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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
Abstract : 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.
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https://hal-u-picardie.archives-ouvertes.fr/hal-03576420
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Soumis le : mercredi 16 février 2022 - 09:21:20
Dernière modification le : mercredi 27 avril 2022 - 04:06:39

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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, SpringerOpen, 2020, 10 (1), ⟨10.1186/s13613-020-00733-0⟩. ⟨hal-03576420⟩

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