Epidural analgesia in ICU chest trauma patients with fractur
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Nonintubated chest trauma patients with fractured ribs admitted to the (ICU) are at risk for complications and may require invasive ventilation at some point. Effective pain control is essential. Assessment was done whether epidural analgesia (EA) in patients with fractured ribs who were not intubated at ICU admission decreased the need for invasive mechanical ventilation (IMV). Risk factors for IMV were also assessed.

This retrospective, observational, multicenter study conducted in 40 ICUs included consecutive patients with three or more fractured ribs who were not intubated at admission. Of the 974 study patients, 788 were included in the analysis of intubation predictors. EA was used in 130 patients, and 65 patients required IMV. Factors independently associated with IMV were chronic respiratory disease, worse SAPS II, flail chest, worse Injury Severity Score, higher respiratory rate at admission, alcohol withdrawal syndrome, and noninvasive ventilation.

EA was not associated with decrease in IMV requirements, median numerical rating scale pain score, or intravenous morphine requirements from day 1 to day 7. 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.

source: https://annalsofintensivecare.springeropen.com/articles/10.1186/s13613-020-00733-0
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