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Lung complications are common in intensive care treated patients with pelvis fractures: a retrospective cohort study
Joakim Engström1, Henrik Reinius2, Jennie Ström2
1Anesthesiology and Intensive Care, Department of Surgical Sciences, Uppsala University, SE-751 85, Uppsala, Sweden. joakim.engstrom@surgsci.uu.se.
Insights
Severe respiratory complications like acute hypoxic failure and acute respiratory distress syndrome are common in intensive care unit patients with pelvis fractures. Surgical stabilization may worsen respiratory function in patients with lung contusions, but mortality remains low.
Area of Science:
- Trauma Surgery
- Intensive Care Medicine
- Pulmonology
Background:
- Severe respiratory complications in pelvis fracture patients requiring ICU care were previously unstudied.
- Pelvis fractures are associated with significant morbidity and mortality, with respiratory issues being a major concern.
- Understanding the incidence and impact of respiratory complications is crucial for optimizing patient management.
Purpose of the Study:
- To determine the incidence of severe respiratory complications in ICU patients with pelvis fractures.
- To investigate the association between surgical intervention and pulmonary condition in these patients.
- To examine the relationship between lung complications and mortality.
Main Methods:
- A registry study included 112 patients admitted to the ICU for surgical stabilization of pelvis fractures between 2007 and 2014.
- Data collected included incidence of acute hypoxic failure (AHF) and acute respiratory distress syndrome (ARDS).
- Analysis focused on respiratory parameters, lung contusions, pneumonia, surgical timing, and mortality.
Main Results:
- The incidence of AHF/ARDS was 67%, with AHF at 44% and ARDS at 23%.
- Patients with AHF/ARDS had higher rates of lung contusions and pneumonia.
- Surgical stabilization was associated with worsening respiratory function in patients with lung contusions, and earlier surgery was noted in AHF/ARDS patients.
Conclusions:
- Respiratory failure is highly prevalent in ICU patients with pelvis fractures.
- Surgical stabilization may negatively impact respiratory function, particularly in those with lung contusions.
- Mortality was low and not significantly linked to respiratory complications.
Background:
The incidence of severe respiratory complications in patients with pelvis fractures needing intensive care have not previously been studied. Therefore, the aims of this registry study were to 1) determine the number of ICU patients with pelvis fractures who had severe respiratory complications 2) whether the surgical intervention in these patients is associated with the pulmonary condition and 3) whether there is an association between lung complications and mortality. We hypothesized that acute hypoxic failure (AHF) and acute respiratory distress syndrome (ARDS) 1) are common in ICU treated patients with pelvis fractures, 2) are not related to the reconstructive surgery, or to 3) to mortality.
Methods:
All patients in the database cohort (n = 112), scheduled for surgical stabilization of pelvis ring and/or acetabulum fractures, admitted to the general ICU at Uppsala University Hospital between 2007 and 2014 for intensive care were included.
Results:
The incidence of AHF/ARDS was 67 % (75/112 patients), i.e., the percentage of patients that at any period during the ICU stay fulfilled the AHF/ARDS criteria. The incidence of AHF was 44 % and incidence of ARDS was 23 %. The patients with AHF/ARDS had more lung contusions and pneumonia than the patients without AHF/ARDS. Overall, there were no significant changes in oxygenation variables associated with surgery. However, 23 patients with pre-operative normal lung status developed AHF/ARDS in relation to the surgical procedure, whereas 12 patients with AHF/ARDS normalized their lung condition. The patients who developed AHF/ARDS had a higher incidence of lung contusion (P = 0.04) and the surgical stabilization was performed earlier (5 versus 10 days) in these patients (P = 0.03).
Conclusions:
We found that the incidence of respiratory failure in ICU treated patients with pelvis fractures was high, that the procedure around surgical stabilization seems to be associated with a worsening in the respiratory function in patients with lung contusion, and that mortality was low and was probably not related to the respiratory condition.
Trial Registration:
Study was registered at ISRCTN.org number, ISRCTN10335587 .
