Clinical and epidemiological characterization of acute respiratory distress syndrome in adult patients with femoral shaft fractures
Keywords:
Respiratory distress, adult, Femoral fractures, Fracture fixation, intramedullary, Blood transfusion, Epidemiology
Abstract
Objective: To describe the epidemiology of post-traumatic acute respiratory distress syndrome.
Methodology: Descriptive observational study of patients with traumatic femoral shaft fracture requiring surgical management. The variables included in the analysis were demographics, injury severity, treatment methods, and in-hospital outcomes. A descriptive multivariate analysis was performed in order to explore the factors associated with the development of Acute Respiratory Distress Syndrome (ARDS).
Results: Of the 267 patients with femoral fractures, 86% were male patients with a mean age of 28.7 years and Injury Severity Score (ISS) of 12.7. The overall prevalence of ARDS was 8.6% while the prevalence among multiple trauma patients was 20%. Mortality was 7.5%. In the bivariate analysis, the variables associated with ARDS were the following: time between the trauma and hospital admission, ISS, contused lung, associated tibial fracture, urgent surgery requirement, and need for red blood cell transfusion. In the multivariate analysis, the associated variables were: blunt chest trauma, time elapsed until definitive fixation, and red blood celltrans fusion during surgery. In the cohort, there was an increase in the annual prevalence of ARDS, from 4.3% in 2006 to 26.1% in 2011, as was also the case with multiple trauma, which increased from 14.5% in 2006 to 23.6% in 2011. A change in treatment was also evidenced, with increase in early total care (ETC) and damage control orthopaedics (DCO).
Conclusions: In our population, the prevalence of ARDS in patients with femoral fractures increases when associated with blunt chest trauma, delayed stabilization time, and the need for blood transfusion.
References
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14. Stübig T, Mommsen P, Krettek C, Probst C, Frink M, Zeckey C, et al. Comparison of early total care (ETC) and damage control orthopedics (DCO) in the treatment of multiple trauma with femoral shaft fractures: benefit and costs. Unfallchirurg. 2010;113:923-30.
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21. Bosse MJ, MacKenzie EJ, Riemer BL, Brumback RJ, McCarthy ML, Burgess AR, et al. Adult respiratory distress syndrome, pneumonia, and mortality following thoracic injury and a femoral fracture treated either with intramedullary nailing with reaming or with a plate. A comparative study. J Bone Joint Surg Am. 1997;79:799-809.
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23. Vallier HA, Super DM, Moore TA, Wilber JH. Do patients with multiple system injury benefit from early fixation of unstable axial fractures? The effects of timing of surgery on initial hospital course. J Orthop Trauma. 2013;27:405-12.
24. Bernard GR, Artigas A, Brigham KL, Carlet J, Falke K, Hudson L, et al., The American-European Consensus Conference on ARDS. Definitions, mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med. 1994;149 3 Pt 1:818-24.
25. Morshed S, Miclau 3rd T, Bembom O, Cohen M, Knudson MM, Colford Jr JM. Delayed internal fixation of femoral shaft fracture reduces mortality among patients with multisystem trauma. J Bone Joint Surg Am. 2009;91:3-13. Pubmed Central PMCID: 2663326.
26. Zambon M, Vincent JL. Mortality rates for patients with acute lung injury/ARDS have decreased over time. Chest. 2008;133:1120-7.
27. Erickson SE, Martin GS, Davis JL, Matthay MA, Eisner MD, Network NNA. Recent trends in acute lung injury mortality: 1996-2005. Crit Care Med. 2009;37:1574-9. Pubmed Central PMCID: 2696257.
28. Riska EB, von Bonsdorff H, Hakkinen S, Jaroma H, Kiviluoto O, Paavilainen T. Prevention of fat embolism by early internal fixation of fractures in patients with multiple injuries. Injury. 1976;8:110-6.
29. Pallister I. Current concepts of respiratory insufficiency syndromes after fracture [replica]. J Bone Joint Surg Br. 2002;84:464.
30. Charash WE, Fabian TC, Croce MA. Delayed surgical fixation of femur fractures is a risk factor for pulmonary failure independent of thoracic trauma. J Trauma. 1994;37:667-72.
31. Pinney SJ, Keating JF, Meek RN. Fat embolism syndrome in isolated femoral fractures: Does timing of nailing influence incidence? Injury. 1998;29:131-3.
32. Meek RN, Vivoda EE, Pirani S. Comparison of mortality of patients with multiple injuries according to type of fracture treatment-a retrospective age-and injury-matched series. Injury. 1986;17:2-4.
33. Nicholas B, Toth L, van Wessem K, Evans J, Enninghorst N, Balogh ZJ. Borderline femur fracture patients: Early total care or damage control orthopaedics? ANZ J Surg. 2011;81: 148-53.
34. Pape HC, Rixen D, Morley J, Husebye EE, Mueller M, Dumont C, et al. Impact of the method of initial stabilization for femoral shaft fractures in patients with multiple injuries at risk for complications (borderline patients). Ann Surg. 2007;246:491-9, discusión 499-501.
2. Pape HC, Auf'm'Kolk M, Paffrath T, Regel G, Sturm JA, Tscherne H. Primary intramedullary femur fixation in multiple trauma patients with associated lung contusion-a cause of posttraumatic ARDS? J Trauma. 1993;34:540-7, discusión 547-548.
3. White TO, Jenkins PJ, Smith RD, Cartlidge CW, Robinson CM. The epidemiology of posttraumatic adult respiratory distress syndrome. J Bone Joint Surg Am. 2004;86-A:2366-76.
4. Navarrete-Navarro P, Rivera-Fernandez R, Rincon-Ferrari MD, Garcia-Delgado M, Munoz A, Jimenez JM, et al. Early markers of acute respiratory distress syndrome development in severe trauma patients. J Crit Care. 2006;21:253-8.
5. Bone LB, Johnson KD, Weigelt J, Scheinberg R. Early versus delayed stabilization of femoral fractures. A prospective randomized study. J Bone Joint Surg Am. 1989;71:336-40.
6. Boulanger BR, Stephen D, Brenneman FD. Thoracic trauma and early intramedullary nailing of femur fractures: are we doing harm? J Trauma. 1997;43:24-8.
7. Johnson KD, Cadambi A, Seibert GB. Incidence of adult respiratory distress syndrome in patients with multiple musculoskeletal injuries: Effect of early operative stabilization of fractures. J Trauma. 1985;25:375-84.
8. Anwar IA, Battistella FD, Neiman R, Olson SA, Chapman MW, Moehring HD. Femur fractures and lung complications: A prospective randomized study of reaming. Clin Orthop Relat Res. 2004:71-6.
9. Pape HC, Regel G, Dwenger A, Krumm K, Schweitzer G, Krettek C, et al. Influences of different methods of intramedullary femoral nailing on lung function in patients with multiple trauma. J Trauma. 1993;35:709-16.
10. Pape HC, van Griensven M, Rice J, Gansslen A, Hildebrand F, Zech S, et al. Major secondary surgery in blunt trauma patients and perioperative cytokine liberation: Determination of the clinical relevance of biochemical markers. J Trauma. 2001;50:989-1000.
11. Roberts CS, Pape HC, Jones AL, Malkani AL, Rodriguez JL, Giannoudis PV. Damage control orthopaedics: evolving concepts in the treatment of patients who have sustained orthopaedic trauma. Instr Course Lect. 2005;54:447-62.
12. Rixen D, Steinhausen E, Sauerland S, Lefering R, Meier M, Maegele MG, et al. Protocol for a randomized controlled trial on risk adapted damage control orthopedic surgery of femur shaft fractures in multiple trauma patients. Trials. 2009;10:72.
13. Pape HC. Effects of changing strategies of fracture fixation on immunologic changes and systemic complications after multiple trauma: Damage control orthopedic surgery. J Orthop Res. 2008;26:1478-84.
14. Stübig T, Mommsen P, Krettek C, Probst C, Frink M, Zeckey C, et al. Comparison of early total care (ETC) and damage control orthopedics (DCO) in the treatment of multiple trauma with femoral shaft fractures: benefit and costs. Unfallchirurg. 2010;113:923-30.
15. Newey ML, Ricketts D, Roberts L. The AO classification of long bone fractures: An early study of its use in clinical practice. Injury. 1993;24:309-12.
16. Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E, Fan E, et al. Acute respiratory distress syndrome: The Berlin Definition. JAMA. 2012;307:2526-33.
17. Dushianthan A, Grocott MP, Postle AD, Cusack R. Acute respiratory distress syndrome and acute lung injury. Postgrad Med J. 2011;87:612-22.
18. Butcher N, Balogh ZJ. The definition of polytrauma: The need for international consensus. Injury. 2009;40 Suppl 4:S12-22.
19. Hoyt DB, Simons RK, Winchell RJ, Cushman J, Hollingsworth-Fridlund P, Holbrook T, et al. A risk analysis of pulmonary complications following major trauma. J Trauma. 1993;35:524-31.
20. Croce MA, Fabian TC, Davis KA, Gavin TJ. Early and late acute respiratory distress syndrome: Two distinct clinical entities. J Trauma. 1999;46:361-6, discusión 366-368.
21. Bosse MJ, MacKenzie EJ, Riemer BL, Brumback RJ, McCarthy ML, Burgess AR, et al. Adult respiratory distress syndrome, pneumonia, and mortality following thoracic injury and a femoral fracture treated either with intramedullary nailing with reaming or with a plate. A comparative study. J Bone Joint Surg Am. 1997;79:799-809.
22. Miller PR, Croce MA, Kilgo PD, Scott J, Fabian TC. Acute respiratory distress syndrome in blunt trauma: Identification of independent risk factors. Am Surg. 2002;68:845-50, discusión 850-851.
23. Vallier HA, Super DM, Moore TA, Wilber JH. Do patients with multiple system injury benefit from early fixation of unstable axial fractures? The effects of timing of surgery on initial hospital course. J Orthop Trauma. 2013;27:405-12.
24. Bernard GR, Artigas A, Brigham KL, Carlet J, Falke K, Hudson L, et al., The American-European Consensus Conference on ARDS. Definitions, mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med. 1994;149 3 Pt 1:818-24.
25. Morshed S, Miclau 3rd T, Bembom O, Cohen M, Knudson MM, Colford Jr JM. Delayed internal fixation of femoral shaft fracture reduces mortality among patients with multisystem trauma. J Bone Joint Surg Am. 2009;91:3-13. Pubmed Central PMCID: 2663326.
26. Zambon M, Vincent JL. Mortality rates for patients with acute lung injury/ARDS have decreased over time. Chest. 2008;133:1120-7.
27. Erickson SE, Martin GS, Davis JL, Matthay MA, Eisner MD, Network NNA. Recent trends in acute lung injury mortality: 1996-2005. Crit Care Med. 2009;37:1574-9. Pubmed Central PMCID: 2696257.
28. Riska EB, von Bonsdorff H, Hakkinen S, Jaroma H, Kiviluoto O, Paavilainen T. Prevention of fat embolism by early internal fixation of fractures in patients with multiple injuries. Injury. 1976;8:110-6.
29. Pallister I. Current concepts of respiratory insufficiency syndromes after fracture [replica]. J Bone Joint Surg Br. 2002;84:464.
30. Charash WE, Fabian TC, Croce MA. Delayed surgical fixation of femur fractures is a risk factor for pulmonary failure independent of thoracic trauma. J Trauma. 1994;37:667-72.
31. Pinney SJ, Keating JF, Meek RN. Fat embolism syndrome in isolated femoral fractures: Does timing of nailing influence incidence? Injury. 1998;29:131-3.
32. Meek RN, Vivoda EE, Pirani S. Comparison of mortality of patients with multiple injuries according to type of fracture treatment-a retrospective age-and injury-matched series. Injury. 1986;17:2-4.
33. Nicholas B, Toth L, van Wessem K, Evans J, Enninghorst N, Balogh ZJ. Borderline femur fracture patients: Early total care or damage control orthopaedics? ANZ J Surg. 2011;81: 148-53.
34. Pape HC, Rixen D, Morley J, Husebye EE, Mueller M, Dumont C, et al. Impact of the method of initial stabilization for femoral shaft fractures in patients with multiple injuries at risk for complications (borderline patients). Ann Surg. 2007;246:491-9, discusión 499-501.
How to Cite
1.
Valderrama Molina CO, Cardona A. JM, Gaviria Uribe J, Giraldo Ramirez N. Clinical and epidemiological characterization of acute respiratory distress syndrome in adult patients with femoral shaft fractures. Colomb. J. Anesthesiol. [Internet]. 2014 Jul. 1 [cited 2024 Apr. 26];42(3):176-83. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/662
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Published
2014-07-01
How to Cite
1.
Valderrama Molina CO, Cardona A. JM, Gaviria Uribe J, Giraldo Ramirez N. Clinical and epidemiological characterization of acute respiratory distress syndrome in adult patients with femoral shaft fractures. Colomb. J. Anesthesiol. [Internet]. 2014 Jul. 1 [cited 2024 Apr. 26];42(3):176-83. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/662
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