the time of ventilation and to extubate as soon as possible. In this retrospective study our patient collective was investigated to find out if early extubation is linked to a higher complication rate. A total of 26 ventilated patients with severe thoracic trauma and an abbreviated injury scale score (AIS thorax) >3 were included in the study. The mean time of ventilation was 98.4 h and in patients without head injury 71.3 h. Out of 22 patients 4 had to be reintubated which had to be repeated for 2 patients. Of the patients 3 developed pneumonia but no cases of adult respiratory distress syndrome (ARDS) were observed. Of the patients 4 died due to other injuries. The mean stay on the intensive care unit was 6.3 days and the mean stay in hospital 22.6 days. Our findings indicate that even with early and aggressive weaning from a respirator with extensive lung contusions an adequate therapy of thorax trauma is possible without having a higher incidence of complications.
Klinik für Unfallchirurgie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, 24105 Kiel. lutz.mahlke@uksh-kiel.de
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L
Mahlke
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Oestern
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J
Drost
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Frerichs
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Seekamp
D055371:Acute Lung Injury / Q000401:mortality / Q000628:therapy*; D000293:Adolescent; D000328:Adult; D000368:Aged; D002423:Cause of Death; D003131:Combined Modality Therapy; D003288:Contusions / Q000401:mortality / Q000628:therapy*; D005260:Female; D005858:Germany; D006801:Humans; D007362:Intensive Care Units; D007385:Intermittent Positive-Pressure Ventilation; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000401:mortality / Q000628:therapy*; D026741:Physical Therapy Modalities; D053717:Pneumonia, Ventilator-Associated / Q000209:etiology / Q000401:mortality; D012151:Resuscitation / Q000379:methods; D012189:Retrospective Studies; D013898:Thoracic Injuries / Q000401:mortality / Q000628:therapy*; D015300:Ventilator Weaning / Q000401:mortality; D014949:Wounds, Nonpenetrating / Q000401:mortality / Q000628:therapy*; D055815:Young Adult