Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Sep 1;133(3):723-730.
doi: 10.1213/ANE.0000000000005442.

Blunt Chest Trauma and Regional Anesthesia for Analgesia of Multitrauma Patients in French Intensive Care Units: A National Survey

Raiko Blondonnet  1   2 , Marc Begard  1 , Matthieu Jabaudon  1   2 , Thomas Godet  1 , Benjamin Rieu  1 , Jules Audard  1   2 , Kevin Lagarde  1 , Emmanuel Futier  1   2 , Bruno Pereira  3 , Pierre Bouzat  4 , Jean-Michel Constantin  5
Affiliations

Blunt Chest Trauma and Regional Anesthesia for Analgesia of Multitrauma Patients in French Intensive Care Units: A National Survey

Raiko Blondonnet et al. Anesth Analg. .

Abstract

Background: Chest injuries are associated with mortality among patients admitted to the intensive care unit (ICU) and require multimodal pain management strategies, including regional anesthesia (RA). We conducted a survey to determine the current practices of physicians working in ICUs regarding RA for the management of chest trauma in patients with multiple traumas.

Methods: An online questionnaire was sent to medical doctors (n = 1230) working in French ICUs, using the Société Française d'Anesthésie Réanimation (SFAR) mailing list of its members. The questionnaire addressed 3 categories: general characteristics, practical aspects of RA, and indications and contraindications.

Results: Among the 333 respondents (response rate = 27%), 78% and 40% of 156 respondents declared that they would consider using thoracic epidural analgesia (TEA) and thoracic paravertebral blockade (TPB), respectively. The main benefits declared for performing RA were the ability to have effective analgesia, a more effective cough, and early rehabilitation. For 70% of the respondents, trauma patients with a theoretical indication of RA did not receive TEA or TPB for the following reasons: the ICU had no experience of RA (62%), no anesthesiologist-intensivist working in the ICU (46%), contraindications (27%), ignorance of the SFAR guidelines (19%), and no RA protocol available (13%). In this survey, 95% of the respondents thought the prognosis of trauma patients could be influenced by the use of RA.

Conclusions: While TEA and TPB are underused because of several limitations related to the patterns of injuries in multitrauma patients, lack of both experience and confidence in combination with the absence of available protocols appear to be the major restraining factors, even if physicians are aware that patients' outcomes could be improved by RA. These results suggest the need to strengthen initial training and provide continuing education about RA in the ICU.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflicts of interest.

Comment in

  • Ultrasound Offers a Change to Refine ATLS Standards.
    Bello C, Sauter AR, Doll D, Luedi MM. Bello C, et al. Anesth Analg. 2022 Jan 1;134(1):e3-e4. doi: 10.1213/ANE.0000000000005781. Anesth Analg. 2022. PMID: 34908553 No abstract available.
  • In Response.
    Blondonnet R, Begard M, Bouzat P, Jabaudon M. Blondonnet R, et al. Anesth Analg. 2022 Jan 1;134(1):e4. doi: 10.1213/ANE.0000000000005782. Anesth Analg. 2022. PMID: 34908554 No abstract available.

References

    1. Willenberg L, Curtis K, Taylor C, Jan S, Glass P, Myburgh J. The variation of acute treatment costs of trauma in high-income countries. BMC Health Serv Res. 2012;12:267.
    1. Ramin S, Charbit J, Jaber S, Capdevila X. Acute respiratory distress syndrome after chest trauma: epidemiology, specific physiopathology and ventilation strategies. Anaesth Crit Care Pain Med. 2019;38:265–276.
    1. Chapman BC, Herbert B, Rodil M, et al. RibScore: a novel radiographic score based on fracture pattern that predicts pneumonia, respiratory failure, and tracheostomy. J Trauma Acute Care Surg. 2016;80:95–101.
    1. Antonelli M, Conti G, Moro ML, et al. Predictors of failure of noninvasive positive pressure ventilation in patients with acute hypoxemic respiratory failure: a multi-center study. Intensive Care Med. 2001;27:1718–1728.
    1. Hernandez G, Fernandez R, Lopez-Reina P, et al. Noninvasive ventilation reduces intubation in chest trauma-related hypoxemia: a randomized clinical trial. Chest. 2010;137:74–80.

MeSH terms