Kinetic therapy in multiple trauma patients with severe thoracic trauma: a treatment option to reduce ventilator time and improve outcome.
OBJECTIVE
Continuous lateral rotational therapy (CLRT) has been described as a promising approach for prophylaxis and treatment of respiratory complications in critically ill patients over two decades ago. However, meta-analyses failed to demonstrate any significant benefit on outcome by CLRT, possibly due to the heterogeneity and low overall quality of available studies.


METHODS
Observational trial over a 3-year period on outcome in trauma patients (Injury Severity Score, ISS ≥16) with severe thoracic injury (Abbreviated Injury Scale, AISThorax≥3) initially treated with CLRT as standard of care. Epidemiological data, injury severity, and pattern and physiological parameters were recorded. Outcome indicators were time on mechanical ventilation, length of stay, rates of pneumonia, sepsis and acute respiratory distress syndrome, hospital mortality, and rates of re-intubation. Additionally, data are compared with the results from the TraumaRegister®of the German Trauma Society.


RESULTS
Over the 3-year period 76 patients with ISS ≥16/AISThorax≥3 received CLRT, equaling 24 % of all patients with ISS ≥16 between 18 and 80 years. Mean ISS was 35.3 (standard deviations, SD 12.2) [71.1 % male, 97.4 % blunt trauma, mean age 43.9 years (SD 18.7)]. Mean time on CLRT was 3.3 days (SD 2.2), time on mechanical ventilation 7.8 days (SD 7.1), and 9.2 % had to be re-intubated due to respiratory complications. CLRT-related complications occurred in 8.9 %. Overall 25 % of the patients developed pneumonia (VAP = 13.2 %). Despite a significantly higher ISS we observed shorter times on mechanical ventilation and intensive care unit in our collective in comparison to data published from the nationwide TraumaRegister®.


CONCLUSIONS
CLRT remains a therapeutic option to reduce pulmonary complications after severe chest trauma in our center. However, a RCT is needed to study the effects of other treatment options such as early extubation and non-invasive ventilation or prone/supine positioning.
Department of Trauma, Hand and Reconstructive Surgery, University Hospital Frankfurt am Main, Theodor-Stern-Kai 7, 60596, Frankfurt am Main, Germany. sebastian.wutzler@kgu.de.
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Wutzler
Department of Trauma, Hand and Reconstructive Surgery, University Hospital Frankfurt am Main, Theodor-Stern-Kai 7, 60596, Frankfurt am Main, Germany.
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Sturm
Department of Trauma, Hand and Reconstructive Surgery, University Hospital Frankfurt am Main, Theodor-Stern-Kai 7, 60596, Frankfurt am Main, Germany.
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Lustenberger
Department of Trauma, Hand and Reconstructive Surgery, University Hospital Frankfurt am Main, Theodor-Stern-Kai 7, 60596, Frankfurt am Main, Germany.
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Wyen
Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt am Main, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany.
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Zacharowksi
Department of Trauma, Hand and Reconstructive Surgery, University Hospital Frankfurt am Main, Theodor-Stern-Kai 7, 60596, Frankfurt am Main, Germany.
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Marzi
Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt am Main, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany.
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Bingold
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003422:Critical Care / Q000379:methods*; D005060:Europe / Q000453:epidemiology; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015601:Injury Severity Score; D007362:Intensive Care Units; D007700:Kinetics; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D015915:Motion Therapy, Continuous Passive / Q000379:methods*; D009104:Multiple Trauma / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D056888:Patient Positioning; D011014:Pneumonia / Q000401:mortality; D011446:Prospective Studies; D012128:Respiratory Distress Syndrome / Q000401:mortality; D018805:Sepsis / Q000401:mortality; D013898:Thoracic Injuries / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D014193:Trauma Centers; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D055815:Young Adult
Chest trauma; Critical care; Kinetic therapy; Pneumonia