Brooke Army Medical Center, Department of Internal Medicine, Fort Sam Houston, Texas.
University of Cincinnati Medical Center, Department of Trauma Surgery, Cincinnati, Ohio.
J Surg Res. 2024 Aug;300:247-252. doi: 10.1016/j.jss.2024.04.013. Epub 2024 Jun 1.
Sarcopenia has been shown to portend worse outcomes in injured patients; however, little is known about the impact of thoracic muscle wasting on outcomes of patients with chest wall injury. We hypothesized that reduced pectoralis muscle mass is associated with poor outcomes in patients with severe blunt chest wall injury.
All patients admitted to the intensive care unit between 2014 and 2019 with blunt chest wall injury requiring mechanical ventilation were retrospectively identified. Blunt chest wall injury was defined as the presence of one or more rib fractures as a result of blunt injury mechanism. Exclusion criteria included lack of admission computed tomography imaging, penetrating trauma, <18 y of age, and primary neurologic injury. Thoracic musculature was assessed by measuring pectoralis muscle cross-sectional area (cm) that was obtained at the fourth thoracic vertebral level using Slice-O-Matic software. The area was then divided by the patient height in meters to calculate pectoralis muscle index (PMI) (cm/m). Patients were divided into two groups, 1) the lowest gender-specific quartile of PMI and 2) second-fourth gender-specific PMI quartiles for comparative analysis.
One hundred fifty-three patients met the inclusion criteria with a median (interquartile range) age 48 y (34-60), body mass index of 30.1 kg/m (24.9-34.6), and rib score of 3.0 (2.0-4.0). Seventy-five percent of patients (116/153) were male. Fourteen patients (8%) had prior history of chronic lung disease. Median (IQR) intensive care unit length-of-stay and duration of mechanical ventilation (MV) was 18.0 d (13.0-25.0) and 15.0 d (10.0-21.0), respectively. Seventy-three patients (48%) underwent tracheostomy and nine patients (6%) expired during hospitalization. On multivariate linear regression, reduced pectoralis muscle mass was associated with increased MV duration when adjusting for rib score and injury severity score (β 5.98, 95% confidence interval 1.28-10.68, P = 0.013).
Reduced pectoralis muscle mass is associated with increased duration of MV in patients with severe blunt chest wall injury. Knowledge of this can help guide future research and risk stratification of critically ill chest wall injury patients.
肌少症已被证明与受伤患者的预后较差有关；然而，关于胸肌减少对胸壁损伤患者结局的影响知之甚少。我们假设，严重钝性胸壁损伤患者的胸大肌质量减少与不良结局相关。
回顾性分析 2014 年至 2019 年间因钝性创伤机制导致一根或多根肋骨骨折而需要机械通气的 ICU 收治的所有钝性胸壁损伤患者。钝性胸壁损伤定义为存在一处或多处肋骨骨折。排除标准包括缺乏入院 CT 影像学检查、穿透性损伤、年龄<18 岁和原发性神经损伤。通过 Slice-O-Matic 软件在第 4 胸椎水平测量胸大肌的横截面积（cm）来评估胸肌。然后将面积除以患者的身高（米），以计算胸大肌指数（PMI）（cm/m）。患者分为两组，1）最低性别特定 PMI 四分位数，2）第二四分位至第四四分位性别特定 PMI 四分位数，用于比较分析。
153 名患者符合纳入标准，中位（四分位间距）年龄 48 岁（34-60 岁），体重指数 30.1kg/m（24.9-34.6），肋骨评分 3.0（2.0-4.0）。75%的患者（116/153）为男性。14 名患者（8%）有慢性肺部疾病病史。ICU 住院时间和机械通气时间的中位数（IQR）分别为 18.0d（13.0-25.0）和 15.0d（10.0-21.0）。73 名患者（48%）行气管切开术，9 名患者（6%）住院期间死亡。多元线性回归分析显示，在校正肋骨评分和损伤严重程度评分后，胸大肌质量减少与机械通气时间延长相关（β5.98，95%置信区间 1.28-10.68，P=0.013）。
严重钝性胸壁损伤患者胸大肌质量减少与机械通气时间延长有关。了解这一点有助于指导未来对危重症胸壁损伤患者的研究和风险分层。
