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Experimental Model to Evaluate Resolution of Pneumonia
Published on: February 17, 2023
Attenuation of MODS-related and ARDS-related mortality makes infectious complications a remaining challenge in the
Karlijn J P van Wessem1, Falco Hietbrink1, Luke P H Leenen1
1Department of Trauma Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
Introduction:
The recent decrease in multiple organ dysfunction syndrome (MODS)-associated and adult respiratory distress syndrome (ARDS)-associated mortality could be considered a success of improvements in trauma care. However, the incidence of infections remains high in patients with polytrauma, with high morbidity and hospital resources usage. Infectious complications might be a residual effect of the decrease in MODS-related/ARDS-related mortality. This study investigated the current incidence of infectious complications in polytrauma.
Methods:
A 5.5-year prospective population-based cohort study included consecutive severely injured patients (age >15) admitted to a (Level-1) trauma center intensive care unit (ICU) who survived >48 hours. Demographics, physiologic and resuscitation parameters, multiple organ failure and ARDS scores, and infectious complications (pneumonia, fracture-related infection, meningitis, infections related to blood, wound, and urinary tract) were prospectively collected. Data are presented as median (IQR), p<0.05 was considered significant.
Results:
297 patients (216 (73%) men) were included with median age of 46 (27-60) years, median Injury Severity Score was 29 (22-35), 96% sustained blunt injuries. 44 patients (15%) died. One patient (2%) died of MODS and 1 died of ARDS. 134 patients (45%) developed 201 infectious complications. Pneumonia was the most common complication (50%). There was no difference in physiologic parameters on arrival in emergency department and ICU between patients with and without infectious complications. Patients who later developed infections underwent more often a laparotomy (32% vs 18%, p=0.009), had more often pelvic fractures (38% vs 25%, p=0.02), and received more blood products <8 hours. They had more often MODS (25% vs 13%, p=0.005), stayed longer on the ventilator (10 (5-15) vs 5 (2-8) days, p<0.001), longer in ICU (11 (6-17) vs 6 (3-10) days, p<0.001), and in hospital (30 (20-44) vs 16 (10-24) days, p<0.001). There was however no difference in mortality (12% vs 17%, p=0.41) between both groups.
Conclusion:
45% of patients developed infectious complications. These patients had similar mortality rates, but used more hospital resources. With low MODS-related and ARDS-related mortality, infections might be a residual effect, and are one of the remaining challenges in the treatment of patients with polytrauma.
Level Of Evidence:
Level 3.
Study Type:
Population-based cohort study.
Insights
Infectious complications affect nearly half of polytrauma patients, increasing hospital resource use without raising mortality. Infections remain a key challenge in severe trauma care.
Area of Science:
- Trauma Surgery
- Critical Care Medicine
- Infectious Diseases
Background:
- Advances in trauma care have reduced mortality from multiple organ dysfunction syndrome (MODS) and adult respiratory distress syndrome (ARDS).
- However, infections remain a significant challenge in polytrauma patients, contributing to high morbidity and resource utilization.
- This study aimed to determine the current incidence of infectious complications in this patient population.
Purpose of the Study:
- To investigate the incidence and characteristics of infectious complications in severely injured polytrauma patients.
- To identify factors associated with the development of infections post-trauma.
- To assess the impact of infections on patient outcomes and hospital resource consumption.
Main Methods:
- A prospective, population-based cohort study was conducted over 5.5 years.
- Included were severely injured patients (age >15) admitted to a Level-1 trauma center ICU who survived >48 hours.
- Data collected included demographics, injury severity, physiological parameters, organ failure scores, and specific infectious complications.
Main Results:
- 45% of 297 polytrauma patients developed infectious complications, with pneumonia being the most frequent (50%).
- Patients with infections had higher rates of MODS, required longer ventilation and ICU stays, and consumed more hospital resources.
- Despite increased resource use and MODS, infectious complications did not significantly impact overall mortality rates.
Conclusions:
- Infectious complications are highly prevalent in polytrauma patients, presenting a significant challenge.
- While not increasing mortality, infections substantially elevate morbidity and hospital resource utilization.
- Addressing infectious complications is crucial for improving outcomes and managing resources in severe trauma care.
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