Lung complications are common in intensive care treated patients with pelvis fractures: a retrospective cohort study

Joakim Engström; Henrik Reinius; Jennie Ström; Monica Frick Bergström; Ing-Marie Larsson; Anders Larsson; Tomas Borg

doi:10.1186/s13049-016-0244-1

Lung complications are common in intensive care treated patients with pelvis fractures: a retrospective cohort study

Scand J Trauma Resusc Emerg Med. 2016 Apr 19:24:52. doi: 10.1186/s13049-016-0244-1.

Authors

Joakim Engström¹, Henrik Reinius², Jennie Ström², Monica Frick Bergström², Ing-Marie Larsson², Anders Larsson², Tomas Borg³

Affiliations

¹ Anesthesiology and Intensive Care, Department of Surgical Sciences, Uppsala University, SE-751 85, Uppsala, Sweden. joakim.engstrom@surgsci.uu.se.
² Anesthesiology and Intensive Care, Department of Surgical Sciences, Uppsala University, SE-751 85, Uppsala, Sweden.
³ Orthopedics, Department of Surgical Sciences, Uppsala University, SE-751 85, Uppsala, Sweden.

Abstract

Background: The incidence of severe respiratory complications in patients with pelvis fractures needing intensive care have not previously been studied. Therefore, the aims of this registry study were to 1) determine the number of ICU patients with pelvis fractures who had severe respiratory complications 2) whether the surgical intervention in these patients is associated with the pulmonary condition and 3) whether there is an association between lung complications and mortality. We hypothesized that acute hypoxic failure (AHF) and acute respiratory distress syndrome (ARDS) 1) are common in ICU treated patients with pelvis fractures, 2) are not related to the reconstructive surgery, or to 3) to mortality.

Methods: All patients in the database cohort (n = 112), scheduled for surgical stabilization of pelvis ring and/or acetabulum fractures, admitted to the general ICU at Uppsala University Hospital between 2007 and 2014 for intensive care were included.

Results: The incidence of AHF/ARDS was 67 % (75/112 patients), i.e., the percentage of patients that at any period during the ICU stay fulfilled the AHF/ARDS criteria. The incidence of AHF was 44 % and incidence of ARDS was 23 %. The patients with AHF/ARDS had more lung contusions and pneumonia than the patients without AHF/ARDS. Overall, there were no significant changes in oxygenation variables associated with surgery. However, 23 patients with pre-operative normal lung status developed AHF/ARDS in relation to the surgical procedure, whereas 12 patients with AHF/ARDS normalized their lung condition. The patients who developed AHF/ARDS had a higher incidence of lung contusion (P = 0.04) and the surgical stabilization was performed earlier (5 versus 10 days) in these patients (P = 0.03).

Conclusions: We found that the incidence of respiratory failure in ICU treated patients with pelvis fractures was high, that the procedure around surgical stabilization seems to be associated with a worsening in the respiratory function in patients with lung contusion, and that mortality was low and was probably not related to the respiratory condition.

Trial registration: Study was registered at ISRCTN.org number, ISRCTN10335587 .

Keywords: Acute hypoxic failure; Acute respiratory distress syndrome; Intensive care units; Traumatic pelvis fracture.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Blood Gas Analysis
Critical Care / methods*
Female
Follow-Up Studies
Fracture Fixation, Internal / adverse effects*
Fractures, Bone / complications*
Fractures, Bone / diagnosis
Fractures, Bone / surgery
Humans
Incidence
Intensive Care Units*
Male
Middle Aged
Pelvic Bones / injuries*
Respiration, Artificial / methods
Respiratory Distress Syndrome / epidemiology
Respiratory Distress Syndrome / etiology*
Respiratory Distress Syndrome / therapy
Retrospective Studies
Risk Factors
Survival Rate / trends
Sweden / epidemiology
Tomography, X-Ray Computed

Associated data

ISRCTN/ISRCTN10335587