Trauma Department, Hannover Medical School, Hannover, Germany
Trauma Department, Hannover Medical School, Hannover, Germany.
In Vivo. 2019 Sep-Oct;33(5):1539-1545. doi: 10.21873/invivo.11634.
BACKGROUND/AIM: Blunt chest trauma is one of the major injuries in multiply injured patients and is associated with an increased risk of acute respiratory distress syndrome (ARDS) and ventilator-associated pneumonia (VAP). Accidental hypothermia is a common accompaniment of multiply injured patients. The objective of this study was to analyze the influence of accidental hypothermia on pulmonary complications in multiply injured patients with blunt chest trauma.
Multiply injured patients [injury severity score (ISS) ≥16] with severe blunt chest trauma [abbreviated injury scale of the chest (AISchest) ≥3] were analyzed. Hypothermia was defined as body core temperature <35°C. The primary endpoint was the development of ARDS and VAP. Propensity score matching was performed.
Data were analyzed for 238 patients, with a median ISS of 26 (interquartile range=12). A total of 67 patients (28%) were hypothermic on admission. Hypothermic patients were injured more severely (median ISS 34 vs. 24, p<0.001) and had a higher transfusion requirement (p<0.001). Their mortality rate was consequently increased (10% vs. 1%, p=0.002); After propensity score matching, the mortality rate was still higher (10% vs. 2%, p=0.046). However, hypothermia was not an independent predictor of mortality. Hypothermic patients had to be ventilated longer (p=0.02). However, there were no differences in occurrence of ARDS and VAP. Hypothermia was not identified as an independent predictor of ARDS and VAP.
Among multiply injured patients with severe blunt chest trauma, accidental hypothermia is not an independent predictor of ARDS and VAP and is more likely to be an accompaniment of injury severity and hemorrhage.
背景/目的：钝性胸部创伤是多发伤患者的主要损伤之一，与急性呼吸窘迫综合征（ARDS）和呼吸机相关性肺炎（VAP）的风险增加相关。意外低体温是多发伤患者的常见伴随症状。本研究旨在分析意外低体温对钝性胸部创伤多发伤患者肺部并发症的影响。
分析了严重钝性胸部创伤（胸部损伤严重程度评分 [AISchest] ≥3）的多发伤患者 [损伤严重程度评分（ISS）≥16]。低体温定义为核心体温<35°C。主要终点是 ARDS 和 VAP 的发生。进行了倾向评分匹配。
共分析了 238 例患者的数据，ISS 中位数为 26（四分位距=12）。共有 67 例患者（28%）入院时体温过低。低体温患者损伤更严重（中位数 ISS 34 比 24，p<0.001），需要更多的输血（p<0.001）。因此，他们的死亡率增加（10%比 1%，p=0.002）；在进行倾向评分匹配后，死亡率仍然更高（10%比 2%，p=0.046）。然而，低体温并不是死亡率的独立预测因素。低体温患者需要更长时间的通气（p=0.02）。然而，ARDS 和 VAP 的发生率没有差异。低体温未被确定为 ARDS 和 VAP 的独立预测因素。
在严重钝性胸部创伤的多发伤患者中，意外低体温不是 ARDS 和 VAP 的独立预测因素，更可能是损伤严重程度和出血的伴随症状。
