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. 2022 Jan 1;92(1):28-37.
doi: 10.1097/TA.0000000000003362.

Respiratory events after intensive care unit discharge in trauma patients: Epidemiology, outcomes, and risk factors

Joshua E Rosen  1 , Eileen M Bulger, Joseph Cuschieri
Affiliations

Respiratory events after intensive care unit discharge in trauma patients: Epidemiology, outcomes, and risk factors

Joshua E Rosen et al. J Trauma Acute Care Surg. .

Abstract

Background: Respiratory complications are associated with significant morbidity and mortality in trauma patients. The care transition from the intensive care unit (ICU) to the acute care ward is a vulnerable time for injured patients. There is a lack of knowledge about the epidemiology of respiratory events and their outcomes during this transition.

Methods: Retrospective cohort study in a single Level I trauma center of injured patients 18 years and older initially admitted to the ICU from 2015 to 2019 who survived initial transfer to the acute care ward. The primary outcome was occurrence of a respiratory event, defined as escalation in oxygen therapy beyond nasal cannula or facemask for three or more consecutive hours. Secondary outcomes included unplanned intubation for a primary pulmonary cause, adjudicated via manual chart review, as well as in-hospital mortality and length of stay. Multivariable logistic regression was used to examine patient characteristics associated with posttransfer respiratory events.

Results: There were 6,561 patients that met the inclusion criteria with a mean age of 52.3 years and median Injury Severity Score of 18 (interquartile range, 13-26). Two hundred and sixty-two patients (4.0%) experienced a respiratory event. Respiratory events occurred early after transfer (median, 2 days, interquartile range, 1-5 days), and were associated with high mortality (16% vs. 1.8%, p < 0.001), and ICU readmission rates (52.6% vs. 4.7%, p < 0.001). Increasing age, male sex, severe chest injury, and comorbidities, including preexisting alcohol use disorder, congestive heart failure, and chronic obstructive pulmonary disease, were associated with increased odds of a respiratory event. Fifty-eight patients experienced an unplanned intubation for a primary pulmonary cause, which was associated with an in-hospital mortality of 39.7%.

Conclusion: Respiratory events after transfer to the acute care ward occur close to the time of transfer and are associated with high mortality. Interventions targeted at this critical time are warranted to improve patient outcomes.

Level of evidence: Prognostic and Epidemiological study, level III.

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Conflict of interest statement

Conflicts of Interest and Sources of Funding

All authors declare no conflicts of interest

Figures

Figure 1:
Figure 1:
Patient selection flow diagram *Intubated for primary pulmonary causes
Figure 2:
Figure 2:
Number of days from ICU transfer until first occurrence of a respiratory event and unplanned intubation for a pulmonary cause
See this image and copyright information in PMC

References

    1. Mangram AJ, Sohn J, Zhou N, Hollingworth AK, Ali-Osman FR, Sucher JF, Moyer M, Dzandu JK. Trauma-associated pneumonia: time to redefine ventilator-associated pneumonia in trauma patients. Am J Surg. 2015;210(6):1056–1062. - PubMed
    1. Hoyt DB, Simons RK, Winchell RJ, Cushman J, Hollingsworth-Fridlund P, Holbrook T, Fortlage D. A risk analysis of pulmonary complications following major trauma. J Trauma. 1993;35(4):524–531. - PubMed
    1. Christmas AB, Freeman E, Chisolm A, Fischer PE, Sachdev G, Jacobs DG, Sing RF. Trauma Intensive Care Unit ‘Bouncebacks’: Identifying Risk Factors for Unexpected Return Admission to the Intensive Care Unit. Am Surg. 2014;80(8):778–782. - PubMed
    1. Bradburn EH, Jammula S, Horst MA, Morgan M, Vernon TM, Gross BW, Miller JA, Cook AD, Kim PK, Nieda DV, et al. An analysis of outcomes and predictors of intensive care unit bouncebacks in a mature trauma system. J Trauma Acute Care. 2020;88(4):486–490. - PubMed
    1. Rubano JA, Vosswinkel JA, McCormack JE, Huang EC, Shapiro MJ, Jawa RS. Unplanned intensive care unit admission following trauma. J Crit Care. 2016;33:174–179. - PubMed

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