Résumé
Objective:Severe trauma events are emergent, with low incidence and unpredictable. Current guideline does not provide precise recommendations on how the trauma centers should arrange the number of beds in trauma intensive care units while making rational use of medical resources. We analyzed the trauma intensive care unit bed requirement in the branch campus of our hospital to propose a reasonable assessment.Methods:Patients with severe trauma sent to the Intensive Care Unit of Peking University People's Hospital from January 2022 to June 2022 were collected. The daily number of patients received intensive care was counted. The bed requirement of the intensive care unit covering 99% of clinical needs was calculated based on the probability distribution function.Results:From January 2022 to June 2022, 103 patients with severe trauma [74 males and 29 females, aged (51.47±16.06) years, ranging 16 to 87 years] were included in the study. Among the 103 patients, 57 were injured in traffic accidents, 26 fell from a high altitude, 12 fell, 4 were hit by heavy objects, and 4 were stabbed. TISS ranged from 16 to 50. The range of the daily bed requirement in the intensive care unit was 0–10, which was consistent with the Poisson distribution. According to the probability distribution function, nine trauma intensive care beds could meet 99.19% of clinical needs.Conclusions:In severe traumatic events, patients need to be transferred to intensive care unit as soon as possible. For our branch campus, nine trauma intensive care beds can cover more than 99% of clinical needs. It follows that, in accordance with the basic requirements of trauma center construction, hospitals with trauma centers need at least 9 beds in intensive care units. However, traumatic events cannot be predicted; thus, the bed requirement needs to be regularly evaluated.
Résumé
PURPOSE@#To investigate the effect of early enteral nutrition on outcomes of trauma patients in the intensive care unit (ICU).@*METHODS@#Clinical data of trauma patients in the ICU of Daping Hospital, China from January 2012 to December 2017 was retrospectively analyzed, including patient age, gender, injury mechanism, injury severity score (ISS), nutritional treatment, postoperative complications (wound infection, abdominal abscess, anastomotic rupture, pneumonia), mortality, and adverse events (nausea, vomiting, abdominal distention). Only adult trauma patients who developed bloodstream infection after surgery for damage control were included. Patients were divided into early enteral nutrition group (48 h). Data of all trauma patients were collected by the same investigator. Data were expressed as frequency (percentage), mean ± standard deviation (normal distribution), or median (Q, Q) (non-normal distribution) and analyzed by Chi-square test, Student's t-test, or rank-sum test accordingly. Multiple logistic regression analysis was further adopted to investigate the significant variables with enteral nutrition.@*RESULTS@#Altogether 876 patients were assessed and 110 were eligible for this study, including 93 males and 17 females, with the mean age of (50.0 ± 15.4) years. Traffic accidents (46 cases, 41.8%) and fall from height (31 cases, 28.2%) were the dominant injury mechanism. There were 68 cases in the early enteral nutrition group and 42 cases in the control group. Comparison of general variables between early enteral nutrition group and control group revealed significant difference regarding surgeries of enterectomy (1.5% vs. 19.0%, p = 0.01), ileum/transverse colon/sigmoid colostomy (4.4% vs. 16.3%, p = 0.01) and operation time (h) (3.2 (1.9, 6.1) vs. 4.2 (1.8, 8.8), p = 0.02). Other variables like ISS (p = 0.31), acute physiology and chronic health evaluation≥20 (p = 0.79), etc. had no obvious difference. Chi-square test showed a much better result in early enteral nutrition group than in control group regarding morality (0 vs. 11.9%, p = 0.03), length of hospital stay (days) (76.8 ± 41.4 vs. 81.4 ± 44.7, p = 0.01) and wound infection (10.3% vs. 26.2%, p = 0.03). Logistic regression analysis showed that the incidence of wound infection was related to the duration required to achieve the enteral nutrition standard (OR = 1.095, p = 0.002). Seventy-six patients (69.1%) achieved the nutritional goal within a week and 105 patients (95.5%) in the end. Trauma patients unable to reach the enteral nutrition target within one week were often combined with abdominal infection, peritonitis, bowel resection, intestinal necrosis, intestinal fistula, or septic shock.@*CONCLUSION@#Early enteral nutrition for trauma patients in the ICU is correlated with less wound infection, lower mortality, and shorter hospital stay.