Epidural analgesia in ICU chest trauma patients with fractured ribs: retrospective study of pain control and intubation requirements

Edouard Soum , Vlad Botoc (1) , Muriel Fartoukh (2) , Marie-Helene Hausermann , Toufik Kamel (3, 4) , Jean Morin (5) , Roland de Varax , Gaetan Plantefeve (6) , Alexandre Herbland (7) , Matthieu Jabaudon (8, 9, 10) , Thibault Duburcq (11) , Christelle Simon (12) , Russell Chabanne (13) , Francis Schneider (14) , Frederique Ganster (15) , Cedric Bruel (16, 17) , Ahmed-Said Laggoune , Delphine Bregeaud , Bertrand Souweine (18) , Jean Reignier (19) , Jean-Baptiste Lascarrou (5) , Konstantinos Bachoumas (20) , Albrice Levrat (21) , Aurelie Le Thuaut (22) , Stephane Rouleau , Samuel Groyer (23) , Herve Dupont (24, 25, 26) , Paul Rooze (27, 28) , Nathanael Eisenmann (29) , Timothee Trampont (30) , Julien Bohe (31) , Benjamin Rieu (10) , Jean-Charles Chakarian , Aurelie Godard , Laura Frederici , Stephanie Gelinotte (32) , Aurelie Joret (33) , Pascale Roques , Benoit Painvin (34, 35) , Christophe Leroy (36) , Marcel Benedit (37) , Loic Dopeux (38)

1 CH de Saint-Malo [Broussais]
2 CHU Tenon [AP-HP]
3 CHRO - Centre Hospitalier Régional d'Orléans
4 CRESS (U1153 / UMR_A 1125) - Centre for Research in Epidemiology and Statistics | Centre de Recherche Épidémiologie et Statistiques
5 CHU Nantes - Centre Hospitalier Universitaire de Nantes
6 Centre Hospitalier Victor Dupouy
7 CH La Rochelle - Hôpital Saint-Louis de La Rochelle
8 Vanderbilt University Medical Center [Nashville]
9 GReD - Génétique, Reproduction et Développement
10 CHU Clermont-Ferrand
11 CHRU Lille - Centre Hospitalier Régional Universitaire [CHU Lille]
12 CHV - Centre Hospitalier de Versailles André Mignot
13 Pôle de Médecine Périopératoire [CHU Clermont-Ferrand]
14 HUS - Les Hôpitaux Universitaires de Strasbourg
15 HIFIH - Hémodynamique, Interaction Fibrose et Invasivité tumorales Hépatiques
16 Service de réanimation polyvalente
17 Medical and Surgical Intensive Care Unit, Groupe Hospitalier Paris Saint Joseph, Paris,
18 CHU Gabriel Montpied [Clermont-Ferrand]
19 Hôtel-Dieu de Nantes
20 CHU La Roche sur Yon
21 Centre Hospitalier Annecy-Genevois [Saint-Julien-en-Genevois]
22 CHD Vendée - Centre Hospitalier Départemental - Hôpital de La Roche-sur-Yon
23 Pôle Anesthésie Réanimation [CHU de Toulouse]
24 CHU Amiens-Picardie
25 SSPC - Simplification des soins chez les patients complexes - UR UPJV 7518
26 MP3CV - Mécanismes physiopathologiques et conséquences des calcifications vasculaires - UR UPJV 7517
27 EA 3826 - Thérapeutiques cliniques et expérimentales des infections (EA 3826)
28 Anesthésie Réanimation chirurgicale [CHU Nantes]
29 UNICANCER/CJP - Centre Jean Perrin [Clermont-Ferrand]
30 Service des urgences [CHU Limoges]
31 Service de Réanimation Médicale Sud
32 Centre hospitalier de Dieppe
33 CIC - Centre d’Investigation Clinique [Tours] CIC 1415
34 Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Ponchaillou]
35 Biosit : Biologie - Santé - Innovation Technologique - Structure Fédérative de Recherche en Biologie et Santé de Rennes
36 AP-HP - Assistance publique - Hôpitaux de Paris (AP-HP)
37 Service de Reanimation Hôpital de Moulins Yzeure, Moulins, France
38 Pôle Urgences [CHU Clermont-Ferrand]

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.

Domaines: Sciences du Vivant [q-bio]

Edouard Soum, Vlad Botoc, Muriel Fartoukh, Marie-Helene Hausermann, Toufik Kamel, et al.. Epidural analgesia in ICU chest trauma patients with fractured ribs: retrospective study of pain control and intubation requirements. Annals of Intensive Care, 2020, 10 (1), ⟨10.1186/s13613-020-00733-0⟩. ⟨hal-03576420⟩