Department of Trauma, Hand and Reconstructive Surgery, Hospital of the Johann Wolfgang Goethe-University, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany.
Injury. 2013 Jan;44(1):70-4. doi: 10.1016/j.injury.2011.11.003. Epub 2011 Dec 6.
Blunt chest injuries are amongst the most life threatening injuries in adult multiple trauma patients. Nevertheless, the treatment of these thoracic injuries has not been standardized yet. Previous publications have reported on the prevention and the treatment of respiratory complications by using continuous lateral rotational bed therapy (CLRT), but there is still a lack of information using this approach in the presence of pulmonary contusions. Therefore current literature indicates a variety of treatment protocols and its use is contended.
We submitted a 32-item online-questionnaire to 155 hospitals participating in the nationwide TraumaNetwork to assess current treatment concepts in multiple trauma patients suffering from blunt chest trauma including lung contusions with particular focus on the use of CLRT. Overall, 21 level I, 53 level II and 81 level III trauma centres were contacted. The questionnaire was created using "interview 123 5.5.b.de ND6".
The overall response rate was 35.5% (55/155) and responses were received from 10 level I (47.6%), 17 level II (32.1%) and 24 level III (29.6%) trauma centres. Thirty-five of the responders (63.6%) declared to be able to perform lateral rotational bed therapy. For level I and II trauma centres more than 80% were able to apply kinetic positioning in contrast to only 50% of level III trauma centres. Although 42.9% of the participants reported on the existence of standardized treatment protocols, 57.1% failed to report a standardized operating procedure for CLRT. The annual mean number of patients per centre treated via CLRT was 15 (0-130). Treatment modalities such as PEEP and the duration of CLRT also showed great variability. Against this background three out of four centres declared an urgent need for further clinical research in the field.
Our data reflect the wide range of different CLRT treatment strategies performed for blunt pulmonary trauma involving lung contusions in German trauma centres. We conclude that a high-quality randomized-controlled trial is warranted to critically assess the role of CLRT in multiple trauma patients with blunt chest trauma to provide a sound basis for future clinical guidelines.
钝性胸部损伤是成人多发创伤患者中最具生命威胁的损伤之一。然而，这些胸部损伤的治疗尚未标准化。先前的出版物已经报道了使用连续横向旋转床治疗（CLRT）预防和治疗呼吸并发症，但在存在肺挫伤的情况下，使用这种方法的信息仍然缺乏。因此，目前的文献表明存在多种治疗方案，其使用存在争议。
我们向参与全国创伤网络的 155 家医院提交了一份包含 32 个项目的在线问卷，以评估多发创伤患者钝性胸部创伤（包括肺挫伤）的治疗现状，特别关注 CLRT 的使用。共有 21 家一级、53 家二级和 81 家三级创伤中心参与了调查。问卷使用“interview 123 5.5.b.de ND6”创建。
总体回复率为 35.5%（55/155），收到了 10 家一级（47.6%）、17 家二级（32.1%）和 24 家三级（29.6%）创伤中心的回复。35 名回复者（63.6%）表示能够进行横向旋转床治疗。对于一级和二级创伤中心，超过 80%的中心能够应用动力定位，而只有 50%的三级创伤中心能够应用。尽管 42.9%的参与者报告存在标准化治疗方案，但 57.1%的中心未能报告 CLRT 的标准化操作程序。每年每中心接受 CLRT 治疗的患者平均数量为 15 例（0-130 例）。治疗方式如 PEEP 和 CLRT 的持续时间也存在很大差异。在此背景下，四分之三的中心表示迫切需要在该领域进行进一步的临床研究。
我们的数据反映了德国创伤中心在治疗涉及肺挫伤的钝性肺创伤时，采用了广泛的不同 CLRT 治疗策略。我们得出结论，需要进行高质量的随机对照试验来批判性评估 CLRT 在多发创伤患者中治疗钝性胸部创伤的作用，为未来的临床指南提供可靠的依据。
