Risk factors for severe chest trauma complicated by acute respiratory distress syndrome / 中华创伤杂志

ABSTRACT

Objective:To investigate the risk factors of severe chest trauma complicated by acute respiratory distress syndrome (ARDS).Methods:A case control study was conducted to analyze the clinical data of 120 patients with severe chest trauma admitted to 909th Hospital of Joint Logistics Support Force (Affiliated Dongnan Hospital of Xianmen University Medical College) from January 2018 to December 2020. There were 75 males and 45 females; aged 21-72 years [(42.2±4.8)years]. The causes of injury were traffic injury in 57 patients, crush injury in 21, fall injury in 21, smash injury in 11 and others in 10. There were 34 patients accompanied by fracture of the limb, spine and pelvis, 23 by abdominal organ injury and 8 by head trauma, with the exception of simple thoracic trauma in 55 patients. The patients were divided into ARDS group ( n=25) and non-ARDS group ( n=95) according to the condition of concurrent ARDS. The two groups were compared regarding the gender, age, causes of injury, respiratory rate, lung contusion, lung infection, flail chest, chest abbreviated injury scale (AIS), hemothorax, blood pressure, partial arterial oxygen pressure (PaO 2), initial central venous pressure (CVP) on admission, combined fracture of the limb, spine and pelvis, combined head injury and combined abdominal organ injury. The correlation between the above indexes and ARDS after severe chest trauma was analyzed by univariate analysis. Multivariate Logistic regression analysis was used to determine the independent risk factors for ARDS after severe chest trauma. Results:Univariate analysis showed a positive correlation of ARDS with age, respiratory rate, lung contusion, lung infection, flail chest, chest AIS, hemothorax, blood pressure, PaO 2, initial CVP on admission, combined fracture of the limb, spine and pelvis and combined abdominal organ injury ( P<0.05 or 0.01), but not with gender, causes of injury or combined head injury (all P>0.05). Multivariate Logistic regression analysis revealed that age ≥60 years ( OR=2.45, 95% CI 1.81-7.50, P<0.01), dyspnea (respiratory rate ≥28 times/minute or <10 times/minute) ( OR=9.55, 95% CI 2.26-9.38, P<0.01), lung contusion ( OR=6.78, 95% CI 1.84-6.96, P<0.01), lung infection ( OR=27.71, 95% CI 11.97-64.14, P<0.01), flail chest ( OR=8.97, 95% CI 2.29-14.97, P<0.01), chest AIS score ( OR=5.77, 95% CI 2.85-9.20, P<0.01), above medium amount of hemothorax ( OR=6.84, 95% CI 1.69-13.39, P<0.01), blood pressure <90 mmHg ( OR=7.93, 95% CI 1.64-11.84, P<0.01), PaO 2<60 mmHg ( OR=6.39, 95% CI 1.06-9.47, P<0.01) and absent initial CVP on admission ( OR=4.56, 95% CI 1.86-8.44, P<0.01) were significantly correlated with ARDS. Conclusion:Age ≥60 years, dyspnea (respiratory rate ≥28 times/minute or <10 times/minute), lung contusion, lung infection, flail chest, chest AIS, above medium l amount of hemothorax, blood pressure <90 mmHg, PaO 2<60 mmHg and absent initial CVP on admission are independent risk factors for ARDS in patients with severe chest trauma.