J. F. Xie1,2, P. K. Gallagher1,2, M. E. Tharp1,2, K. C. Brinton1,2, J. Wycech Knight1,2, I. Puente1,2,3, A. A. Fokin1,2 1Delray Medical Center, Trauma And Critical Care Services, DELRAY BEACH, FL, USA 2Florida Atlantic University, Charles E Schmidt College Of Medicine, Boca Raton, FL, USA 3Broward Health Medical Center, Trauma And Critical Care Services, Fort Lauderdale, FL, USA
Introduction: Respiratory complications are the most common cause of unplanned intensive care unit (ICU) admissions. The aim was to analyze trauma patients with a variety of respiratory causes for unplanned ICU admissions.
Methods: A retrospective cohort study included 80 adult (≥ 18 years old) trauma patients with unplanned ICU admissions due to respiratory causes at a level 1 trauma center (01/2017 to 05/2023). Analyzed variables were: age, sex, comorbidities, mechanism of injury (MOI), Injury Severity Score (ISS), Glasgow Coma Scale (GCS), injury types, time to unplanned ICU admission, respiratory complication types, blood transfusions, rate of surgical procedures, mechanical ventilation requirements, ICU and hospital lengths-of-stay (ICULOS, HLOS), and mortality.
Results: Out of 203 patients with unplanned trauma ICU admissions, 80 (39.4%) patients were admitted for respiratory reasons. Mean age of these patients was 69.0 years, 66.3% were male, and 65.0% were geriatric (≥ 65 years old). 90.0% of patients had comorbidities, the main being cardiological (62.5%). Only 11 patients had respiratory comorbidities (13.8%). The leading MOI were falls (62.5%) and motor vehicle accidents (35.0%). Mean ISS was 11.9 and GCS was 14.3. The main injuries on hospital admission were thoracic (32.5%), brain (20.0%) and spine (17.5%). In total, 81 respiratory events occurred in 80 patients and lead to an ICU upgrade: acute hypoxemic respiratory failure (55.6%), pneumonia (29.6%), post-surgical respiratory complications (6.2%), pulmonary edema (3.7%), aspiration (2.5%), and pulmonary emboli (2.5%). [Fig.1] Overall, the mean time from trauma floor admission to the ICU admission was 4.0 days, with 45.7% of upgrades occurring within 48 hours of floor admission. Blood transfusions were required in 48.8% of patients and surgery in 53.8% of patients. Mechanical ventilation was administered in 67.5% of patients, including tracheostomy in 16.3%, while reintubation was required in 17.5%. Mean duration of mechanical ventilation was 6.3 days, ICULOS was 12.8 days and HLOS was 21.1 days. Mortality rate in the study cohort was 30.0% compared to 11.9% in the general trauma ICU population and 25.6% in unplanned trauma ICU admissions.
Conclusion: Respiratory complications were the main cause of unplanned ICU admission in trauma patients. Over half of these patients were admitted due to acute hypoxemic respiratory failure, and nearly one-third for pneumonia. Respiratory complications occurred most often within 48 hours of admission to the trauma floor and seemingly were not correlated to respiratory comorbidities. Patients with unplanned ICU admissions for respiratory complications had a three times higher mortality rate than the overall trauma ICU patients.
