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. 2020 Aug 27;10(1):116.
doi: 10.1186/s13613-020-00733-0.

Epidural analgesia in ICU chest trauma patients with fractured ribs: retrospective study of pain control and intubation requirements

Konstantinos Bachoumas  1 , Albrice Levrat  2 , Aurélie Le Thuaut  3 , Stéphane Rouleau  4 , Samuel Groyer  5 , Hervé Dupont  6 , Paul Rooze  7 , Nathanael Eisenmann  8 , Timothée Trampont  9 , Julien Bohé  10 , Benjamin Rieu  11 , Jean-Charles Chakarian  12 , Aurélie Godard  13 , Laura Frederici  14 , Stephanie Gélinotte  15 , Aurélie Joret  16 , Pascale Roques  17 , Benoit Painvin  18 , Christophe Leroy  19 , Marcel Benedit  20 , Loic Dopeux  21 , Edouard Soum  22 , Vlad Botoc  23 , Muriel Fartoukh  24 , Marie-Hélène Hausermann  25 , Toufik Kamel  26 , Jean Morin  27 , Roland De Varax  28 , Gaetan Plantefève  29 , Alexandre Herbland  30 , Matthieu Jabaudon  31 , Thibault Duburcq  32 , Christelle Simon  33 , Russell Chabanne  34 , Francis Schneider  35 , Frederique Ganster  36 , Cedric Bruel  37 , Ahmed-Saïd Laggoune  38 , Delphine Bregeaud  39 , Bertrand Souweine  40 , Jean Reignier  41 , Jean-Baptiste Lascarrou  42
Affiliations

Epidural analgesia in ICU chest trauma patients with fractured ribs: retrospective study of pain control and intubation requirements

Konstantinos Bachoumas et al. Ann Intensive Care. .

Abstract

Background: Nonintubated chest trauma patients with fractured ribs admitted to the intensive care unit (ICU) are at risk for complications and may require invasive ventilation at some point. Effective pain control is essential. We assessed whether epidural analgesia (EA) in patients with fractured ribs who were not intubated at ICU admission decreased the need for invasive mechanical ventilation (IMV). We also looked for risk factors for IMV.

Study design and methods: This retrospective, observational, multicenter study conducted in 40 ICUs in France included consecutive patients with three or more fractured ribs who were not intubated at admission between July 2013 and July 2015.

Results: Of the 974 study patients, 788 were included in the analysis of intubation predictors. EA was used in 130 (16.5%) patients, and 65 (8.2%) patients required IMV. Factors independently associated with IMV were chronic respiratory disease (P = 0.008), worse SAPS II (P < 0.0001), flail chest (P = 0.02), worse Injury Severity Score (P = 0.0003), higher respiratory rate at admission (P = 0.02), alcohol withdrawal syndrome (P < 0.001), and noninvasive ventilation (P = 0.04). EA was not associated with decreases in IMV requirements, median numerical rating scale pain score, or intravenous morphine requirements from day 1 to day 7.

Conclusions: EA was not associated with a lower risk of IMV in chest trauma patients with at least 3 fractured ribs, moderate pain, and no intubation on admission. Further studies are needed to clarify the optimal pain control strategy in chest trauma patients admitted to the ICU, notably those with severe pain or high opioid requirements.

Keywords: Chest trauma; Epidural analgesia.

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Conflict of interest statement

The authors have no competing interests to declare.

Figures

Fig. 1
Fig. 1
Cumulative incidence of invasive mechanical ventilation
See this image and copyright information in PMC

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