Document Detail


Early intubation in severely injured patients.
MedLine Citation:
PMID:  9422129     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
In a prospectively studied trauma population from 1986 to 1991 the influence of early intubation (EI) within 2 h after the accident on post-traumatic (multiple) organ failure (M)OF was compared with delayed intubation (DI) in 131 patients with multiple injuries (Injury severity score (ISS) 37). Indications for intubation were unconsciousness following severe head injury in 45 cases (45 EI, 0 DI), major chest trauma (AIS > or = 3) in 40 (31 EI, 9 DI) and the severity of injuries (no head or chest trauma, but ISS > 24) in 40 patients (30 EI, 10 DI). One hundred and six trauma victims (81%) have been intubated early and 19 patients (14.5%) required intubation and artificial ventilation later in the course, whereas 6 subjects (4.5%) could manage spontaneous breathing. The pattern of injured body regions and respiratory parameters on admission showed no remarkable difference in the two groups, but the severity of injury was significantly higher (p < 0.001) in the EI group (ISS 39) compared with the DI patients (ISS 29). Due to a significantly worse haemodynamic condition of the EI patients on admission, they showed significantly higher volume requirements throughout the resuscitation period. All patients were treated to a standard resuscitation protocol. Sixty-seven per cent of the EI patients developed at least one OF, 45% respiratory failure (RF), 28% multiple organ failure (MOF) and 15% died. The DI group showed almost the same incidence of RF (42%) and other OF (63%) and an even higher (n.s.) incidence of MOF (37%) and mortality rate (26%). Corresponding to the significantly lower injury severity of the DI group, the observed OF and mortality rates are inappropriately high in comparison with the incidence of OF and death in the EI group. We conclude that EI of multiple injured patients within 2 h after trauma along with ventilatory support--even in alert patients without major chest trauma or signs of cardiocirculatory or respiratory insufficiency, but a known or suspected ISS > 24--may help to reduce post-traumatic organ failure and improve outcome.
Authors:
A Trupka; C Waydhas; D Nast-Kolb; L Schweiberer
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article    
Journal Detail:
Title:  European journal of emergency medicine : official journal of the European Society for Emergency Medicine     Volume:  1     ISSN:  0969-9546     ISO Abbreviation:  Eur J Emerg Med     Publication Date:  1994 Mar 
Date Detail:
Created Date:  1998-02-06     Completed Date:  1998-02-06     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  9442482     Medline TA:  Eur J Emerg Med     Country:  ENGLAND    
Other Details:
Languages:  eng     Pagination:  1-8     Citation Subset:  IM    
Affiliation:
Department of Surgery, Klinikum Innenstadt, Ludwig-Maximilians-University of Munich, Germany.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Female
Humans
Injury Severity Score
Intubation, Intratracheal / methods*,  mortality
Male
Middle Aged
Multiple Organ Failure / mortality,  therapy*
Multiple Trauma / mortality,  therapy*
Prospective Studies
Survival Rate
Time Factors
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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