Epidural analgesia in ICU chest trauma patients with fractured ribs: retrospective study of pain control and intubation requirements
Abstract Background Nonintubated chest trauma patients with fractured ribs admitted to the intensive care unit (ICU) are at risk for complications and may require invasive ventilation at some point. Effective pain control is essential. We assessed whether epidural analgesia (EA) in patients with fra...
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| Format: | Article |
| Language: | English |
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SpringerOpen
2020-08-01
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| Series: | Annals of Intensive Care |
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| Online Access: | http://link.springer.com/article/10.1186/s13613-020-00733-0 |
| _version_ | 1818306774208348160 |
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| author | Konstantinos Bachoumas Albrice Levrat Aurélie Le Thuaut Stéphane Rouleau Samuel Groyer Hervé Dupont Paul Rooze Nathanael Eisenmann Timothée Trampont Julien Bohé Benjamin Rieu Jean-Charles Chakarian Aurélie Godard Laura Frederici Stephanie Gélinotte Aurélie Joret Pascale Roques Benoit Painvin Christophe Leroy Marcel Benedit Loic Dopeux Edouard Soum Vlad Botoc Muriel Fartoukh Marie-Hélène Hausermann Toufik Kamel Jean Morin Roland De Varax Gaetan Plantefève Alexandre Herbland Matthieu Jabaudon Thibault Duburcq Christelle Simon Russell Chabanne Francis Schneider Frederique Ganster Cedric Bruel Ahmed-Saïd Laggoune Delphine Bregeaud Bertrand Souweine Jean Reignier Jean-Baptiste Lascarrou |
| author_facet | Konstantinos Bachoumas Albrice Levrat Aurélie Le Thuaut Stéphane Rouleau Samuel Groyer Hervé Dupont Paul Rooze Nathanael Eisenmann Timothée Trampont Julien Bohé Benjamin Rieu Jean-Charles Chakarian Aurélie Godard Laura Frederici Stephanie Gélinotte Aurélie Joret Pascale Roques Benoit Painvin Christophe Leroy Marcel Benedit Loic Dopeux Edouard Soum Vlad Botoc Muriel Fartoukh Marie-Hélène Hausermann Toufik Kamel Jean Morin Roland De Varax Gaetan Plantefève Alexandre Herbland Matthieu Jabaudon Thibault Duburcq Christelle Simon Russell Chabanne Francis Schneider Frederique Ganster Cedric Bruel Ahmed-Saïd Laggoune Delphine Bregeaud Bertrand Souweine Jean Reignier Jean-Baptiste Lascarrou |
| author_sort | Konstantinos Bachoumas |
| collection | DOAJ |
| description | Abstract Background Nonintubated chest trauma patients with fractured ribs admitted to the intensive care unit (ICU) are at risk for complications and may require invasive ventilation at some point. Effective pain control is essential. We assessed whether epidural analgesia (EA) in patients with fractured ribs who were not intubated at ICU admission decreased the need for invasive mechanical ventilation (IMV). We also looked for risk factors for IMV. Study design and methods This retrospective, observational, multicenter study conducted in 40 ICUs in France included consecutive patients with three or more fractured ribs who were not intubated at admission between July 2013 and July 2015. Results Of the 974 study patients, 788 were included in the analysis of intubation predictors. EA was used in 130 (16.5%) patients, and 65 (8.2%) patients required IMV. Factors independently associated with IMV were chronic respiratory disease (P = 0.008), worse SAPS II (P < 0.0001), flail chest (P = 0.02), worse Injury Severity Score (P = 0.0003), higher respiratory rate at admission (P = 0.02), alcohol withdrawal syndrome (P < 0.001), and noninvasive ventilation (P = 0.04). EA was not associated with decreases in IMV requirements, median numerical rating scale pain score, or intravenous morphine requirements from day 1 to day 7. Conclusions EA was not associated with a lower risk of IMV in chest trauma patients with at least 3 fractured ribs, moderate pain, and no intubation on admission. Further studies are needed to clarify the optimal pain control strategy in chest trauma patients admitted to the ICU, notably those with severe pain or high opioid requirements. |
| first_indexed | 2024-12-13T06:47:49Z |
| format | Article |
| id | doaj.art-ee14d848a9bd464aac8e57c6f0cc9a43 |
| institution | Directory Open Access Journal |
| issn | 2110-5820 |
| language | English |
| last_indexed | 2024-12-13T06:47:49Z |
| publishDate | 2020-08-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Annals of Intensive Care |
| spelling | doaj.art-ee14d848a9bd464aac8e57c6f0cc9a432022-12-21T23:56:13ZengSpringerOpenAnnals of Intensive Care2110-58202020-08-0110111210.1186/s13613-020-00733-0Epidural analgesia in ICU chest trauma patients with fractured ribs: retrospective study of pain control and intubation requirementsKonstantinos Bachoumas0Albrice Levrat1Aurélie Le Thuaut2Stéphane Rouleau3Samuel Groyer4Hervé Dupont5Paul Rooze6Nathanael Eisenmann7Timothée Trampont8Julien Bohé9Benjamin Rieu10Jean-Charles Chakarian11Aurélie Godard12Laura Frederici13Stephanie Gélinotte14Aurélie Joret15Pascale Roques16Benoit Painvin17Christophe Leroy18Marcel Benedit19Loic Dopeux20Edouard Soum21Vlad Botoc22Muriel Fartoukh23Marie-Hélène Hausermann24Toufik Kamel25Jean Morin26Roland De Varax27Gaetan Plantefève28Alexandre Herbland29Matthieu Jabaudon30Thibault Duburcq31Christelle Simon32Russell Chabanne33Francis Schneider34Frederique Ganster35Cedric Bruel36Ahmed-Saïd Laggoune37Delphine Bregeaud38Bertrand Souweine39Jean Reignier40Jean-Baptiste Lascarrou41Médecine Intensive Réanimation, District Hospital CenterIntensive Care Unit, Regional Hospital CenterPlateforme de la méthodologie et de la Biostatistique, Direction de la Recherche Clinique, CHU de NantesIntensive Care Unit, Hospital CenterIntensive Care Unit, Hospital CenterSurgical Intensive Care Unit, University HospitalSurgical Intensive Care Unit, University HospitalIntensive Care Unit, Jean Perrin CenterIntensive Care Unit, University HospitalUniversity Hospital, Lyon SudSurgical Intensive Care Unit, Gabriel-Montpied University HospitalIntensive Care Unit, Regional Hospital CenterIntensive Care Unit, Regional Hospital CenterIntensive Care Unit, Regional Hospital Center, Sud FrancilienIntensive Care Unit, Regional Hospital CenterSurgical Intensive Care Unit, University HospitalIntensive Care Unit, Regional Hospital CenterIntensive Care Unit, Regional Hospital CenterIntensive Care Unit, Regional Hospital CenterIntensive Care Unit, Regional Hospital CenterIntensive Care Unit, Regional Hospital CenterIntensive Care Unit, Regional Hospital CenterIntensive Care Unit, Regional Hospital CenterIntensive Care Unit, University Hospital, TenonIntensive Care Unit, Regional Hospital CenterIntensive Care Unit, Regional Hospital CenterRespiratory Care Unit, University HospitalIntensive Care Unit, Regional Hospital CenterIntensive Care Unit, Regional Hospital CenterIntensive Care Unit, Regional Hospital CenterDepartment of Perioperative Medicine, CHU Clermont-Ferrand and GReD, CNRS, UMR 6293, INSERM U1103, Universite Clermont AuvergneMedical Intensive Care Unit, University HospitalIntensive Care Unit, Regional Hospital CenterNeurological Intensive Care Unit, University HospitalMédecine Intensive-Réanimation, Hôpital de Hautepierre, Hôpitaux Universitaires de StrasbourgIntensive Care Unit, Regional Hospital CenterIntensive Care Unit, Saint-Joseph Hospital CenterIntensive Care Unit, Regional Hospital CenterIntensive Care Unit, Regional Hospital CenterMedical Intensive Care Unit, Gabriel-Montpied University HospitalMédecine Intensive Réanimation, University HospitalMédecine Intensive Réanimation, University HospitalAbstract Background Nonintubated chest trauma patients with fractured ribs admitted to the intensive care unit (ICU) are at risk for complications and may require invasive ventilation at some point. Effective pain control is essential. We assessed whether epidural analgesia (EA) in patients with fractured ribs who were not intubated at ICU admission decreased the need for invasive mechanical ventilation (IMV). We also looked for risk factors for IMV. Study design and methods This retrospective, observational, multicenter study conducted in 40 ICUs in France included consecutive patients with three or more fractured ribs who were not intubated at admission between July 2013 and July 2015. Results Of the 974 study patients, 788 were included in the analysis of intubation predictors. EA was used in 130 (16.5%) patients, and 65 (8.2%) patients required IMV. Factors independently associated with IMV were chronic respiratory disease (P = 0.008), worse SAPS II (P < 0.0001), flail chest (P = 0.02), worse Injury Severity Score (P = 0.0003), higher respiratory rate at admission (P = 0.02), alcohol withdrawal syndrome (P < 0.001), and noninvasive ventilation (P = 0.04). EA was not associated with decreases in IMV requirements, median numerical rating scale pain score, or intravenous morphine requirements from day 1 to day 7. Conclusions EA was not associated with a lower risk of IMV in chest trauma patients with at least 3 fractured ribs, moderate pain, and no intubation on admission. Further studies are needed to clarify the optimal pain control strategy in chest trauma patients admitted to the ICU, notably those with severe pain or high opioid requirements.http://link.springer.com/article/10.1186/s13613-020-00733-0Epidural analgesiaChest trauma |
| spellingShingle | Konstantinos Bachoumas Albrice Levrat Aurélie Le Thuaut Stéphane Rouleau Samuel Groyer Hervé Dupont Paul Rooze Nathanael Eisenmann Timothée Trampont Julien Bohé Benjamin Rieu Jean-Charles Chakarian Aurélie Godard Laura Frederici Stephanie Gélinotte Aurélie Joret Pascale Roques Benoit Painvin Christophe Leroy Marcel Benedit Loic Dopeux Edouard Soum Vlad Botoc Muriel Fartoukh Marie-Hélène Hausermann Toufik Kamel Jean Morin Roland De Varax Gaetan Plantefève Alexandre Herbland Matthieu Jabaudon Thibault Duburcq Christelle Simon Russell Chabanne Francis Schneider Frederique Ganster Cedric Bruel Ahmed-Saïd Laggoune Delphine Bregeaud Bertrand Souweine Jean Reignier Jean-Baptiste Lascarrou Epidural analgesia in ICU chest trauma patients with fractured ribs: retrospective study of pain control and intubation requirements Annals of Intensive Care Epidural analgesia Chest trauma |
| title | Epidural analgesia in ICU chest trauma patients with fractured ribs: retrospective study of pain control and intubation requirements |
| title_full | Epidural analgesia in ICU chest trauma patients with fractured ribs: retrospective study of pain control and intubation requirements |
| title_fullStr | Epidural analgesia in ICU chest trauma patients with fractured ribs: retrospective study of pain control and intubation requirements |
| title_full_unstemmed | Epidural analgesia in ICU chest trauma patients with fractured ribs: retrospective study of pain control and intubation requirements |
| title_short | Epidural analgesia in ICU chest trauma patients with fractured ribs: retrospective study of pain control and intubation requirements |
| title_sort | epidural analgesia in icu chest trauma patients with fractured ribs retrospective study of pain control and intubation requirements |
| topic | Epidural analgesia Chest trauma |
| url | http://link.springer.com/article/10.1186/s13613-020-00733-0 |
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