A Preventative Respiratory Protocol to Identify Trauma Subjects at Risk for Respiratory Compromise on a General In-Patient Ward.
BACKGROUND
Patients are at risk for respiratory complications after sustaining blunt chest trauma, yet contradictory evidence exists about the utility of prophylactic respiratory therapy to reduce respiratory complications in this population. This study assessed the effectiveness of a proactive respiratory protocol on an in-patient ward to identify trauma patients at risk for pulmonary complications, administer appropriate therapies, and prevent deterioration requiring transfer to the ICU.


METHODS
Trauma patients received a respiratory therapy evaluation at the time of admission to a general in-patient ward at a Level 1 trauma center. If subjects met protocol inclusion criteria, they received prophylactic respiratory treatments, primarily MetaNeb therapy, Vest therapy, or EzPAP. Multiple phases were included to evaluate the effectiveness of the protocol, with 50 subjects in each phase: a pre-protocol phase before adoption of the protocol; phase 1, which was found to have low physician adherence and overly broad inclusion criteria; and phase 2, with improved adherence and narrower inclusion criteria. Study inclusion criteria mirror the protocol criteria from phase 2: ≥3 rib fractures; pulmonary contusion; exacerbation of COPD, asthma, or other lung disease; or age ≥65 y with expected immobility of ≥48 h.


RESULTS
The respiratory protocol was associated with an elimination of unplanned admissions to the ICU. After controlling for injury severity and other important clinical factors, receiving the protocol significantly decreased hospital stay by approximately 1.5 d. More subjects were admitted from the emergency department directly to the ward, avoiding the ICU. Bronchodilator use also decreased, although the result did not reach statistical significance.


CONCLUSIONS
Study results suggest that a preventive respiratory protocol had a beneficial effect on patient outcomes; receiving the protocol reduced hospital days and eliminated unplanned admission to the ICU.
General Surgery Residency Program, Iowa Methodist Medical Center, Des Moines, Iowa.
Bethany A
BA
Nyland
Department of Trauma Services, UnityPoint Health, Des Moines, Iowa. sarah.spilman@unitypoint.org.
Sarah K
SK
Spilman
General Surgery Residency Program, Iowa Methodist Medical Center, Des Moines, Iowa.
Meghan E
ME
Halub
Department of Respiratory Therapy, UnityPoint Health, Des Moines, Iowa.
Keith D
KD
Lamb
Department of Respiratory Therapy, UnityPoint Health, Des Moines, Iowa.
Julie A
JA
Jackson
Department of Respiratory Therapy, UnityPoint Health, Des Moines, Iowa.
Trevor W
TW
Oetting
Department of Trauma Services, UnityPoint Health, Des Moines, Iowa.
Sheryl M
SM
Sahr
D000368:Aged; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010362:Patients' Rooms; D012131:Respiratory Insufficiency / Q000209:etiology / Q000517:prevention & control*; D012138:Respiratory Therapy / Q000379:methods*; D012189:Retrospective Studies; D012307:Risk Factors; D013898:Thoracic Injuries / Q000150:complications*; D014949:Wounds, Nonpenetrating / Q000150:complications*
bronchodilators; chest injury; metaneb; prophylactic respiratory therapy; respiratory complications; stay; trauma