Reitano Elisa, Gavelli Francesco, Iannantuoni Giacomo, Fattori Silvia, Airoldi Chiara, Matranga Simone, Cioffi Stefano Piero Bernardo, Ingala Silvia, Virdis Francesco, Rizzo Martina, Marcomini Nicole, Motta Alberto, Spota Andrea, Maestrone Matteo, Ragozzino Roberta, Altomare Michele, Castello Luigi Mario, Della Corte Francesco, Vaschetto Rosanna, Avanzi Gian Carlo, Chiara Osvaldo, Cimbanassi Stefania
Department of Translational Medicine, University of Eastern Piedmont, Via Solaroli 17, 28100 Novara, Italy.
Emergency Medicine Department, Ospedale Maggiore della Carità, Corso Mazzini 18, 28100 Novara, Italy.
J Clin Med. 2023 Jan 16;12(2):714. doi: 10.3390/jcm12020714.
Chest trauma management often requires the use of invasive and non-invasive ventilation. To date, only a few studies investigated the predictors of the need for ventilatory support. Data on 1080 patients with chest trauma managed in two different centers were retrospectively analyzed. Univariate and multivariate analyses were performed to identify the predictors of tracheal intubation (TI), non-invasive mechanical ventilation (NIMV), and mortality. Rib fractures (p = 0.0001) fracture of the scapula, clavicle, or sternum (p = 0.045), hemothorax (p = 0.0035) pulmonary contusion (p = 0.0241), and a high Injury Severity Score (ISS) (p ≤ 0001) emerged as independent predictors of the need of TI. Rib fractures (p = 0.0009) hemothorax (p = 0.0027), pulmonary contusion (p = 0.0160) and a high ISS (p = 0.0001) were independent predictors of NIMV. The center of trauma care (p = 0.0279), age (p < 0.0001) peripheral oxygen saturation in the emergency department (p = 0.0010), ISS (p < 0.0001), and Revised Trauma Score (RTS) (p < 0.0001) were independent predictors of outcome. In conclusion, patients who do not require TI, while mandating ventilatory support with selected types of injuries and severity scores, are more likely to be subjected to NIMV. Trauma team expertise and the level of the trauma center could influence patient outcomes.
胸部创伤的管理通常需要使用有创和无创通气。迄今为止，只有少数研究调查了通气支持需求的预测因素。对在两个不同中心接受治疗的1080例胸部创伤患者的数据进行了回顾性分析。进行单因素和多因素分析以确定气管插管（TI）、无创机械通气（NIMV）和死亡率的预测因素。肋骨骨折（p = 0.0001）、肩胛骨、锁骨或胸骨骨折（p = 0.045）、血胸（p = 0.0035）、肺挫伤（p = 0.0241）和高损伤严重度评分（ISS）（p≤0.001）是TI需求的独立预测因素。肋骨骨折（p = 0.0009）、血胸（p = 0.0027）、肺挫伤（p = 0.0160）和高ISS（p = 0.0001）是NIMV的独立预测因素。创伤护理中心（p = 0.0279）、年龄（p < 0.0001）、急诊科外周血氧饱和度（p = 0.0010）、ISS（p < 0.0001）和改良创伤评分（RTS）（p < 0.0001）是结局的独立预测因素。总之，不需要TI的患者，在因特定类型的损伤和严重度评分而需要通气支持时，更有可能接受NIMV。创伤团队的专业知识和创伤中心的水平可能会影响患者的结局。
