RT Journal Article
SR Electronic
T1 Onset of Respiratory Complications in ICU Patients With Three or More Rib Fractures
JF Respiratory Care
FD American Association for Respiratory Care
SP 3451195
VO 65
IS Suppl 10
A1 Kyle m Schmitt
A1 Jeffery Musgrave
A1 Terry Forrette
A1 Marianna Tumminello
A1 Patrick Greiffenstein
YR 2020
UL http://rc.rcjournal.com/content/65/Suppl_10/3451195.abstract
AB Background: Patients with multiple rib fractures are at higher risk for respiratory complications and mortality. Current recommendations are admission with close observation for patients at high risk for significant respiratory complications (SRC); namely over sixty-five years of age concurrent with four or more rib fractures. However, the duration of close monitoring is not clear and often patients are transferred out of critical care setting after a brief period. We hypothesize that SRC arise beyond seventy-two hours from time of hospital admission. Methods: Retrospective chart review of adult patients admitted to Level 1 Trauma Center from 2015 to 2018 with three or more rib fractures who were initially breathing spontaneously and developed SRC. Demographic and clinical data were analyzed and date of onset of SRC was noted. SRC were defined as respiratory failure or respiratory distress requiring intubation or noninvasive ventilatory support. Institutional Review Board approval was obtained and data were analyzed using standard statistical methods. Results: 1078 patients met inclusion criteria, of which 343 (32%) developed a complication. Of these, twenty-two patients developed a rib-fracture-related SRC and were included in the final analysis. All were admitted to the Trauma ICU for close observation. The average age was 60 years old and average Chest Abbreviated Injury Score (AIS) was 3.1. Nine patients (40%) were transferred out of the TICU after this initial observation period (3.5 days avg.) and developed SRC thereafter. One of these patients died. Onset of SRC in this group was 7.4 days following admission. On average, patients with 3 or more rib fractures were transferred from the ICU 7.6 days after admission, and developed SRC 6 days after admission. Conclusions: Significant respiratory complications are uncommon amongst patients with rib fractures admitted to our trauma center. When they did occur, they commonly developed after their initial period of close observation in the ICU. Therefore strategies to prevent SRC should include daily reassessment of respiratory risk and be sustained beyond the initial close observation period.