Anaesthesia, critical care & pain medicine 2017 01 18() pii S2352-5568(16)30177-1
The aim of this study was to assess the performance of Forced Vital Capacity (FCV) for prediction of secondary pulmonary complications in blunt-chest trauma patients.
During a 15-month period, all consecutive blunt chest trauma patients admitted in our emergency intensive care unit with more than 3 rib fractures were eligible, unless they required mechanical ventilation in the prehospital or emergency settings. FVC was measured at enrolment and at emergency discharge after therapeutic interventions. The main outcome was the occurrence of secondary respiratory complications defined by hospital-acquired pulmonary infection, secondary admission in intensive care unit or mechanical ventilation for respiratory failure or death. The performance of FVC for prediction of secondary complications was assessed by receiver operating characteristic (ROC) curve analysis and logistic regression.
62 consecutive patients were included and 13 (21%) presented respiratory complications. Only FVC measured at emergency discharge – not FCV at admission – was significantly lower in patients who developed secondary complications (44 ± 15 vs 61 ± 20 %, p = 0.002). The area under the ROC curves for FCV in predicting secondary pulmonary complications was 0.79 [95% CI: 0.66 – 0.88], p = 0.0001. An FVC at discharge ≤ 50 % was independently associated with the occurrence of secondary complications with an OR at 6.8 [1.5 – 30.3], p = 0.01.
The non-improvement of FVC ≤ 50% at emergency discharge is associated with secondary complications and should prevent the under-triage of patients with no sign of respiratory failure at admission.