Lung complications are common in intensive care treated patients with pelvis fractures: a retrospective cohort study.
BACKGROUND
The incidence of severe respiratory complications in patients with pelvis fractures needing intensive care have not previously been studied. Therefore, the aims of this registry study were to 1) determine the number of ICU patients with pelvis fractures who had severe respiratory complications 2) whether the surgical intervention in these patients is associated with the pulmonary condition and 3) whether there is an association between lung complications and mortality. We hypothesized that acute hypoxic failure (AHF) and acute respiratory distress syndrome (ARDS) 1) are common in ICU treated patients with pelvis fractures, 2) are not related to the reconstructive surgery, or to 3) to mortality.


METHODS
All patients in the database cohort (n = 112), scheduled for surgical stabilization of pelvis ring and/or acetabulum fractures, admitted to the general ICU at Uppsala University Hospital between 2007 and 2014 for intensive care were included.


RESULTS
The incidence of AHF/ARDS was 67 % (75/112 patients), i.e., the percentage of patients that at any period during the ICU stay fulfilled the AHF/ARDS criteria. The incidence of AHF was 44 % and incidence of ARDS was 23 %. The patients with AHF/ARDS had more lung contusions and pneumonia than the patients without AHF/ARDS. Overall, there were no significant changes in oxygenation variables associated with surgery. However, 23 patients with pre-operative normal lung status developed AHF/ARDS in relation to the surgical procedure, whereas 12 patients with AHF/ARDS normalized their lung condition. The patients who developed AHF/ARDS had a higher incidence of lung contusion (P = 0.04) and the surgical stabilization was performed earlier (5 versus 10 days) in these patients (P = 0.03).


CONCLUSIONS
We found that the incidence of respiratory failure in ICU treated patients with pelvis fractures was high, that the procedure around surgical stabilization seems to be associated with a worsening in the respiratory function in patients with lung contusion, and that mortality was low and was probably not related to the respiratory condition.


BACKGROUND
Study was registered at ISRCTN.org number, ISRCTN10335587 .
Anesthesiology and Intensive Care, Department of Surgical Sciences, Uppsala University, SE-751 85, Uppsala, Sweden. joakim.engstrom@surgsci.uu.se.
Joakim
J
Engström
Anesthesiology and Intensive Care, Department of Surgical Sciences, Uppsala University, SE-751 85, Uppsala, Sweden.
Henrik
H
Reinius
Anesthesiology and Intensive Care, Department of Surgical Sciences, Uppsala University, SE-751 85, Uppsala, Sweden.
Jennie
J
Ström
Anesthesiology and Intensive Care, Department of Surgical Sciences, Uppsala University, SE-751 85, Uppsala, Sweden.
Monica Frick
MF
Bergström
Anesthesiology and Intensive Care, Department of Surgical Sciences, Uppsala University, SE-751 85, Uppsala, Sweden.
Ing-Marie
IM
Larsson
Anesthesiology and Intensive Care, Department of Surgical Sciences, Uppsala University, SE-751 85, Uppsala, Sweden.
Anders
A
Larsson
Orthopedics, Department of Surgical Sciences, Uppsala University, SE-751 85, Uppsala, Sweden.
Tomas
T
Borg
D001784:Blood Gas Analysis; D003422:Critical Care / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000009:adverse effects*; D050723:Fractures, Bone / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D010384:Pelvic Bones / Q000293:injuries*; D012121:Respiration, Artificial / Q000379:methods; D012128:Respiratory Distress Syndrome / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013548:Sweden / Q000453:epidemiology; D014057:Tomography, X-Ray Computed
Acute hypoxic failure; Acute respiratory distress syndrome; Intensive care units; Traumatic pelvis fracture