Lung failure after polytrauma with concomitant thoracic trauma in the elderly: an analysis from the TraumaRegister DGU®

Abstract

Background: In developed countries worldwide, the number of older patients is increasing. Pulmonary complications are common in multiple injured patients with chest injuries. We assessed whether geriatric patients develop lung failure following multiple trauma with concomitant thoracic trauma more often than younger patients.

Methods: A retrospective analysis of severely injured patients with concomitant blunt thoracic trauma registered in the TraumaRegister DGU® (TR-DGU) between 2009 and 2018 was performed. Patients were categorized into four age groups: 55-64 y, 65-74 y, 75-84 y, and ≥ 85 y. Adult patients aged 18-54 years served as a reference group. Lung failure was defined as PaO2/FIO2 ≤ 200 mm Hg, if mechanical ventilation was performed.

Results: A total of 43,289 patients were included, of whom 9238 (21.3%) developed lung failure during their clinical stay. The rate of posttraumatic lung failure was seen to increase with age. While lung failure markedly increased the length of hospital stay, duration of mechanical ventilation, and length of ICU stay independent of the patient's age, differences between younger and older patients with lung failure in regard to these parameters were clinically comparable. In addition, the development of respiratory failure showed a distinct increase in mortality with higher age, from 16.9% (18-54 y) to 67.2% (≥ 85 y).

Conclusion: Development of lung failure in severely injured patients with thoracic trauma markedly increases hospital length of stay, length of ICU stay, and duration of mechanical ventilation in patients, regardless of age. The development of respiratory failure appears to be related to the severity of the chest trauma rather than to increasing patient age. However, the greatest effects of lung failure, particularly in terms of mortality, were observed in the oldest patients.

Keywords: Geriatric patients; Lung failure; Thoracic trauma.

Fig. 1

Flowchart study population. Abbreviations ICU, Intensive Care Unit; MAIS, Maximum Abbreviated Injury Scale; D, Germany; A, Austria; CH, Switzerland

Fig. 2

Duration of intubation and ICU stay. The duration of intubation (A) and ICU stay (B) of all patients with or without lung failure are shown for the different age groups. Abbreviations LF−, without lung failure; LF+, with lung failure; y, years

Fig. 3

Duration of in-hospital stay and in-hospital mortality. The duration of in-hospital stay (A) and in-hospital mortality (B) of all patients with or without lung failure are shown for the different age groups. Abbreviations LF−, without lung failure; LF+, with lung failure; y, years

Fig. 4

Rate of lung failure according to the Abbreviated Injury Scale. The rate of lung failure (%) according to the AIS severity for rib fractures (A) or hemo-/pneumothorax (B) is shown for the different age groups. AIS rib fracture: AIS 1: Fracture, 1 rib; AIS 2: Fracture, 2 ribs; AIS 3: Fracture, ≥ 3 ribs or multi-fragment fractures of 3–5 ribs (unstable thorax), unilateral; AIS 4: Multi-fragment fractures of > 5 ribs (unstable thorax), unilateral; AIS 5: Multi-fragment fractures (unstable thorax), bilateral. Abbreviations AIS, Abbreviated Injury Scale