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Vol. 40. Issue 11.
Pages 489-494 (November 2004)
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Vol. 40. Issue 11.
Pages 489-494 (November 2004)
Original Articles
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Predictors of Outcome in Blunt Chest Trauma
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B. Virgós Señora,
Corresponding author
beaagus@wanadoo.es

Correspondence: Dra. B. Virgós Señor. Avda. de Valencia, 51-53, escalera 1.a, 8.° B. 50005 Zaragoza. España
, A.C. Nebra Puertasa, C. Sánchez Polob, A. Broto Civerac, M.A. Suárez Pinillad
a Servicio de Medicina Intensiva, Hospital Universitario Miguel Servet, Zaragoza, Spain
b Servicio de Medicina Intensiva, Hospital Obispo Polanco, Teruel, Spain
c Servicio de Admisión, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
d Servicio de Medicina Intensiva, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
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Introduction

Thoracic trauma is often associated with polytrauma. Because mortality is high, the search for prognostic tools is useful.

Patients and methods

A total of 108 patients with blunt thoracic trauma, 73 of whom had multiple injuries, were studied in an intensive care unit (ICU). The variables named as potential predictors of outcome were the need for mechanical ventilation, duration of ventilation, and high positive end-expiratory pressure (PEEP); the presence of rib fractures, pulmonary contusion, pleural involvement (hemo-and/or pneumothorax), or lung infection; the need for emergency surgery; mean duration of ICU stay, and age. We also studied whether or not the mortality rate was higher in polytrauma patients. Student t and CH2 tests (95% confidence level) and multiple regression analysis (Hosmer-Lemeshow goodness of fit) were used to analyze the results.

Results

The need for mechanical ventilation, radiographic evidence of pulmonary contusion, emergency surgery, and hemodynamic instability were risk factors for increased mortality. Higher risk of mortality was not demonstrated for patients with multiple injuries. For patients in need of mechanical ventilation, high PEEP was a predictor of poor prognosis.

Conclusions

The presence of the aforementioned predictors (mechanical ventilation, high PEEP, pulmonary contusion, emergency surgery, and hemodynamic instability) indicate serious injury to the lung parenchyma, which is the main determinant of outcome for patients with thoracic trauma.

Key Words:
Thoracic trauma
Multiple injuries
Prognosis
Mortality
Mechanical ventilation
Introducción

El traumatismo torácico suele producirse en el contexto de un politraumatismo. La mortalidad eleva-da de esta patología hace lógica la investigación de marcadores pronósticos.

Pacientes Y Métodos

Estudio sobre 108 pacientes ingresa-dos en una unidad de cuidados intensivos, con traumatismo torácico cerrado, de los cuales 73 fueron politraumatizados. Analizamos, como marcadores pronósticos, la necesidad de ventilación mecánica, su duración, la presión positiva máxima final de la espiración, las fracturas costales, la contusión pulmonar, las alteraciones pleurales (hemo y/o neumotórax), la sobreinfección respiratoria, la inestabilidad hemodinámica, la necesidad de cirugía urgente, así como la estancia media y la edad. Estudiamos si fue mayor la mortalidad en los politraumatizados. Se emplearon como herramientas estadísticas las pruebas de la t de Student y de la CH2 (intervalo míni-mo de confianza del 95%), y se realizó un análisis de regresión logística (bondad de ajuste test de Hosmer-Lemeshow).

Resultados

La necesidad de ventilación mecánica, la presencia radiológica de contusión pulmonar, la cirugía urgente y la inestabilidad hemodinámica comportan mayor mortalidad. No se demuestra mayor mortalidad en los en-fermos politraumatizados. En los pacientes con ventilación mecánica, la presión positiva máxima final de la espiración requerida es un indicador de mayor mortalidad.

Conclusiones

Los marcadores positivos indican una mayor lesión en el parénquima pulmonar, lesión que es el de-terminante principal de la evolución de los pacientes con traumatismo torácico.

Palabras clave:
Traumatismo torácico
Politraumatismo
Pronóstico
Mortalidad
Ventilación mecánica
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Copyright © 2004. Sociedad Española de Neumología y Cirugía Torácica (SEPAR)
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