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Mortality amongst multiple trauma patients admitted to an intensive therapy unit
Anaesthesia
|October 1, 1984
Summary
A specific anesthetic combination in ventilated patients significantly increased intensive care unit mortality. Discontinuing this regimen led to a sharp decline in patient deaths, suggesting a link between anesthetic agents and survival rates.
Area of Science:
- Critical Care Medicine
- Anesthesiology
- Trauma Surgery
Background:
- Between 1969 and 1982, a retrospective review analyzed 428 severely injured patients in an intensive therapy unit.
- Patient outcomes were assessed using the Injury Severity Score (ISS), Complications Impact Index, and Sepsis Score.
Purpose of the Study:
- To investigate a sudden increase in mortality among severely injured patients between 1981-1982.
- To identify potential causes for increased mortality, particularly in ventilated patients surviving over 5 days.
Main Methods:
- Retrospective analysis of patient data from 1969 to 1982.
- Correlation of mortality rates with injury severity, complications, and specific analgesic/sedative drug regimens used in ventilated patients.
Main Results:
- Mortality rose from 19-29% (1969-1980) to 47% (1981-1982) despite unchanged Injury Severity Score.
- A significant increase in mortality (28% to 77%) was observed in ventilated patients receiving morphine with etomidate compared to morphine with or without benzodiazepines.
- Discontinuation of the etomidate regimen in May 1983 coincided with a decrease in mortality to 25%.
Conclusions:
- The combination of morphine and etomidate as an analgesic/sedative regimen in ventilated patients was strongly associated with increased mortality.
- Potential mechanisms for increased mortality may involve etomidate-induced adrenocortical insufficiency or excessive anesthetic depth.
- Changes in anesthetic management, not injury severity, appear to be the primary driver of the observed rise in mortality.
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